Article(id=1240395007723631407, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412272, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734278400000, receivedDateStr=2024-12-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662815266, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662815266, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662815266, creator=13701087609, updateTime=1773662815266, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2545, endPage=2550, ext={EN=ArticleExt(id=1240395009082585906, articleId=1240395007723631407, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Development, reliability and validity testing of the screen exposure knowledge, attitude, and practice(KAP) questionnaire among child caregivers, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To develop a knowledge, attitude, and behavior questionnaire on screen use among caregivers of children and to test its reliability and validity.

Methods

Based on the theory of “Knowledge-Attitude-Practice”, the initial questionnaire was formed through literature analysis, research group discussion, two rounds of Delphi expert consultation and pre-investigation. Through convenient sampling, 270 main caregivers of children aged 2 to 12 in Heilongjiang Province were selected for questionnaire investigation. Item analysis of the data was conducted, and internal consistency coefficient was used to analyze the reliability of the questionnaire. Exploratory factor analysis and content validity were used to evaluate the validity of the questionnaire.

Results

The formal questionnaire consisted of 5 items on general information, 10 items on knowledge dimension, 7 items on attitude dimension, and 9 items on behavior dimension. The Item - Level Content Validity Index (I-CVI) ranged from 0.850 to 1.000. The Scale-Level Content Validity Index (S-CVI) was 0.808, and the Scale-Level Content Validity Index/Average (S-CVI/Ave) was 0.982. The factor loadings for all items were greater than 0.4, and the contribution rate of cumulative variance was 63.346%, indicating good validity. The Cronbach’s α coefficient of the questionnaire overall was 0.892, and the Cronbach’s α coefficient of the three dimensions ranged between 0.738 and 0.886, with good reliability.

Conclusion

The questionnaire has good reliability and validity, and can be used as an evaluation tool for the level of knowledge, attitude, and behavior of caregivers of children.

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目的

编制儿童照护者屏幕使用的知识、态度、行为问卷,并检验其信效度。

方法

以“知信行”理论为框架,通过文献分析、课题组讨论、2轮德尔菲专家函询和预调查形成初始问卷,通过方便抽样,选取黑龙江省270名2~12岁儿童的主要照护者进行问卷调查,对数据进行项目分析,采用内部一致性系数、对问卷的信度进行分析,应用探索性因素分析、内容效度等测评问卷的效度。

结果

正式问卷由一般资料5个条目、知识维度10个条目、态度维度7个条目、行为维度9个条目组成。条目水平的内容效度指数(Item-Level Content Validity Index, I-CVI)范围为0.850~1.000,量表水平的内容效度指数(Scale-Level Content Validity Index, S-CVI)=0.808,均值S-CVI(Scale-Level Content Validity Index/Average, S-CVI/Ave)=0.982;条目因子载荷均>0.4,累积方差贡献率为63.346%,效度良好。问卷整体的Cronbach α系数为0.892,3个维度的Cronbach α系数在0.738~0.886之间,信度良好。

结论

问卷具有良好的信度和效度,可作为儿童照护者屏幕使用的知识、态度、行为水平的评估工具。

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吴洪梅,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=oBHU90BSz2U/+TxpwC9NIg==, magXml=7d3MDTpz0vFRyB1hIP06eA==, pdfUrl=null, pdf=RJ4uH/rYTW4TSsD9sRTg5w==, pdfFileSize=862703, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=AlP2VwxhUphxmReUUqzqMw==, mapNumber=null, authorCompany=null, fund=null, authors=

张培(1998—),女,硕士在读,研究方向:儿童心理与精神卫生

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张培(1998—),女,硕士在读,研究方向:儿童心理与精神卫生

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(In Chinese), articleTitle=Development and psychometric evaluation of motivation questionnaire for intestinal stoma patients’ health promotion behaviors, refAbstract=null)], funds=[Fund(id=1240413540486541884, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, awardId=DSGB2024067, language=CN, fundingSource=大庆市哲学社会科学规划研究项目(DSGB2024067), fundOrder=null, country=null), Fund(id=1240413540599788096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, awardId=21YJAZH046, language=CN, fundingSource=教育部人文社会科学研究规划基金(21YJAZH046), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413532529946795, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, xref=1., ext=[AuthorCompanyExt(id=1240413532538335403, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, companyId=1240413532529946795, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Daqing Campus, Harbin Medical University, Daqing, Helongjiang 163000, China), AuthorCompanyExt(id=1240413532542529708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, companyId=1240413532529946795, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.哈尔滨医科大学大庆校区护理学院,黑龙江 大庆 163000)]), AuthorCompany(id=1240413532643193009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, xref=2., ext=[AuthorCompanyExt(id=1240413532651581618, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, companyId=1240413532643193009, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.浙江省肿瘤医院)])], figs=[ArticleFig(id=1240413539534434806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=EN, label=Table 1, caption=

