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Article(id=1322168513595294118, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168481081049284, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.09.015, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753027200000, receivedDateStr=2025-07-21, revisedDate=1773936000000, revisedDateStr=2026-03-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159138344, onlineDateStr=2026-10-28, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159138344, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159138344, creator=13701087609, updateTime=1793159138344, updator=13701087609, issue=Issue{id=1322168481081049284, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='9', pageStart='1425', pageEnd='1616', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159130592, creator='13701087609', updateTime=1793159130592, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1542, endPage=1548, ext={EN=ArticleExt(id=1322168515268821415, articleId=1322168513595294118, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Development and reliability and validity test of a exercise adherence scale for maintenance hemodialysis patients, columnId=1220689492655129450, journalTitle=Chinese Nursing Research, columnName=Scale Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To develop an exercise adherence scale for maintenance hemodialysis(MHD) patients based on behavioral change theory and test its reliability and validity,aiming to provide a tool for measuring exercise adherence in MHD patients.

Methods

Guided by the Capability-Opportunity-Motivation Behavior(COM-B) model and the Theoretical Domains Framework(TDF),an initial item pool was constructed through literature review and semi-structured interviews.The initial version of the scale was determined after two rounds of Delphi expert consultations(n=20).Item selection was conducted based on survey results from 293 MHD patients,followed by validity and reliability testing in another sample of MHD patients.

Results

The developed exercise adherence scale for maintenance hemodialysis patients consisted of two parts:Part 1 is the exercise adherence process subscale for MHD,including three dimensions(capability,opportunity,motivation) with 35 items;Part 2 is the exercise adherence outcome subscale for MHD,a single dimension with 12 items.Exploratory factor analysis extracted three common factors,with a cumulative variance contribution rate of 57.706%;confirmatory factor analysis showed good model fit;the Cronbach's α coefficient for the process subscale was 0.954,split-half reliability was 0.712,and test-retest reliability was 0.907;the test-retest reliability for the outcome subscale was 0.932.

Conclusions

The developed exercise adherence scale for maintenance hemodialysis patients demonstrates good reliability and validity and can be used to assess exercise adherence in MHD patients.

, authors=Min LI1, Xuejiao ZHU1, Yaping FENG2, authorsList=Min LI, Xuejiao ZHU, Yaping FENG, authorCompany=null, correspAuthors=Xuejiao ZHU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168516048961961, articleId=1322168513595294118, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=维持性血液透析病人运动依从性量表的编制及信效度检验, columnId=1220689492902593405, journalTitle=护理研究, columnName=量表研究, runingTitle=null, highlight=null, articleAbstract=
目的

基于行为改变相关理论编制维持性血液透析病人运动依从性量表并检验其信效度，旨在为维持性血液透析病人运动依从性的测量提供工具。

方法

以能力-机会-动机行为模型及理论域模型为框架，通过文献回顾及半结构式访谈构建量表初始条目池。经过2轮德尔菲法专家（n=20）函询确定量表初始版。基于293例维持性血液透析病人的调查结果进行量表条目筛选，随后又调查维持性血液透析病人进行量表效度检验和信度检验。

结果

编制的维持性血液透析病人运动依从性量表包括两部分，第1部分为维持性血液透析运动依从性过程分量表，包括能力、机会、动机3个维度、35个条目；第2部分为维持性血液透析运动依从性结果分量表，为单维度共12个条目。探索性因子分析提取3个公因子，累计方差贡献率为57.706%；验证性因子分析结果显示模型拟合度良好；过程分量表Cronbach's α系数为0.954，折半信度为0.712，重测信度为0.907；结果分量表重测信度为0.932。

结论

编制的维持性血液透析病人运动依从性量表具有良好的信效度，可用于评估维持性血液透析病人的运动依从性。

, authors=李敏1, 朱雪娇1, *, *, 封亚萍2, authorsList=李敏, 朱雪娇, 封亚萍, authorCompany=null, correspAuthors=朱雪娇, authorNote=

李敏，护士，硕士研究生

, correspAuthorsNote=
朱雪娇，E-mail:
ZHU Xuejiao, E-mail:
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tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168513595294118, language=EN, label=Table 1, caption=

