糖尿病セルフケア能力測定ツール（修正版）の信頼性・妥当性の検討

The Reliability and Validity of Instrument of Diabetes self-Care Agency (IDSCA)

　本研究の目的は，開発中の糖尿病セルフケア能力測定ツール（以下，IDSCAと略す）の信頼性・妥当性を検討することである．セルフケア能力測定ツールの開発は，第1段階：メタデータ分析による糖尿病患者セルフケア能力の要素の抽出，第2段階：糖尿病患者セルフケア能力測定項目の作成，第3段階：専門家会議に基づくIDSCA（試案）の作成，第4段階：IDSCA（試案）の試用による内容妥当性と実用可能性の検討，第5段階：試用に基づくIDSCA（修正版）の信頼性・妥当性の検証の5段階で進めており，本研究は，その第5段階となる．

　368名の糖尿病患者に調査を行った結果，8要素77項目のIDSCA（修正版）は，因子分析により，第Ⅰ因子【自分らしく自己管理する力】12項目，第Ⅱ因子【自己管理の原動力】8項目，第Ⅲ因子【モニタリング力】6項目，第Ⅳ因子【応用・調整力】9項目，第Ⅴ因子【知識獲得力】7項目，第Ⅵ因子【サポート活用力】5項目，第Ⅶ因子【ストレス対処力】7項目，の合計7因子54項目に洗練した．この54項目のIDSCAのChronbachのα係数は0.936で内的整合性が保たれ，再検査信頼性係数は0.725で再現性が確認された．本庄氏の慢性病患者のセルフケア能力の質問紙との相関係数は全体で0.645となり収束的妥当性が支持されたが，基準関連妥当性の指標となる3ヵ月後のHbA1cとの相関係数は-0.145と小さな負の値に留まった．

　今後は，妥当性の確認を継続するとともに，看護援助の効果を測定するツールとして活用するために，看護援助前後のIDSCAの得点の変化についての検討が必要と言える．

Objective: The aim of this study was to assess the reliability and validity of the Instrument of diabetes self-care agency (IDSCA).

Methods: The pathway to develop the instrument of diabetes self-care agency (IDSCA) goes as follows. Stage 1: Extracting the elements of diabetes self-care agency by the meta-analysis of twenty theses on the qualitative study of diabetes nursing in Japan. Stage 2: Making the questions about diabetes self-care agency on the basis of Stage 1 Stage 3 Making the instrument of diabetes self-care agency (draft version) the discussions held by the multidiscipline group. Stage 4: Refining IDSCA (draft version) on the basis of the field trial Stage 5: Assessing the reliability and validity of IDSCA (modified version) This study reports stage 5. A total of 368 adults with diabetes responded to 77 items and 29items (SCAQ self-care Agency Questionnaire for chronic illness). Factor validity and internal consistency were analyzed.

Results: Factory analysis showed seven factors 54items: ability of own one's self-management (12 items), motivity of self-management (8 items), monitoring ability (8 items), application or adjustment ability (9 items), ability to get knowledge (7 items), ability to make the most of the available support (5 items), stress-coping ability (7 items). IDSCA (54items) has .936 of Chronbach's α coefficient, . 725 of Pearson's correlation coefficients in test-retest, 0.645 of Pearson's correlation coefficients for IDSCA and SCAQ.

Conclusion: IDCSA is reasonably reliable and valid is expected to prove useful for the assessment of people with diabetes.