General demographic characteristics(n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)
儿童年龄(岁)
2~698(36.30)
7~12172(63.70)
儿童性别
186(68.89)
84(31.11)
主要照护人
父亲5(1.85)
母亲72(26.67)
父母共同154(57.04)
祖(外)父母27(10.00)
保姆及其他12(4.44)
照护人年龄(岁)
≤309(3.33)
31~40136(50.37)
41~5081(30.00)
51~6021(7.78)
>6023(8.52)
照护人教育程度
初中及以下44(16.30)
高中/中专48(17.78)
大专51(18.89)
本科100(37.04)
硕士及以上27(10.00)
), ArticleFig(id=1240413539651875330, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=CN, label=表1, caption=

一般人口学特征(n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)
儿童年龄(岁)
2~698(36.30)
7~12172(63.70)
儿童性别
186(68.89)
84(31.11)
主要照护人
父亲5(1.85)
母亲72(26.67)
父母共同154(57.04)
祖(外)父母27(10.00)
保姆及其他12(4.44)
照护人年龄(岁)
≤309(3.33)
31~40136(50.37)
41~5081(30.00)
51~6021(7.78)
>6023(8.52)
照护人教育程度
初中及以下44(16.30)
高中/中专48(17.78)
大专51(18.89)
本科100(37.04)
硕士及以上27(10.00)
), ArticleFig(id=1240413539786093064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=EN, label=Table 2, caption=

Screen exposure of children(n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)
首次使用屏幕月龄(月)
≤1296(35.56)
13~1865(24.07)
19~36109(40.37)
常用屏幕类型
手机65(24.07)
平板电脑95(35.18)
电脑/电视100(37.04)
其他5(1.85)
日均屏幕时间(h)
≤1102(37.78)
>1~291(33.70)
>2~451(18.89)
>426(9.63)
屏幕内容
动画片153(56.67)
儿童益智类游戏视频99(36.67)
学校或补习班教育类内容106(39.26)
非儿童导向类内容54(20.00)
非教育类游戏12(4.44)
屏幕动机
希望孩子保持安静37(13.70)
安抚孩子情绪15(5.56)
满足儿童使用屏幕的要求55(20.37)
孩子表现好作为奖励137(50.74)
休息/约定80(29.63)
), ArticleFig(id=1240413539916116498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=CN, label=表2, caption=

儿童的屏幕暴露情况(n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数(%)
首次使用屏幕月龄(月)
≤1296(35.56)
13~1865(24.07)
19~36109(40.37)
常用屏幕类型
手机65(24.07)
平板电脑95(35.18)
电脑/电视100(37.04)
其他5(1.85)
日均屏幕时间(h)
≤1102(37.78)
>1~291(33.70)
>2~451(18.89)
>426(9.63)
屏幕内容
动画片153(56.67)
儿童益智类游戏视频99(36.67)
学校或补习班教育类内容106(39.26)
非儿童导向类内容54(20.00)
非教育类游戏12(4.44)
屏幕动机
希望孩子保持安静37(13.70)
安抚孩子情绪15(5.56)
满足儿童使用屏幕的要求55(20.37)
孩子表现好作为奖励137(50.74)
休息/约定80(29.63)
), ArticleFig(id=1240413540033557024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=EN, label=Table 3, caption=