Structure matrix of the process subscale after the second factor analysis rotation（factor loading）

, figureFileSmall=null, figureFileBig=null, tableContent=
条目动机能力机会
A1知道运动的益处（如提高肌肉力量、有利于排出毒素等）0.3290.5360.327
A2知道适合自己的运动类型0.2430.5980.234
A3知道适合自己的运动时长0.1140.8510.024
A4知道适合自己的运动频率0.0690.8560.101
A5知道适合自己的运动强度0.2010.548-0.018
A6知道运动可能存在的风险（如低血糖、低血压、头晕等）0.1910.4250.246
A7知道何时终止运动（如出现严重的胸闷、肌肉痉挛等）0.1810.6490.123
A8能掌握运动（如步行、骑自行车、使用哑铃、使用沙袋、太极拳等）的方法0.1900.5950.247
A9能识别和避免运动中可能存在的风险（如低血糖、低血压、头晕等）0.0660.8770.066
A10能正确处理运动中出现的不适（如低血糖、低血压、头晕等）0.1340.770-0.009
A11能合理调节运动时长0.1200.8000.086
A12能合理调节运动强度0.1620.7670.088
A13能合理调节运动频率0.1260.7450.097
A14能合理调节运动类型0.1590.6880.120
A15能合理决定是否运动0.2720.5930.196
B1有医护人员、康复师等给予的运动宣教与指导（如运动益处、适宜的运动类型、运动频率、运动时长、运动强度等）0.2270.1590.744
B2周围有适宜的运动场所（如公园、步道等）和运动设施0.2990.1690.679
B3有足够的空闲时间去运动0.1860.1500.679
B4在运动方面有家人或朋友的支持0.2420.0910.738
B5在运动方面有医护人员的支持0.2090.1140.702
C1运动能帮自己更好地承担家庭和社会角色0.6850.3150.066
C2身体检查指标（如透析间期体重、透析前后血压、肌酐等）保持稳定时，更愿意运动0.7880.2850.252
C3透析后无身体不适（如疲乏等）时，更愿意运动0.7350.2420.246
C4相信自己有足够的体力运动0.6690.1120.140
C5相信自己能够坚持运动0.6990.1780.142
C6相信运动可以改善疲劳0.763-0.0130.011
C7相信运动可以改善心血管健康0.8380.1410.229
C8相信运动可以提高身体功能（如行走能力、双腿力量、肌力和耐力等）0.7860.1980.325
C9相信运动有利于体内毒素和多余水分的排出0.7360.2420.338
C10相信运动可以改善睡眠0.6520.1900.240
C11即使无他人陪伴也会去运动0.6830.2340.144
C12即使运动后产生轻微疲劳也会去运动0.7320.1050.170
C13即使运动后产生轻微肌肉酸痛也会去运动0.7120.2300.019
C14近期会开始或继续运动0.7150.2060.248
C15打算做到规律运动0.6280.0750.133
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第2次因子分析旋转后过程分量表结构矩阵（因子载荷）

