基于健康促进模式的胃癌术后患者口服营养补充依从性量表的编制与信度、效度检验 [中文引用][英文引用]

目的  编制基于健康促进模式的胃癌术后患者口服营养补充（oral nutritional supplements，ONS）依从性量表，并对其信度、效度进行评价，为医护人员提供有效的评估工具。方法  2024 年 10 月— 2025 年 2 月在文献回顾、质性访谈与德尔菲专家函询的基础上基于 PENDER 健康促进模式（health promotion model，HPM）构建量表修订版，通过预调查形成预试量表。2025 年 4 月— 9 月采用便利抽样法，选取广州市某三级甲等肿瘤专科医院的 423 例胃癌术后患者进行问卷调查，并对量表的信度、效度进行检验。结果  423 例患者完成研究，其中 211 例用于探索性因子分析，212 例用于验证性因子分析。总量表的内容效度指数为 0.882，条目水平的内容效度指数在 0.821~1.000。探索性因子分析，模型 6 个主要公因子，其条目因子载荷 0.712~0.848，累计方差贡献率为 70.7%。量表总的 Cronbach α 系数为 0.923，折半信度为 0.701，重测信度为 0.816（P<0.001）。验证性因子分析显示，模型适配良好，形成量表包括感知行为益处、感知行为障碍、自我效能、情感体验、社会支持与情境因素 6个维度共 30 个条目。结论  本研究编制的基于健康促进模式的胃癌术后患者 ONS 依从性量表具有良好的信度与效度，可作为临床评估胃癌术后患者 ONS 依从性的测量工具。

Objective To develop an oral nutritional supplement（ONS）adherence scale based on Pender health promotion model（HPM）for the patients after gastric cancer surgery and to test its reliability and validity，thereby providing a scientific tool for assessing ONS adherence in this population. Methods From October 2024 to February 2025，based on the Pender health promotion model（HPM），an initial item pool was constructed through literature review，qualitative interviews and Delphi expert consultation. A pilot scale was established following a preliminary survey. From April to September 2025，a convenience sampling method was used to recruit 423 patients received surgery for gastric cancer at a Tier-IIIA cancer hospital in Guangzhou for a questionnaire-based survey to test the reliability and validity of the scale. Results A total of 423 patients completed the study. Data collected from 211 patients were used for exploratory factor analysis and those from 212 for confirmatory factor analysis. The content validity index of the total scale was 0.882，and the item-level content validity index ranged from 0.821 to 1.000. Exploratory factor analysis revealed six principal common factors，with item factor loadings from 0.712 to 0.848. The cumulative variance contribution rate was 70.7%. The Cronbach's α coefficient of the scale was 0.923，the split-half reliability was 0.701，and the test-retest reliability was 0.816（P<0.001）. Confirmatory factor analysis indicated a good model fit. The finalised scale consisted of 30 items across six dimensions：perceived behavioural benefits，perceived behavioural barriers，self-efficacy，emotional experience，social support and situational factors. Conclusion The developed Pender health promotion model-based ONS adherence scale demonstrates good reliability and validity for the patients after gastric cancer surgery. It can serve as a tool for assessing clinical ONS adherence in this population.