本文選題：記憶抱怨主訴 + 記憶障礙感知��； 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：【目的】1.通過規(guī)范的國際通用問卷翻譯修訂方法,將英文版記憶障礙感知問卷(Illness Perception Questionnaire,IPQ-M)引進我國,結(jié)合我國文化背景進行修訂,形成記憶障礙感知問卷中文版。2.采用橫斷面調(diào)查的研究設(shè)計,應(yīng)用中文版的IPQ-M問卷調(diào)查記憶抱怨主訴(Subjective Memory Complaints,SMCs)人群的記憶障礙感知特征及其影響因素,以幫助社區(qū)醫(yī)療工作者及廣大老年醫(yī)學(xué)領(lǐng)域的研究者更深入地了解SMCs人群的記憶障礙感知狀況,從而更好地為他們提供醫(yī)療服務(wù)和有針對性的認知干預(yù)措施。3.通過分析記憶障礙感知對SMCs人群記憶相關(guān)求助行為的影響,為SMCs人群有針對性的健康宣教和干預(yù)措施的制定提供理論依據(jù),從而促進SMCs人群及早尋醫(yī)問診,以有利于老年癡呆的早期篩查、診斷與防治。【方法】1.通過國際通用的問卷修訂流程“翻譯-逆向翻譯-文化調(diào)試-預(yù)試驗-大樣本調(diào)查的方法”將英文版IPQ-M問卷引進我國,并通過專家咨詢及小樣本預(yù)測試對條目進行修訂,形成初步修訂版IPQ-M問卷。2.采用便利性抽樣方法,以初步修訂版的IPQ-M問卷對重慶市4個社區(qū)衛(wèi)生服務(wù)中心建檔管理的660位符合納入標準的SMCs人群進行調(diào)查評估。數(shù)據(jù)錄入按奇偶折半法將數(shù)據(jù)分成2份,一部分樣本A(330例),做探索性因素分析;另一部分樣本B(330例),運用AMOS20.0軟件對問卷進行驗證性因素分析,并檢測問卷的內(nèi)部一致性、重測信度、折半信度與效標效度,以形成正式版本的中文版IPQ-M問卷。3.以正式形成的中文版IPQ-M問卷為工具,抽取符合納入標準的SMCs人群305例進行調(diào)查,應(yīng)用方差分析、spearman相關(guān)分析、多元線性回歸分析等方法分析社區(qū)SMCs人群的記憶障礙感知特征及影響因素。4.結(jié)合受試者的聽覺詞語學(xué)習(xí)測驗量表(AVLT)、簡易精神狀態(tài)評價量表(MMSE)、老年抑郁量表(GDS)的測量結(jié)果,應(yīng)用Logistic回歸等方法分析記憶障礙感知對SMCs人群記憶相關(guān)求助行為的影響。【結(jié)果】1.中文版IPQ-M問卷的信效度評價。正式形成的中文版IPQ-M問卷包含3個部分,11個維度,共計86個條目。第一部分為癥狀維度,包含19個癥狀特征,認為與記憶下降相關(guān)的癥狀條目累加計分作為癥狀感知得分,得分愈高提示感知的癥狀愈多。第二部分為病情認知,共44個條目,包括病程(急/慢性)、所致后果、進展時間(穩(wěn)定/下降)、個人控制(責備)、個人控制(無助)、情感表現(xiàn)、治療控制、疾病關(guān)聯(lián)、社會比較9個維度。第三部分為疾病歸因,包含23個SMCs人群認為的可能導(dǎo)致記憶下降的原因。問卷的信效度檢驗結(jié)果如下:(1)內(nèi)容效度:中文預(yù)試版的條目水平內(nèi)容效度(I-CVI)為0.83~1.0;問卷整體的(S-CVI)為0.913。(2)結(jié)構(gòu)效度:探索性因素分析顯示中文版IPQ-M問卷的因子累計方差貢獻率為70.757%,且各條目在相應(yīng)因子上有較滿意的因子載荷量(0.4)。驗證性因素分析進一步證實了中文版IPQ-M問卷結(jié)構(gòu)的合理性,其分析結(jié)果顯示,卡方自由度比值(X2/df)為1.865,小于2;RMR為0.027,0.05;RMSEA為0.075,0.08;GFI(0.940)、AGFI(0.910)、NFI(0.903)、CFI(0.939)值均大于0.9,表示數(shù)據(jù)擬合結(jié)果較好。(3)校標效度:以GDS為校標,中文版IPQ-M問卷的維度與GDS呈一定程度的相關(guān),相關(guān)系數(shù)為-0.242~0.614(p0.05)。(4)內(nèi)部一致性:中文版IPQ-M問卷各因子的α系數(shù)范圍為0.770~0.927。(5)重測信度(間隔2周):重測相關(guān)系數(shù)范圍為0.532~0.908(6)折半信度:問卷的Spearman-Brown系數(shù)在0.747~0.916之間2.SMCs人群的記憶障礙感知特征及影響因素本研究對象記憶障礙感知主要特征分析:病程(3.57±0.89分)、進展時間(3.71±0.88分)、個人控制(責備)(3.61±0.92分)、疾病關(guān)聯(lián)(3.14±0.64分)、治療控制(2.78±0.67分)5個維度得分顯示為負性感知;后果(2.24±0.77分)、情感表現(xiàn)(2.29±0.70分)、個人控制(無助)(3.31±0.73分)3個維度得分顯示為正性感知。社會比較維度得分(2.95±0.78分)顯示為中性。記憶下降歸因部分的二十三個條目中,得分頻率排名前五位的分別是:年齡引起的老化(93.5%)、注意力不集中或沒有聽清楚(75.4%)、大腦供血不足(61.1%)、不用腦子(58.4%)、腦細胞丟失(55.9%)。另外,有31.1%的人把記憶下降歸因于機會或運氣不好。多元線性回歸顯示,中文版IPQ-M問卷第2部分的9個因子分別不同程度受SMCs人群的教育程度、性別、居住狀況、婚姻情況、經(jīng)濟水平、癡呆家族史、癡呆知識教育因素的影響。3.SMCs人群的記憶障礙感知對其針對記憶問題相關(guān)求助行為的影響本地區(qū)的SMCs人群記憶相關(guān)求助行為的比率很低,僅為14.4%,其尋求幫助的方式也較單一,其中到社區(qū)衛(wèi)生服務(wù)中心進行咨詢的占5.6%,詢問親戚朋友的占5.2%,觀看養(yǎng)生類節(jié)目和書籍的占1.6%,而到大醫(yī)院記憶診所看專科醫(yī)生的僅占2.0%。Logistic回歸分析顯示:治療控制(OR=2.456)、情感表現(xiàn)(OR=2.268)、癥狀感知(OR=1.455)三個維度和腦供血不足(OR=1.115)、不動腦(OR=2.079)、孤獨(OR=0.253)、老化(OR=0.450)、機會或運氣不好(OR=0.374)五個歸因感知,以及是否接受過癡呆知識教育(OR=5.176)是影響SMCs人群記憶相關(guān)求助行為的主要因素。治療控制、情感表現(xiàn)、癥狀感知三個維度的得分越高,將記憶下降的原因歸于腦供血不足和不動腦,以及接受過癡呆知識教育的人求助的可能性更大;將記憶下降的原因歸于孤獨、老化、機會或運氣不好的人求助的幾率更小。【結(jié)論】1.中文版IPQ-M結(jié)構(gòu)合理,信效度良好,適合于我國文化背景下對中老年SMCs人群進行記憶障礙感知的評估。2.我國SMCs人群記憶障礙感知特征分析顯示:SMCs人群對記憶下降的相關(guān)知識不夠了解,存在較多錯誤和消極的感知,記憶障礙感知的影響因素復(fù)雜。提示在開展認知健康宣教時,應(yīng)有針對性地制定相關(guān)策略,提高記憶抱怨主訴人群對記憶下降和老年癡呆防治知識的了解,培養(yǎng)其積極正確的感知。3.SMCs人群的記憶障礙感知對其針對記憶問題的相關(guān)求助行為有一定的預(yù)測能力,社區(qū)醫(yī)護人員應(yīng)重視SMCs人群關(guān)于記憶下降的感知,督促其及早就醫(yī),以利于癡呆的早期篩查、診斷與防治。