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条目动机能力机会
A1知道运动的益处（如提高肌肉力量、有利于排出毒素等）0.3290.5360.327
A2知道适合自己的运动类型0.2430.5980.234
A3知道适合自己的运动时长0.1140.8510.024
A4知道适合自己的运动频率0.0690.8560.101
A5知道适合自己的运动强度0.2010.548-0.018
A6知道运动可能存在的风险（如低血糖、低血压、头晕等）0.1910.4250.246
A7知道何时终止运动（如出现严重的胸闷、肌肉痉挛等）0.1810.6490.123
A8能掌握运动（如步行、骑自行车、使用哑铃、使用沙袋、太极拳等）的方法0.1900.5950.247
A9能识别和避免运动中可能存在的风险（如低血糖、低血压、头晕等）0.0660.8770.066
A10能正确处理运动中出现的不适（如低血糖、低血压、头晕等）0.1340.770-0.009
A11能合理调节运动时长0.1200.8000.086
A12能合理调节运动强度0.1620.7670.088
A13能合理调节运动频率0.1260.7450.097
A14能合理调节运动类型0.1590.6880.120
A15能合理决定是否运动0.2720.5930.196
B1有医护人员、康复师等给予的运动宣教与指导（如运动益处、适宜的运动类型、运动频率、运动时长、运动强度等）0.2270.1590.744
B2周围有适宜的运动场所（如公园、步道等）和运动设施0.2990.1690.679
B3有足够的空闲时间去运动0.1860.1500.679
B4在运动方面有家人或朋友的支持0.2420.0910.738
B5在运动方面有医护人员的支持0.2090.1140.702
C1运动能帮自己更好地承担家庭和社会角色0.6850.3150.066
C2身体检查指标（如透析间期体重、透析前后血压、肌酐等）保持稳定时，更愿意运动0.7880.2850.252
C3透析后无身体不适（如疲乏等）时，更愿意运动0.7350.2420.246
C4相信自己有足够的体力运动0.6690.1120.140
C5相信自己能够坚持运动0.6990.1780.142
C6相信运动可以改善疲劳0.763-0.0130.011
C7相信运动可以改善心血管健康0.8380.1410.229
C8相信运动可以提高身体功能（如行走能力、双腿力量、肌力和耐力等）0.7860.1980.325
C9相信运动有利于体内毒素和多余水分的排出0.7360.2420.338
C10相信运动可以改善睡眠0.6520.1900.240
C11即使无他人陪伴也会去运动0.6830.2340.144
C12即使运动后产生轻微疲劳也会去运动0.7320.1050.170
C13即使运动后产生轻微肌肉酸痛也会去运动0.7120.2300.019
C14近期会开始或继续运动0.7150.2060.248
C15打算做到规律运动0.6280.0750.133
), ArticleFig(id=1322530776894263877, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168513595294118, language=EN, label=Table 2, caption=

Reliability analysis results of the exercise compliance scale for MHD patients

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项目条目数Cronbach's α系数折半信度重测信度
过程分量表350.9540.7120.907
能力150.9420.9060.892
机会50.8330.8200.805
动机150.9500.9500.849
结果分量表120.932
), ArticleFig(id=1322530776957178438, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168513595294118, language=CN, label=表2, caption=

维持性血液透析病人运动依从性量表信度分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目条目数Cronbach's α系数折半信度重测信度
过程分量表350.9540.7120.907
能力150.9420.9060.892
机会50.8330.8200.805
动机150.9500.9500.849
结果分量表120.932
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维持性血液透析病人运动依从性量表的编制及信效度检验
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李敏 1 , 朱雪娇 1, *, * , 封亚萍 2
护理研究 | 量表研究 2026,40(9): 1542-1548
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护理研究 |量表研究 2026 , 40 (9) : 1542 -1548
维持性血液透析病人运动依从性量表的编制及信效度检验
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李敏，护士，硕士研究生

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李敏1, 朱雪娇1, *, * , 封亚萍2
作者信息
  • 1杭州师范大学公共卫生与护理学院，浙江 311121
  • 2杭州师范大学附属医院
通讯作者:
朱雪娇，E-mail:
ZHU Xuejiao, E-mail:
作者简介:

李敏，护士，硕士研究生

Development and reliability and validity test of a exercise adherence scale for maintenance hemodialysis patients
Min LI1, Xuejiao ZHU1 , Yaping FENG2
Affiliations
  • 1School of Public Health and Nursing, Hangzhou Normal University, Zhejiang 311121 China
  • 2Affiliated Hospital of Hangzhou Normal University
出版时间: 2026-05-10 doi: 10.12102/j.issn.1009-6493.2026.09.015
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摘要
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目的

基于行为改变相关理论编制维持性血液透析病人运动依从性量表并检验其信效度，旨在为维持性血液透析病人运动依从性的测量提供工具。

方法

以能力-机会-动机行为模型及理论域模型为框架，通过文献回顾及半结构式访谈构建量表初始条目池。经过2轮德尔菲法专家（n=20）函询确定量表初始版。基于293例维持性血液透析病人的调查结果进行量表条目筛选，随后又调查维持性血液透析病人进行量表效度检验和信度检验。

