糖尿病性腎症高齢患者の透析導入に伴う移行見通し測定尺度の信頼性と妥当性の検証

Verification of the Reliability and Validity of a Scale that Measures the Prospect of Transition Associated with the Introduction of Dialysis in Elderly Patients with Diabetic Nephropathy

要旨

　目的：糖尿病性腎症高齢患者の透析導入に伴う移行見通し測定尺度を開発し，信頼性と妥当性を検証する．

　方法：インタビュー調査に基づいて尺度原案40項目を作成し，全国1,665施設で定期的に血液透析を行っている糖尿病性腎症から透析を導入した65歳以上の患者に質問紙調査を行い，信頼性と妥当性を検証した．分析には欠損値を補完したデータを用いた．

　結果：収束妥当性の検証では496名，それ以外の検証では502名のデータを分析した．探索的因子分析で6因子32項目が抽出され，確証的因子分析においてCFI = .955，RMSEA = .067であった．収束的妥当性，既知グループ妥当性は統計学的に有意な結果であったが，併存的妥当性は有意な結果ではなかった．信頼性係数は尺度全体で .887，下位尺度で .728〜.922であった．

　結論：併存的妥当性に課題はあるが，一定の信頼性，妥当性を確認できた．

　Purpose: To develop a scale (Scale for Elderly with Diabetic Nephropathy being initiated on dialysis: SEDNID) that measures the prospect of transition associated with the introduction of dialysis in elderly patients with diabetic nephropathy, and then verify the reliability and validity of the scale.

　Methods: A draft scale consisting of 40 items was prepared after an interview-based survey. Using this scale, a questionnaire survey was conducted on patients aged 65 years old or older who were on regular hemodialysis treatment at any of 1,665 facilities nationwide for diabetic nephropathy. Analysis was conducted with data imputed for missing values.

　Results: Data from 496 patients were analyzed to verify the convergence validity. For other validations, data from 502 patients were analyzed. Exploratory factor analysis led to the extraction of 6 factors and 32 items. Confirmatory factor analysis showed a comparative fit index (CFI) of .955 and a root mean square error of approximation (RMSEA) of .067. Thus, the results of convergence validity and known-group validity were statistically significant. However, the results of concurrent validity were not statistically significant. McDonald's ω coefficient was .887 for the entire scale and .728 to .922 for the subscales.

　Conclusion: Although issues of concurrent validity remain, we confirmed a certain level of reliability and validity.