退院後の消化器系永久ストーマ造設患者のための生活安定感尺度の開発

Development of a Scale for Feeling of Stability in Daily Life among Outpatients with Permanent Gastrointestinal Stoma

要旨

　ストーマを持っての生活の安定を把握する生活安定感尺度の開発を目的に，退院後の消化器系永久ストーマ造設患者を対象に調査を実施した．事前の面接により収集し，内容および表面妥当性を確認した尺度案とオストメイトQOL調査票を用いた．回答は133名より得た．

　探索的および検証的因子分析の結果，「日常生活活動の回復・拡大」「ストーマの受け止め」「ストーマケアを受ける場がある安心感」「皮膚トラブルの心配のなさ」「排便と体調の把握」の5因子，24項目を選択した．再検査法にもとづく各項目の重み付きκ統計量と各因子得点の級内相関係数の値から，一定の信頼性を有することが示された．クロンバックのα係数，オストメイトQOL調査票あるいは単項目との相関係数の値から，各因子の内的整合性，収束・判別妥当性が確認された．臨床的に想定される因子間の順序性は，統計的にも確認された．

　以上から，本尺度は一定の信頼性，妥当性を有しており，臨床的に使用可能と考えられた．

Abstract

　The purpose of this study was to develop a scale to rate the feeling of stability in daily life with a stoma. One hundred and thirty three patients with permanent gastrointestinal stoma responded. The questionnaire was consisted of a scale for feeling of stability in daily life and the ostomate's QOL questionnaire. The items of this scale were collected by preliminary interviews, and they were confirmed content and face validity.

　Five factors, consisting of 24 items, by exploratory factor analysis and confirmatory factor analysis, were selected from 40 items, as follows: (1) recovery and expansion of activities, (2) acceptance of the stoma, (3) relief at having a place to go for consultation about stoma care, (4) absence of worry about peristomal skin trouble, and (5) perception of defecation and physical condition. Weighted kappa for each item and the intraclass correlation coefficient for each factor, based on the test-retest method, indicated the moderate level of reliability. Cronbach's α for each factor indicated a certain level of internal consistency. Correlation assessments between the scores for this scale and those for the ostomate's QOL questionnaire or some items confirmed the convergent and discriminant validity. We supposed an ordinal relationship among 3 factors, from the clinical viewpoint, that is, absence of worry about peristomal skin trouble, acceptance of the stoma, and recovery and expansion of activities. This relationship was supported statistically.

　The results of this study suggested that this scale was reliable and valid, indicating that the scale might be used clinically.