结果

编制的维持性血液透析病人运动依从性量表包括两部分，第1部分为维持性血液透析运动依从性过程分量表，包括能力、机会、动机3个维度、35个条目；第2部分为维持性血液透析运动依从性结果分量表，为单维度共12个条目。探索性因子分析提取3个公因子，累计方差贡献率为57.706%；验证性因子分析结果显示模型拟合度良好；过程分量表Cronbach's α系数为0.954，折半信度为0.712，重测信度为0.907；结果分量表重测信度为0.932。

结论

编制的维持性血液透析病人运动依从性量表具有良好的信效度，可用于评估维持性血液透析病人的运动依从性。

维持性血液透析  /  运动  /  依从性  /  量表  /  信度  /  效度
Objective

To develop an exercise adherence scale for maintenance hemodialysis(MHD) patients based on behavioral change theory and test its reliability and validity,aiming to provide a tool for measuring exercise adherence in MHD patients.

Methods

Guided by the Capability-Opportunity-Motivation Behavior(COM-B) model and the Theoretical Domains Framework(TDF),an initial item pool was constructed through literature review and semi-structured interviews.The initial version of the scale was determined after two rounds of Delphi expert consultations(n=20).Item selection was conducted based on survey results from 293 MHD patients,followed by validity and reliability testing in another sample of MHD patients.

Results

The developed exercise adherence scale for maintenance hemodialysis patients consisted of two parts:Part 1 is the exercise adherence process subscale for MHD,including three dimensions(capability,opportunity,motivation) with 35 items;Part 2 is the exercise adherence outcome subscale for MHD,a single dimension with 12 items.Exploratory factor analysis extracted three common factors,with a cumulative variance contribution rate of 57.706%;confirmatory factor analysis showed good model fit;the Cronbach's α coefficient for the process subscale was 0.954,split-half reliability was 0.712,and test-retest reliability was 0.907;the test-retest reliability for the outcome subscale was 0.932.

Conclusions

The developed exercise adherence scale for maintenance hemodialysis patients demonstrates good reliability and validity and can be used to assess exercise adherence in MHD patients.