[Abstract]:[Objective] 1. the English version of Illness Perception Questionnaire (IPQ-M) was introduced into China through the standardized international general questionnaire translation revision method. The Chinese version of the Chinese version of the memory barrier perception questionnaire was designed by the Chinese version of the Chinese version of the Chinese version of the English version of the Illness (IPQ-M), and the Chinese version of the Chinese version of the questionnaire was applied. In order to help community medical workers and researchers in the field of geriatric medicine to know more about the perception of memory disorders in the population of Subjective Memory Complaints (SMCs), it is better to provide medical services and pertinence for them. The effect of cognitive intervention on the memory related recourse behavior of the SMCs population by analyzing the perception of memory disorder (.3.) provides a theoretical basis for the formulation of targeted health education and intervention measures for the population of SMCs, thus promoting the early medical search for the SMCs population to help the early screening, diagnosis and Prevention of Alzheimer's disease. [method] 1. The English version of the IPQ-M questionnaire is introduced to China by the international general revision process, "translation reverse translation, cultural debugging pre test and large sample survey", and revising the items through expert consultation and small sample prediction to form a preliminary revised version of the IPQ-M questionnaire.2. using the convenience sampling method, with a preliminary revision of the IPQ-M question. The volume of 4 community health service centers in Chongqing was investigated and evaluated by the 660 SMCs people in accordance with the standard. Data entry was divided into 2 parts by odd and even half method, one part of the sample A (330 cases), exploratory factor analysis, and another part of B (330 cases), using AMOS20.0 software to carry out confirmatory factor analysis to the questionnaire, The internal consistency, retest reliability, half reliability and validity of the questionnaire were tested to form a formal version of the Chinese version of the IPQ-M questionnaire.3. to formally form the Chinese version of the IPQ-M questionnaire as a tool, to extract 305 cases of SMCs people conforming to the inclusion criteria for investigation, application of variance analysis, Spearman correlation analysis, multiple linear regression analysis and other methods. The perception characteristics and influencing factors of memory disorders in the community SMCs population were analyzed by.4. combined with the subjects' auditory vocabulary learning test scale (AVLT), the simple mental state assessment scale (MMSE), the measurement results of the elderly depression scale (GDS), and the effect of memory impairment perception on the memory related help behavior of SMCs population by using Logistic regression. [results] to evaluate the validity and validity of the Chinese version of the 1. version of IPQ-M. The formal Chinese version of the IPQ-M questionnaire contains 3 parts, 11 dimensions, and a total of 86 items. The first part is the symptom dimension, including 19 symptom features. The cumulative score of the symptom items related to the decline of memory is considered as a symptom perception score, the higher the score is, the higher the symptoms of the symptoms suggest the perceived symptoms. The more. The second part is the cognition of the disease. There are 44 items, including the course (emergency / chronic), the result, the time (stability / decline), the personal control (blame), the personal control (helplessness), the emotional expression, the treatment control, the disease association, the social comparison 9 dimensions. The third part is the disease attribution, including the possibility that the 23 SMCs population may lead to the memory. The results of the reliability and validity of the questionnaire are as follows: (1) content validity: the content validity (I-CVI) of the Chinese pretrial version is 0.83~1.0; the overall (S-CVI) of the questionnaire is 0.913. (2) structure validity: the exploratory factor analysis shows that the cumulative variance contribution rate of the Chinese version of the IPQ-M questionnaire is 70.757%, and the items are compared to the corresponding factors. Satisfactory factor load (0.4). Confirmatory factor analysis further confirmed the rationality of the Chinese version of the IPQ-M questionnaire, which showed that the ratio of chi square's degree of freedom (X2/df) was 1.865, less than 2; RMR was 0.027,0.05; RMSEA was 0.075,0.08; GFI (0.940), AGFI (0.910), NFI (0.903), CFI (0.939) values were more than 0.9, indicating that data fitting results were more than 0.9. (3) calibration validity: with GDS as the standard, the dimension of the Chinese version of IPQ-M questionnaire is related to GDS to a certain extent, the correlation coefficient is -0.242~0.614 (P0.05). (4) internal consistency: the alpha coefficient of each factor of the Chinese version IPQ-M questionnaire is 0.770~0.927. (5) retest reliability (interval 2 weeks): the range of retest correlation coefficient is 0.532~0.908 (6) half reliability: Questionnaire The Spearman-Brown coefficient of the memory impairment of the 2.SMCs population between 0.747~0.916 and the factors influencing the main characteristics of memory impairment: the course (3.57 + 0.89), the time of progression (3.71 + 0.88), personal control (3.61 + 0.92), disease association (3.14 + 0.64), and treatment control (2.78 + 0.67) 5. The degree score was negative perception; the result (2.24 + 0.77), emotional performance (2.29 + 0.70), personal control (3.31 + 0.73) and 3 dimensions showed positive perception. The score of social comparison