https://scholars.lib.ntu.edu.tw/handle/123456789/41156
標題: | 生活品質研究與醫藥衛生成本效性評估─子計畫一:特定疾病版生活品質問卷的發展與結構分析(3/3) | 作者: | 姚開屏 | 關鍵字: | 生活品質;因素結構;探索性因素分析;驗證性因素分析;加權方式;quality of life;factor structure;EFA;CFA;weighting methods | 公開日期: | 2003 | 出版社: | 臺北市:國立臺灣大學心理學系暨研究所 | 摘要: | 本篇的目的是想探討不同疾病患者對生活品質看法之差異。我們使用了過去從全台灣十七家醫院隨機收集到的一千多位健康人與病人的資料,取其中有較多病人的幾種疾病,再加上後來收集到的一百八十一位冠狀動脈繞道手術的病人的資料,來分析健康人與病人之間的差異,以及不同疾病病人之間的差異。分析的方法採探索性因素分析(exploratory factor analysis)及驗證性因素分析(confirmatory factor analysis)於四因子模式,以比較不同組別間的差別。 在比較探索性因素分析二獨立組間因素結構相似度方面,採計算因素適合係數(factor congruence coefficient)的方式。在用驗證性因素分析用於四因子模式因素結構可比較性方面,採多樣本分析(multi-sample analysis)的方法,以確認因素結構間之可比較性。研究結果顯示,不同組別的確對生活品質的看法不相似。詳細內容請見研究論文。 本篇的目的是探討對生活品質量表各向度加權的方式。我們從根本的角度來談這個問題,而問了三個問題。第一個問題是「我們能對生活品質量表各向度做加權嗎?」,這個問題的答案依著我們採何種方式來定義生活品質而定。在某種定義下,我們的確可對生活品質量表各向度做加權(詳見論文內文)。第二個問題是如果第一個問題的答案是肯定的,則繼續問「誰能做加權?」,是醫療健康人員?病人?醫療政策制訂者?還是社會大眾?本研究從不同角度來談,在不同情形下,會考慮由不同的人來做加權。第三個問題則初探加權的方式,我們採用迴歸、因素分析、多元尺度法等,來找出較適當的對生活品質量表各向度的加權分式,以加權前後量表信、效度的變化為選擇參考依據。 The WHOQOL-BREF questionnaire that contains 26 items and forms 4 QOL domains (i.e., physical, psychological, social, and environment) is the simplified version of the WHOQOL-100. The culturally adapted version of the WHOQOL-BREF includes 2 more national items for Taiwanese. The two national items are categorized into “being respected/accepted (Guanxi/Mientze)” and “eating/food” facets respectively. We administered this questionnaire-Taiwan version to 214 health subjects and 854 unhealthy patients with diverse diseases from 17 hospitals over Taiwan and to 181 patients with coronary artery bypass grating (CABG)from two hospitals in Taipei. The purpose of this study is to quantitatively compare the latent QOL factor structures among these subjects. Subjects are classified into groups differently according to disease types and sample sizes. To obtain enough sample size in a group for statistical purpose, we may combine patients such as the patients with different cancers to form a disease group (e.g., “tumor/cancer group”). Only the disease groups with larger sample size are studied. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on a four –factor model are conducted for each group. To compare the EFA factor structures among groups, factor congruence coefficient (FCC) which measures the degree of similarity between two factor structures from two independent samples is calculated for each pair of factors. To compare the CFA factor structures among groups, multi-sample analyses are conducted to confirm the comparability of factor structures among groups. Both EFA and CFA results suggest that subjects with different diseases have different perceptions on their QOL. In the past, quality of life(QOL)researchers usually sum the scores from several dimensions/sub-dimensions/items with equal weights to obtain individual’s overall QOL score. However, this approach has been inquired. One of the arguments is that QOL dimensions/sub-dimensions/items may have different meanings to individuals in terms of importance. Equal weighting approach may underestimate the QOL dimensions/items with more importance and overestimate the QOL dimensions/items with less importance to individuals. As a result, individual’s true QOL level cannot be estimated appropriately. To examine this issue in a more clear way, several questions should be raised. One is “Can we sum scores from different dimensions/items?” The answer may be yes and may be not because this depends on how people define the “overall QOL score”. Under certain conditions, we may sum scores from different dimensions/items to form an overall QOL score. If the answer is YES, we may continue to ask the second question “Who should give the weights?” Should it be the health professionals, the health services users (i.e., patients), the health policy-makers, or the public? We will discuss the advantages and the disadvantages of each type of persons who give weights. Moreover, we would further ask “How to give weights and sum the scores?” The purpose of this exploratory study is to find the appropriate ways to weigh the dimensions of QOL measures so that the assessment of QOL can describe subject’ true QOL level better and the overall QOL score is much more meaningful. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/29400 | 其他識別: | 912320B002083M56 | Rights: | 國立臺灣大學心理學系暨研究所 |
顯示於: | 心理學系 |
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912320B002083M56.pdf | 255.21 kB | Adobe PDF | 檢視/開啟 |
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