maintenance hemodialysis  /  exercise  /  adherence  /  scale  /  reliability  /  validity
李敏, 朱雪娇, 封亚萍. 维持性血液透析病人运动依从性量表的编制及信效度检验. 护理研究, 2026 , 40 (9) : 1542 -1548 . DOI: 10.12102/j.issn.1009-6493.2026.09.015
Min LI, Xuejiao ZHU, Yaping FENG. Development and reliability and validity test of a exercise adherence scale for maintenance hemodialysis patients[J]. Chinese Nursing Research, 2026 , 40 (9) : 1542 -1548 . DOI: 10.12102/j.issn.1009-6493.2026.09.015
正文
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维持性血液透析（maintenance hemodialysis，MHD）是终末期肾脏病病人最常用的肾脏替代治疗方式之一[1]。随着透析技术的发展成熟，维持性血液透析病人的生存期逐渐延长[2]，但长期血液透析治疗常伴随多种并发症，如身体机能下降、心肺功能减退、运动耐力下降及疲乏加重，导致维持性血液透析病人生活质量下降，增加了病人家庭和社会的负担[3]。规律运动被证实可有效改善维持性血液透析病人的健康状况，增强病人心肺功能及耐力，减轻因治疗相关并发症所带来的经济负担[4-5]。然而，运动效果的实现不仅取决于运动方案的科学设计，更依赖病人对运动方案的长期、持续性遵从。科学、系统地评估维持性血液透析病人的运动依从性已成为提升运动干预效果的核心前提[6]。运动依从性是指病人的运动行为与医疗保健者推荐的运动类型、时间、频率、强度的相符程度，是一个从运动态度、信念到行动维持的发生过程[7-8]。目前，国外已有多种运动依从性评估工具，如运动依从性评定量表（EARS）[9]、运动训练康复依从性量表（RADMAT）[10]等，我国则主要以自制问卷[11]为主。然而，这些工具均缺乏针对维持性血液透析病人的特异性，且更多聚焦于运动依从性的实际结果，未能全面反映病人的依从过程。目前尚缺乏系统化的研究工具来全面探讨运动依从性过程及其实际结果。本研究旨在基于行为改变相关理论编制包含运动依从性过程和结果的运动依从性量表，为系统评估维持性血液透析病人运动依从性提供一个科学、本土化的工具。
1　研究方法
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1.1　理论框架
运动依从性本质是一种行为改变。通过回顾常见的行为改变相关理论/理论模型发现，能力-机会-动机行为模型（Capacity,Opportunity,Motivation-Behavior，COM-B）及理论域模型（Theoretical Domains Framework，TDF）[12]已被证实能够全面评估运动行为的发生过程。本研究基于这两个理论编制维持性血液透析病人运动依从性量表的第1部分，即运动依从性过程分量表。COM-B模型认为，行为的发生需要具备能力、机会和动机3个基本要素，该模型指导本研究形成运动依从性过程分量表包括能力、机会、动机3个维度。TDF框架是在COM-B的3个基本要素的基础上进一步细化，涵盖知识、信念、情绪等多个方面[13]，指导本研究对维度的细化。本研究编制量表的第2部分（运动依从性结果分量表）参考运动相关指南[3,14-16]、专家共识[17-19]等，包含运动类型、运动时间、运动频率、运动强度4个方面。
1.2　编制初始量表
1.2.1　通过文献回顾初步确定条目池
检索Cochrane Library、PubMed、Web of Science、EMbase、英国肾脏病协会网站（The Renal Association，RA）、全国肾脏基金会（The National Kidney Foundation，NKF）官网、美国运动医学会（American College of Sports Medicine，ACSM）官网、英国运动和体育科学协会（The British Association of Sport and Exercise Sciences，BASES）官网、中国医脉通网站、中华医学会肾脏病学分会网站、中国知网、维普数据库、万方数据知识服务平台、中国生物医学文献数据库。中文检索词包括血液透析、肾透析、体外透析、血液净化、终末期肾脏病和体力活动、身体活动、运动锻炼、体育锻炼、运动治疗、运动疗法、运动和依从性。