dimension (2.95 + 0.78 points) showed neutral. In twenty-three entries of the attribution part of memory decline, the top five in the scoring frequency were respectively: Age induced aging (93.5%), concentration of attention or lack of hearing (75.4%), cerebral blood supply deficiency (61.1%), brain loss (58.4%), brain cell loss (55.9%). In addition, 31.1% of people attributed the decline in memory to opportunity or bad luck. Multiple linear regression showed that the 9 factors of the Chinese version of IPQ-M questionnaire second part were different to S in varying degrees. The education level, gender, living condition, marital status, economic level, dementia family history, dementia knowledge education factors in the MCs population, the impact of memory impairment on the memory related help behavior in.3.SMCs population is low, only 14.4%, which is 14.4%, to seek help. 5.6% of the community health service centers were consulted, 5.2% of relatives and friends, 1.6% of watching health programs and books, while only 2.0%.Logistic regression analysis showed that treatment control (OR =2.456), emotional expression (OR=2.268), symptom perception (OR=1.455) three The dimensions and cerebral blood supply deficiency (OR=1.115), OR=2.079, OR=0.253, aging (OR=0.450), opportunity or bad luck (OR=0.374) five attribution perception, and whether to accept dementia knowledge education (OR=5.176) are the main factors affecting the recourse behavior of the SMCs population. Treatment control, emotional expression, and symptom perception are three dimensions. The higher the score, the decrease in memory is attributed to the lack of brain blood supply and the brain, and the people who have received dementia knowledge education are more likely to seek help. The reasons for the decline of memory are attributed to loneliness, aging, opportunity or bad luck. [Conclusion] 1. Chinese version of IPQ-M is reasonable in structure and good in reliability and validity. The assessment of memory impairment in middle-aged and elderly SMCs population under the cultural background of China.2., the analysis of the cognitive characteristics of memory disorders in the Chinese SMCs population shows that the knowledge of the memory decline in the SMCs population is not enough, there are more errors and negative perceptions, and the influence factors of the memory impairment are complex. At the time, we should formulate relevant strategies to improve the knowledge of memory decline and Alzheimer's prevention and control in memory complaining, and to cultivate their positive and correct perception of the memory barrier of the.3.SMCs population to a certain pretest ability for their related recourse behaviors against memory problems. The community medical staff should attach importance to the SMCs crowd. In the sense of memory decline, urging them to seek medical treatment early is conducive to early screening, diagnosis and prevention of dementia.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.74

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