Factor load of children’s screen exposure questionnaire (n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目因子1因子2因子3因子4因子5
知识维度
屏幕使用基本知识K1.您了解什么是屏幕暴露(基于电子屏幕的一系列活动,包括看电视、玩虚拟游戏、使用智能手机(平板)、上网等)?0.518
K2.您了解儿童每日使用屏幕的适宜时间(1岁儿童不建议有屏幕时间,5岁以下儿童<1h/d,6~12岁儿童<2h/d)?0.784
K3.您了解儿童每次使用屏幕的适宜时间(20~30min为宜)?0.730
K4.您了解儿童在使用屏幕时眼睛应与屏幕保持适当距离(如眼睛与手机保持30 cm左右,与电脑保持60cm左右,与电视保持1.5m以上等)?0.697
K5.您了解观看非儿童类、非教育类节目、大众娱乐类节目不利于儿童对事物的认识和理解?0.479
健康风险认知K6.您了解儿童过度使用屏幕会影响亲子关系,如减少与家人的沟通?0.725
K7.您了解儿童在吃饭时使用屏幕会增加消化系统疾病的风险,如消化不良?0.747
K8.您了解睡前使用屏幕会对儿童的睡眠产生影响?0.811
K9.您了解儿童过度使用屏幕(超过每日适宜时间)会影响身体成长和心理发育(如注意力等)?0.800
K10.您了解儿童过度使用屏幕将会诱发易怒、冲动、攻击等情绪行为问题?0.771
态度维度
屏幕管理态度A1.家长有必要筛选孩子观看屏幕的内容。0.757
A2.家长有必要限制孩子观看屏幕的时间。0.798
A3.家长有必要陪同孩子观看屏幕并与孩子交流观看内容。0.767
A4.让孩子养成良好的屏幕使用习惯越早越好。0.734
A5.有必要让孩子在观看屏幕时保持正确姿势。0.761
A6.您和家人在孩子面前使用屏幕会影响孩子。0.733
A7.限制孩子过度使用屏幕是正确的育儿行为。0.705
行为维度
积极行为介入P1.您会限制孩子观看屏幕的内容,如评估观看内容的年龄适宜性等。0.547
P2.规定孩子观看屏幕的时间。0.560
P3.您或家人会陪同孩子一起观看屏幕。0.786
P4.您或家人会与孩子交流观看屏幕的内容。0.799
P5.孩子看完屏幕,有窗台远眺保护视力的良好习惯。0.641
P6.孩子使用屏幕时,您会让孩子保持正确的姿势。0.686
放任式行为P7.孩子在家时,即使无人观看,电视机也处于打开状态。0.790
P8.您允许孩子在吃饭时使用屏幕。0.822
P9.您允许孩子在睡觉前使用屏幕。0.811
), ArticleFig(id=1240413540159386150, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395007723631407, language=CN, label=表3, caption=

儿童屏幕暴露问卷的因子载荷(n=270)

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目因子1因子2因子3因子4因子5
知识维度
屏幕使用基本知识K1.您了解什么是屏幕暴露(基于电子屏幕的一系列活动,包括看电视、玩虚拟游戏、使用智能手机(平板)、上网等)?0.518
K2.您了解儿童每日使用屏幕的适宜时间(1岁儿童不建议有屏幕时间,5岁以下儿童<1h/d,6~12岁儿童<2h/d)?0.784
K3.您了解儿童每次使用屏幕的适宜时间(20~30min为宜)?0.730
K4.您了解儿童在使用屏幕时眼睛应与屏幕保持适当距离(如眼睛与手机保持30 cm左右,与电脑保持60cm左右,与电视保持1.5m以上等)?0.697
K5.您了解观看非儿童类、非教育类节目、大众娱乐类节目不利于儿童对事物的认识和理解?0.479
健康风险认知K6.您了解儿童过度使用屏幕会影响亲子关系,如减少与家人的沟通?0.725
K7.您了解儿童在吃饭时使用屏幕会增加消化系统疾病的风险,如消化不良?0.747
K8.您了解睡前使用屏幕会对儿童的睡眠产生影响?0.811
K9.您了解儿童过度使用屏幕(超过每日适宜时间)会影响身体成长和心理发育(如注意力等)?0.800
K10.您了解儿童过度使用屏幕将会诱发易怒、冲动、攻击等情绪行为问题?0.771
态度维度
屏幕管理态度A1.家长有必要筛选孩子观看屏幕的内容。0.757
A2.家长有必要限制孩子观看屏幕的时间。0.798
A3.家长有必要陪同孩子观看屏幕并与孩子交流观看内容。0.767
A4.让孩子养成良好的屏幕使用习惯越早越好。0.734
A5.有必要让孩子在观看屏幕时保持正确姿势。0.761
A6.您和家人在孩子面前使用屏幕会影响孩子。0.733
A7.限制孩子过度使用屏幕是正确的育儿行为。0.705
行为维度
积极行为介入P1.您会限制孩子观看屏幕的内容,如评估观看内容的年龄适宜性等。0.547
P2.规定孩子观看屏幕的时间。0.560
P3.您或家人会陪同孩子一起观看屏幕。0.786
P4.您或家人会与孩子交流观看屏幕的内容。0.799
P5.孩子看完屏幕,有窗台远眺保护视力的良好习惯。0.641
P6.孩子使用屏幕时,您会让孩子保持正确的姿势。0.686
放任式行为P7.孩子在家时,即使无人观看,电视机也处于打开状态。0.790
P8.您允许孩子在吃饭时使用屏幕。0.822
P9.您允许孩子在睡觉前使用屏幕。0.811
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儿童照护者屏幕暴露知信行问卷的编制及信效度检验
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张培 1 , 吴晓雪 2 , 李杨 1 , 田羡 1 , 刁泓竹 1 , 徐小庆 1 , 肖玲蓉 1 , 吴洪梅 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(14): 2545-2550
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(14): 2545-2550
儿童照护者屏幕暴露知信行问卷的编制及信效度检验
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张培1, 吴晓雪2, 李杨1, 田羡1, 刁泓竹1, 徐小庆1, 肖玲蓉1, 吴洪梅1
作者信息
  • 1.哈尔滨医科大学大庆校区护理学院,黑龙江 大庆 163000
  • 2.浙江省肿瘤医院
  • 张培(1998—),女,硕士在读,研究方向:儿童心理与精神卫生