英文检索词包括renal dialysis，dialysis，hemodialys*，maintenance hemodialysis，maintained hemodialysis，extracorporeal dialysis，hemopurification，hematodialysis，haemodialysis及“sports，physical training，physical exercise，exercise，physical activit*及adherence，compliance。检索时限设置为建库至2024年2月15日。初步检索文献获得文献1 543篇，剔除与主题不相关、重复文献后剩余75篇，阅读文章全文后最终共纳入15篇文献，包括3篇专家共识[17-19]、5篇指南[3,14-16,20]、7篇系统评价[21-27]。基于COM-B及TDF模型提取条目池，初步形成维持性血液透析病人运动依从性量表条目池，共包括两部分，过程分量表包括能力维度（19个条目）、机会维度（5个条目）、动机维度（23个条目），结果分量表为单维度共12个条目。
1.2.2　半结构式访谈补充条目池
采用目的抽样的方法，于2024年3月—4月对维持性血液透析病人及血液净化中心医护人员进行访谈。本研究共访谈12例维持性血液透析病人及5名血液净化中心医护人员。纳入标准：符合慢性肾衰竭诊断标准且行规律性血液透析时间≥3个月；病情相对稳定；意识清楚，能进行正常交流；知情同意，自愿参与本次调查。排除标准：合并其他严重并发症的病人；有严重躯体功能障碍的病人；病历资料不完整者。以COM-B及TDF模型为指导制定访谈提纲：您是怎么看待您的运动能力的呢？您是怎么看待您的运动动机的呢？您是怎么看待您的运动机会的呢？您是怎么看待您的运动行为（运动时间、运动频率、运动类型、运动强度）的呢？通过半结构式访谈后补充23个条目，并与课题组充分讨论后，最终确定维持性血液透析病人运动依从性量表初始版，共包括两部分82个条目，过程分量表包括能力（23个条目）、机会（9个条目）、动机（38个条目）3个维度，结果分量表为单维度共12个条目。
1.3　专家函询
1.3.1　遴选函询专家
纳入标准：从事肾脏病临床医学、运动康复、血液透析护理、护理管理、护理教育等相关工作年限≥10 年；学历为本科及以上，职称为中级及以上；知情同意。本研究最终遴选20名专家，符合德尔菲法对专家人数为15~50人的要求[28]。
1.3.2　编制专家函询问卷
专家函询问卷共包括3部分。第1部分向专家介绍本研究的相关内容及填表的注意事项；第2部分为具体函询内容，包括量表维度的重要性评分及意见、量表条目的重要性评分及意见，重要性评价采用Likert 5级评分，从“非常不重要”至“非常重要”依次赋值1~5分；第3部分为专家基本情况调查表，包括专家的基本信息（如姓名、年龄、性别等）、专家对函询内容的熟悉程度和判断依据调查表。
1.3.3　实施专家函询
本研究采用发送邮件的方式联系专家，由专家在10 d内完成问卷并回复。第1轮专家函询后，课题组根据专家意见及评分进行修改，并制定第2轮函询问卷。专家函询后根据筛选标准筛选条目。1）客观标准：重要性均分>3.50分、满分比>0.20、变异系数<0.25[29]；2）主观标准：专家的文字建议或意见。第1轮函询补充8个条目（能力维度5个，动机维度3个），包括“能掌握运动（如步行、骑自行车、使用哑铃、使用沙袋、太极拳等）的方法”“运动能增加自己的社会参与度”等；删除9个条目（能力维度4个，动机维度5个），包括“经常与医护人员交流运动情况”“经常与病友们交流运动情况”等；合并11个条目（能力维度2个，机会维度2个，动机维度7个），包括“身体检查指标维持在正常范围时，更愿意运动”“透析间期体重维持在正常范围时，更愿意运动”等。第2轮函询：删除5个条目（机会维度1个、动机维度4个），包括“能选择适合自己的运动”“运动可以改善抑郁等心理不适症状”等；合并14个条目（能力维度6个、机会维度2个、动机维度6个），包括“运动能增加自己的社会参与度”“运动能帮自己更好地进行工作”等。经过2轮专家函询后，专家的意见基本趋于一致，最终形成维持性血液透析病人运动依从性量表初始版（63个条目），其中过程分量表包括能力（19个条目）、机会（7个条目）、动机（25个条目）3个维度共51个条目，结果分量表为单维度共12个条目。
1.4　预调查
为调查病人对量表整体、量表指导语、量表条目以及选项的理解程度，采用便利抽样法，于2024年6月选取20例维持性血液透析病人自行填写经过2轮专家函询后的维持性血液透析病人运动依从性量表，并进行认知性访谈。维持性血液透析病人的纳入与排除标准同半结构式访谈。结合认知性访谈的反馈结果，并与课题组讨论，进一步修订维持性血液透析病人运动依从性量表初始版。20例研究对象均表示能够轻松完成量表的全部条目，且条目易于理解，未有修改建议，故量表条目不做出修改。
1.5　量表正式形成与评价
1.5.1　研究对象
