Objective To revise human immunodeficiency virus (HIV) Treatment Adherence Self-Efficacy Scale-Chinese Version (HIV-ASES) and to evaluate its reliability and validity for providing an instrument to follow-up studies on the medication compliance of patients with HIV/acquired immunodeficiency syndrome (AIDS) in China.
Methods The HIVASES-Chinese Version was revised with an expert consultation and modified based on Chinese culture background. Then the revised HIV-ASES-Chinese Version was administered among 1 215 HIV/AIDS patients (whom were registered in Henan Provincial Center for Disease Control and Prevention and under highly active antiroviral therapy [HAART]) selected with stratified multistage cluster random sampling in 6 regions of Henan province (Shangcai, Shenqiu, Queshan, Yongcheng, Jiyuan and Sanmenxia) from July 2015 to July 2016 to evaluate therapeutic compliance of patients and to assess the rationality of the theoretical structure of the revised HIV-ASES-Chinese Version based on project analysis. The reliability and validity of the scale were also assessed simultaneously.
Results In comparison with the original scale, one item was excluded and a new item was added to the the HIV-ASES-Chinese Version and the revised scale was consisted of two domains, namely integration (6 entries) and perseverance (6 entries). The results of the project analysis resulted in the correlation coefficients between the 12 entries and the total score of the HIV-ASES-Chinese Version ranging from 0.572 to 0.758 (all P < 0.001), suggesting the scale is of good item discrimination. The overall Cronbach α coefficient, retest reliability and split-half reliability of the revised scale were 0.930, 0.807, and 0.858; the Cronbach α coefficient and test-retest reliability are 0.912 and 0.775 for the integration domain and 0.867 and 0.720 for the perseverance domain, respectively, suggesting a good reliability of the scale. The results of exploratory factor analysis revealed that the cumulative variance contribution of the 2 public factors of the HIV-ASES-Chinese Version was 63.642%, and the structure of the factors belonging to each item is basically the same as that of the original scale. The confirmatory factor analysis on the HIV-ASES-Chinese Version resulted in a comparative goodness of fit index (CFI) of 0.966, an approximate error mean square root (RMSEA) of 0.079, a goodness of fit index (GFI) of 0.944, an adjusted goodness of fit index (AGFI) of 0.905, a root mean square residual value (RMR) of 0.114, and a standardized root mean square residual (SRMR) of 0.033. For all the participants, the overall scores of the HIV-ASES-Chinese Version, the Morisky Questionnaire and the Social Support Rating Scale (SSRS) were 127.32 ± 18.36, 14.58 ± 2.00 and 34.35 ± 1.62; the self-reported medication compliance rate during past one month and one week were 86.5% and 90.7%, respectively. The overall score of the HIV-ASES-Chinese Version was significantly correlated with the overall scores of Morisky Questionnaire and SSRS and with the self-reported medication compliance rate during past one month and one week, with the correlation coefficients of 0.450, 0.261, 0.288, and 0.321 ( P < 0.01 for all), indicating a good criterion validity of the revised scale.
Conclusion The reliability and validity of the revised HIV-ASES-Chinese Version meet the requirements of psychometrics and could be used to evaluate medication compliance among HIV/AIDS patients in China
【摘 要】 目的 修订中文版艾滋病治疗依从性自我效能感量表（HIV-ASES），并评价其信度和效度，为随访人员掌握艾滋病病毒（HIV）感染者/艾滋病（AIDS）患者的服药依从性提供参考工具。 方法 本研究通过专家咨询及中国文化调试后对中文版 HIV-ASES 量表进行了修订，并采用项目分析和信、效度检验方法对在河南省上蔡、沈丘、确山、永城、济源和三门峡 6 个地区 2015 年 7 月和 2016 年 7 月抽取的河南省疾病预防控制中心登记在册且接受高效抗逆转录病毒治疗（HAART）的 1 215 例 HIV 感染者/AIDS 患者的服药依从性进行分析，验证该量表理论结构的合理性。 结果 通过专家咨询及中国文化调试后，中文版 HIV-ASES 量表在原量表基础上删除了 1 个条目（条目 3）并新增 1 个条目后共包括融合（6 个条目）和毅力（6 个条目）2 个维度 12 个条目；项目分析结果显示，中文版 HIV-ASES 量表的 12 个条目得分与总分的相关系数为 0.572～0.758（均 P < 0.001），量表具有较好的项目区分度；量表总体的 Cronbach′s α 系数、重测信度和分半信度分别为 0.930、0.807 和 0.858，融合和毅力 2 个维度的 Cronbach′s α 系数、重测信度分别为 0.912、0.775 和 0.867、0.720，量表具有较好的信度；探索性因子分析结果显示，中文版 HIV-ASES 量表 2 个公因子的累计方差贡献率为 63.642 %，各条目所属因子结构与原量表基本一致；验证性因子分析结果显示，中文版 HIV-ASES 量表的比较拟合优度指数（CFI）为 0.966、近似误差均方根（RMSEA）为 0.079、拟合优度指数（GFI）为 0.944、调整拟合优度指数（AGFI）为 0.905、平方根残值（RMR）为 0.114、标准化残差均方根（SRMR）为0.033；中文版 HIV-ASES 量表、Morisky 问卷和社会支持评定量表（SSRS）的总分分别为（127.32 ± 18.36）、（14.58 ± 2.00）和（34.35 ± 1.62）分，自我报告过去 1 个月服药依从率和调查前 1 周服药依从率分别为 86.5 %和 90.7 %，中文版 HIV-ASES 量表总分与 Morisky 问卷、SSRS 量表总分和自我报告过去 1 个月服药依从率、调查前 1 周服药依从率均呈正相关（ r = 0.450、0.261、0.288、0.321，均 P < 0.01），量表具有较好的效标效度。 结论 修订的中文版 HIV-ASES 量表在 HIV 感染者/AIDS 患者中的信度和效度指标均符合心理测量学的要求，可适用于中国 HIV 感染者/AIDS 患者服药依从性的评价。