科研之友
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摘要
Background: At present, integrated medical and nursing institutions are faced with serious problems such as service supply-demand mismatch and idle resources caused by the emphasis on facility construction and ignorance of service needs.Since there still lacks a unified national instrument assessing institutional elderly service demands in China, and available instruments are found to be with properties of incompleteness, strong locality, monotonous factors, and poor applicability, it is imperative to compile a questionnaire which can comprehensively and accurately assess the service demands of older people in integrated medical and nursing institutions.Objective: To compile a questionnaire with favorable validity and reliability that can comprehensively assess the service demand of older people in integrated medical and nursing institutions.Methods: The initial item pool of the questionnaire was developed on the basis of policy literature review and semi-structural interview.Then the items were screened using the boundary value method according to the results of two rounds of consultation using an Email-based Delphi approach with a convenience sample of 23 experts from 5 regions(Beijing, Shanghai, Jiangsu, Sichuan and Guizhou) during November 2018 to January 2019 after experts' positive and authoritative coefficients and Kendall's W were determined as eligible.Then the Questionnaire on Kano Model-based Service Needs among Older People in Integrated Medical and Nursing Institutions was developed using the screened items, with positive and reverse service quality attributes classified according to the Kano model, and its validity and reliability were tested from February to June 2019 in a convenience sample of older people from 27 elderly care institutions in 4 cities (Chengdu, Panzhihua, Luzhou and Zigong) of Sichuan province.Results: The experts' positive and authoritative coefficients and Kendall's W for the first round of consultation were 87.0%, 0.910, and 0.309, respectively, and for the second round of consultation were 95.0%, 0.927, and 0.349, respectively.After the consultation, the questionnaire was developed, including 5 first-level items (daily care, medical care, health care, psychological and social support, environmental security), and 64 second-level items.The survey for testing its validity and reliability was conducted in 800 participants, received a response rate of 96.6%(773/800).The overall demand priority of the services stratified by the Kano model was: environmental security> daily care> medical care> psychological and social support> health care.The Cronbach's α coefficient of positive questions was 0.906, and Cronbach's α coefficients for the 5 dimensions, daily care, medical care, health care, psychological and social support, environmental security, were 0.921, 0.901, 0.937, 0.873, and 0.902, respectively.The Cronbach's α coefficient of reverse questions was 0.898, with Cronbach's α coefficients for the above-mentioned 5 dimensions of 0.926, 0.881, 0.912, 0.862, 0.894, respectively.The questionnaire had an inter-rater reliability of 0.859, and item-level content validity indices(CVI) ranging from 0.833 to 1.000, S-CVI (S-CVI/UA) of 0.859, and average S-CVI(S-CVI/Ave) of 0.977.Conclusion: Our questionnaire may serve as an instrument assessing the service needs of older people in integrated medical and nursing institutions for its favorable validity and reliability.