采用便利抽样法，于2024年7月—10月在浙江省杭州市2所三级甲等医院血液净化中心选取符合纳入与排除标准的维持性血液透析病人进行调查。维持性血液透析病人的纳入与排除标准同半结构式访谈。样本量：因子分析时，样本量至少是条目数的5~10倍[30]，且验证性因子分析要求样本量至少为200例。本量表的结果分量表无法进行因子分析，故依据量表的过程分量表51个条目的5~10倍[30]计算样本量，考虑10%的无效问卷，需纳入病人280~561例。本研究第1阶段先进行条目筛选以形成正式版量表，实际纳入293例维持性血液透析病人；第2阶段评价正式版量表的信效度，实际纳入222例维持性血液透析病人，符合样本量要求。本研究已通过学校伦理委员会审查（编号：2024009）。
1.5.2　调查工具
1）一般资料调查表：研究者通过文献回顾后自行设计，包括性别、年龄、职业等基本资料及透析龄、透析频率、血管通路类型等疾病相关资料；2）维持性血液透析病人运动依从性量表初始版（用于第1阶段）：包括2个部分，过程分量表包括3个维度、51个条目，结果分量表为单维度共12个条目；3）维持性血液透析病人运动依从性量表正式版（第1阶段修订后形成，用于第2阶段）。
1.5.3　实施调查
采用一对一调查形式，由调查员向调查对象逐一提问，并根据其回答代为填写。填写完成后，调查员当场核对量表的完整性，确保无漏填或错选项。发放与回收环节严格把控，确保数据的可靠性和真实性。对于病人在填写过程中遇到的疑问，研究者及时解答，但避免任何引导性提示，确保填写的客观性和病人真实的回答。同时，病人的填写过程完全匿名。完成量表用时8~14 min，平均11 min。
1.6　统计学方法
采用SPSS 26.0和AMOS 24.0 软件进行数据分析，包括项目分析、探索性因子分析、信度和效度分析。采用临界比值法、相关系数法、同质性检验、共同性与因素负荷量进行项目分析；采用探索性因子分析及验证性因子分析检验量表的结构效度；采用量表水平的内容效度指数（S-CVI）和条目水平的内容效度指数（I-CVI）评价量表的内容效度；采用标准化因子载荷、平均方差抽取量(AVE)和组合信度(CR)评价量表的聚合效度；采用相关系数和AVE算术平方根评价量表的区分效度；采用内部一致性信度、折半信度及重测信度评价量表的信度。以P<0.05为有统计学意义。
2　结果
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2.1　项目分析
对过程分量表进行项目分析。1）临界比值法：将样本得分的前27%划分为高分组，后27%划分为低分组，采用独立样本t检验判断两组在各条目得分比较差异是否有统计学意义，临界比值<3.00或无统计学意义（P>0.05），考虑删除该条目[31]。2）相关系数法：计算单个条目与总分的相关系数，若相关系数r值<0.40，考虑删除该条目[32]。3）同质性检验法（克隆巴赫系数法）：删除某一条目后，Cronbach's α系数增大，考虑删除该条目[32];同时若条目的校正题项与总分的相关系数<0.40，考虑删除该条目[33-34]。4）共同性与因素负荷量：通常采用主成分分析法提取出1个共同因素，若因子载荷<0.45或共同性<0.20，考虑删除该条目[35]。根据项目分析结果并与课题组讨论后，若条目不能同时满足指标中的4个及以上，则删除该条目，最终删除“在运动方面有病友们的支持”“担心运动的安全性（如害怕跌倒、害怕损伤血管通路）”等6个条目。最终过程分量表共保留3个维度、45个条目，分别为能力（18个条目）、机会（5个条目）、动机（22个条目）。
2.2　效度分析
2.2.1　内容效度
本研究邀请6名专家（科研教学专家2人、运动康复专家2人、临床护理专家2人）对量表各条目与相应维度间的相关性进行评价，过程分量表I-CVI和S-CVI分别为0.833~1.000和0.990，结果分量表I-CVI和S-CVI分别为0.833~1.000和0.958。
2.2.2　结构效度
基于第1阶段的数据（n=293）对项目分析后的过程分量表进行探索性因子分析，经过2轮探索性因子分析，删除10个条目，过程分量表结构趋于稳定。若因子载荷<0.4，条目在多个因子上均有载荷，且因子包含条目数<3个，予以删除。第2次探索性因子分析得到3个公因子，累计方差贡献率为57.706%。3个因子与本研究理论框架相一致，分别命名为能力、机会、动机。所有条目旋转后都进入预想维度，并且符合条目纳入标准，因此保留35个条目。见表1。基于第2阶段数据（n=222）进行验证性因子分析显示：卡方/自由度比（χ2/df）=1.779；近似误差均方根（RMSEA）=0.059；残差均方和平方根（RMR）=0.044；比较拟合指数（CFI）=0.914；Tueker-Lewis指数（TLI）=0.908；增值适配指数（IFI）=0.915，表明模型拟合良好。说明能力、机会、动机3个因子的各项指标都在适配标准范围内，因此保留35个条目。
2.2.3　聚合效度
