中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/669
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    Please use this identifier to cite or link to this item: http://ir.cmu.edu.tw/ir/handle/310903500/669


    Title: 世界衛生組織生活品質問卷用於自填模式與面訪模式之比較
    Authors: 許雅琳;Ya-Lin Hsu
    Contributors: 中國醫藥大學：環境醫學研究所碩士班
    Keywords: 世界衛生組織生活品質問卷;自填模式;面訪模式;項目反應理論;WHOQOL-BREF;self-administration;face-to-face interview;IRT
    Date: 2007-06-16
    Issue Date: 2009-08-11 16:56:43 (UTC+8)
    Abstract: 研究目的：
    世界衛生組織生活品質問卷(WHOQOL-BREF)原先設計用在自我填答施測模式，但實際在臨床應用上，卻有許多限制，尤其在讀或寫不方便的族群，有鑑於此，在臨床上就常常用面對面訪問的方式完成問卷，本研究即在探究WHOQOL-BREF實際用在自填模式或面訪模式上的差異。
    方法：
    本研究在中國醫藥大學附設醫院健檢門診收案，採取交叉研究設計，一共收取212位自願參與者。自願者則先分派為先面訪或先自填兩組，隨後再進行交叉自填或面訪。我們利用古典測驗理論(classic test theory, CTT)及項目反應理論(item response theory, IRT)，看WHOQOL-BREF在使用兩種施測之心理特質及差異性，進而深入探討。
    結果：
    整體而言，不論施測模式的順序先後，WHOQOL-BREF全部範疇的面訪得分均高於自填得分。
    比較兩組的再現性，結果顯示先面訪組內在等級相關係數(ICC):0.71~0.8，較先自填組ICC: (0.56~0.77)穩定。再區分年齡、性別來看再現性，發現男性、年齡大於65歲者其ICC指標較不穩定。不論CTT或IRT來看問卷各範疇內部一致性，WHOQOL-BREF之生理、心理與環境範疇信度均不錯，但在社會範疇之中，CTT與IRT信度均較差，結果與WHOQOL-BREF其他相關文獻吻合。
    項目反應理論的結果顯示：在兩種施測模式下，反向題”需要醫療應付日常生活”、”負面感覺”和”疼痛會妨礙需要做的事”，不符合單一向度的假設，反向題會降低其單一向度指標。另外，在”性生活”對於老年人不符合單一向度的假設。
    不同的施測模式下，題目相對的難度順序亦不同，變化較顯著的題目如：在反向題”負面感覺”男性在自填較面訪容易傾向有負面得分，女性則相反；老年人在”接受自己的外表”，自填較面訪容易傾向有不滿意的感覺；而在字面上較抽象的題目，需要訪員進一步解釋題意，也會造成受訪者對不同施測模式之間的感受不同。
    試題差別功能結果顯示在”身體疼痛會妨礙您所需要做的事”、”性生活”和”方便得到資訊”則在不同性別上兩種模式均出現差別，這3題在不同施測模式之間的特質呈現不穩定。
    結論：
    WHOQOL-BREF用在面訪與自填兩種施測模式之下，面訪分數均高於自填。施測模式的不同其測量結果隨人口特質不同亦有差異。比起古典測驗理論，項目反應理論提供了另一種方式，讓我們進一步從試題層面看到兩種施測模式的不同。

    Purpose:
    The Taiwan version of the WHOQOL-BREF has been designed mainly for using as a self-administered questionnaire inheriting difficulties in clinical application for subjects of limitated in reading or writing. The purpose of this study is to test the difference of the face-to-face interview mode and the self-completion mode of administration on the measurement of WHOQOL-BREF.
    Methods:
    A crossover study was carried out on 212 volunteers from the center of health examination clinic at a teaching hospital in central Taiwan. We divided the sample into two groups, one group used self-completion first, followed by face-to-face interview, another group used face-to-face interview first and then followed by self-completion. The outcome was the difference in WHOQOL-BREF profiles comparing clinical based self-administration with face-to-face interview by using the classical test theory (CTT) and item response theory (IRT).
    Results:
    All domain scores were higher by interviews than by self-administration. The ICC indices in interview first group (0.71~0.8) were higher than those in self-administration first group (0.56~0.77). In addition, stratifying by age and gender, the reproducibility was lower for the elderly and males. Physical, psychological and environment domains demonstrated satisfactory reliability. However, the social relationships domain exhibited poor reliability.
    Three items:“need medication”, “negative feeling”and “pain/discomfort”did not show unidimensionality. When we considered the sequence of item difficulty, for the item “negative feeling”, males in the self-administration mode had lower scores than males in the interview mode; female had opposite result. For the item “accepting appearance”, the elderly in the self-administration mode had lower scores than in the interview mode. For the items, of vague abstract in the wording requiring explaination at interview, the difference of scores between the two modes was more significant.
    Significant differenential item functioning (DIF) presented in items ” pain and discomfort”, ” sexual activity” and ” opportunities”.
    Conclusions:
    The scores obtained from interview mode were generally higher than those by self-administration mode in WHOQOL-BREF. The patterns of compared between the two modes varied by age and gender. Compared with CTT, IRT offers a new way to show the pattern of psychological characteristic, which is more structured and detailed in the item level.
    Appears in Collections:[Graduate Institute of Environmental Medicine] Theses & dissertations

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