本研究编制过程分量表的能力、机会、动机3个维度的AVE值分别为0.522，0.503，0.563，均>0.50，且CR值分别为0.942，0.834，0.950，均>0.60，说明过程分量表具有良好的聚合效度。
2.2.4　区分效度
本研究编制过程分量表的能力、机会、动机3个维度的相关系数为0.480~0.611，且均小于所对应的AVE平方根，表示过程分量表的各维度之间具有相关性又具有区分度，说明量表的区分效度符合心理测量学的标准。
2.3　信度分析（见表2）
3　讨论
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3.1　编制的维持性血液透析病人运动依从性量表具有良好的科学性
本研究基于COM-B和TDF模型进行文献回顾和半结构式访谈编制条目池，并邀请来自临床医疗、科研教学等领域的20名具有代表性的专家对量表维度和条目进行评估后对量表进行修订，提升了量表的科学性。通过预调查、项目分析及探索性因子分析对量表条目进行筛选，随后从内容效度、结构效度、区分效度、聚合效度、内部一致性、折半信度和重测信度等多个方面对量表进行全面评估，表明量表具有良好的鉴别力和区分度。研究表明，编制的量表在评估维持性血液透析病人运动依从性方面具有较高的科学性和实用性，能够对维持性血液透析病人的运动依从性进行科学、全面的评估。
3.2　编制的维持性血液透析病人运动依从性量表具有良好的信效度
本研究从信度和效度的多个方面对量表进行了检验。信度分析结果显示，量表的Cronbach's α系数、折半信度和重测信度均较高，说明编制的量表具有良好的内部一致性和稳定性[30]。结果显示，量表的内容效度较好，条目具有代表性。探索性因子分析提取3个公因子，与原理论假设一致，累计方差贡献率为57.706%，说明量表结构稳定性较好。验证性因子分析结果显示，各模型拟合指数均在可接受范围内，说明量表的结构效度良好。聚合效度、区分效度结果显示，量表的聚合效度、区分效度均良好，表明量表各条目间既存在紧密的相关性，也具备一定的区分度。综上，本研究编制的维持性血液透析病人运动依从性量表具有良好的信效度。
3.3　编制的维持性血液透析病人运动依从性量表具有良好的实用性
目前，国外的运动依从性评估工具有运动依从性评定量表（EARS）[9]、运动训练康复依从性量表（RADMAT）[10]等，我国关于运动依从性的评估主要以自制问卷[11]为主。但以上量表均未显示出维持性血液透析病人的特异性，且侧重于运动依从性的实际结果，未能准确反映病人的依从过程。本研究依据理论模型将维持性血液透析病人的运动依从性过程分为能力、机会、动机3个维度，将维持性血液透析病人运动依从性结果分为运动类型、运动时间、运动频率、运动强度。将运动依从性过程与运动依从性结果相联系，过程是对结果的主观评估，结果是对过程的客观反映。本研究编制的量表弥补了普适性工具缺乏特异性的不足，同时结合行为改变相关理论在运动依从性过程和结果两个方面评价维持性血液透析病人的运动依从性，能帮助病人及医护人员制定更具有针对性的措施。
4　小结
收起
本研究基于COM-B及TDF模型编制的维持性血液透析病人运动依从性量表，其中过程分量表包括能力、机会、动机3个维度、35个条目，结果分量表为单维度共12个条目。量表基于行为改变相关理论，从对运动依从性过程及结果双重视角下探究运动依从性，经检验具有良好的信效度，能够作为评估维持性血液透析病人运动依从性的有效工具。本研究的样本来源于杭州市2所三级甲等医院，开展了多点调查减少了选择偏倚，但由于样本局限于杭州市，地区代表性仍需进一步提升。未来研究应通过多样本、多中心验证，以增强研究结果的广泛适用性。

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2026年第40卷第9期
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doi: 10.12102/j.issn.1009-6493.2026.09.015
  • 接收时间：2025-07-21
  • 首发时间：2026-10-28
  • 出版时间：2026-05-10
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  • 收稿日期：2025-07-21
  • 修回日期：2026-03-20
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    1杭州师范大学公共卫生与护理学院，浙江 311121
    2杭州师范大学附属医院

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朱雪娇，E-mail:
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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