通讯作者:

吴洪梅,E-mail:
Development, reliability and validity testing of the screen exposure knowledge, attitude, and practice(KAP) questionnaire among child caregivers
Pei ZHANG1, Xiao-xue WU2, Yang LI1, Xian TIAN1, Hong-zhu DIAO1, Xiao-qing XU1, Ling-rong XIAO1, Hong-mei WU1
Affiliations
  • School of Nursing, Daqing Campus, Harbin Medical University, Daqing, Helongjiang 163000, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202412272
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目的

编制儿童照护者屏幕使用的知识、态度、行为问卷,并检验其信效度。

方法

以“知信行”理论为框架,通过文献分析、课题组讨论、2轮德尔菲专家函询和预调查形成初始问卷,通过方便抽样,选取黑龙江省270名2~12岁儿童的主要照护者进行问卷调查,对数据进行项目分析,采用内部一致性系数、对问卷的信度进行分析,应用探索性因素分析、内容效度等测评问卷的效度。

结果

正式问卷由一般资料5个条目、知识维度10个条目、态度维度7个条目、行为维度9个条目组成。条目水平的内容效度指数(Item-Level Content Validity Index, I-CVI)范围为0.850~1.000,量表水平的内容效度指数(Scale-Level Content Validity Index, S-CVI)=0.808,均值S-CVI(Scale-Level Content Validity Index/Average, S-CVI/Ave)=0.982;条目因子载荷均>0.4,累积方差贡献率为63.346%,效度良好。问卷整体的Cronbach α系数为0.892,3个维度的Cronbach α系数在0.738~0.886之间,信度良好。

结论

问卷具有良好的信度和效度,可作为儿童照护者屏幕使用的知识、态度、行为水平的评估工具。

屏幕暴露  /  问卷编制  /  知信行理论  /  儿童  /  信效度检验
Objective

To develop a knowledge, attitude, and behavior questionnaire on screen use among caregivers of children and to test its reliability and validity.

Methods

Based on the theory of “Knowledge-Attitude-Practice”, the initial questionnaire was formed through literature analysis, research group discussion, two rounds of Delphi expert consultation and pre-investigation. Through convenient sampling, 270 main caregivers of children aged 2 to 12 in Heilongjiang Province were selected for questionnaire investigation. Item analysis of the data was conducted, and internal consistency coefficient was used to analyze the reliability of the questionnaire. Exploratory factor analysis and content validity were used to evaluate the validity of the questionnaire.

Results

The formal questionnaire consisted of 5 items on general information, 10 items on knowledge dimension, 7 items on attitude dimension, and 9 items on behavior dimension. The Item - Level Content Validity Index (I-CVI) ranged from 0.850 to 1.000. The Scale-Level Content Validity Index (S-CVI) was 0.808, and the Scale-Level Content Validity Index/Average (S-CVI/Ave) was 0.982. The factor loadings for all items were greater than 0.4, and the contribution rate of cumulative variance was 63.346%, indicating good validity. The Cronbach’s α coefficient of the questionnaire overall was 0.892, and the Cronbach’s α coefficient of the three dimensions ranged between 0.738 and 0.886, with good reliability.

Conclusion

The questionnaire has good reliability and validity, and can be used as an evaluation tool for the level of knowledge, attitude, and behavior of caregivers of children.

Screen exposure  /  Questionnaire development  /  Knowledge-Attitude-Practice Model  /  Children  /  Reliability and validity test
张培, 吴晓雪, 李杨, 田羡, 刁泓竹, 徐小庆, 肖玲蓉, 吴洪梅. 儿童照护者屏幕暴露知信行问卷的编制及信效度检验. 现代预防医学, 2025 , 52 (14) : 2545 -2550 . DOI: 10.20043/j.cnki.MPM.202412272
Pei ZHANG, Xiao-xue WU, Yang LI, Xian TIAN, Hong-zhu DIAO, Xiao-qing XU, Ling-rong XIAO, Hong-mei WU. Development, reliability and validity testing of the screen exposure knowledge, attitude, and practice(KAP) questionnaire among child caregivers[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2545 -2550 . DOI: 10.20043/j.cnki.MPM.202412272
随着数字化时代的发展,儿童在婴儿时期已开始接触电子屏幕设备[1]。美国儿科学会(American Academy of Pediatrics, APP)建议,2~5岁儿童屏幕时间应<1h/d,5岁以上的儿童屏幕时间1~2 h/d为宜[2]。然而,研究显示,37.7%的学龄前儿童和46.4%的6~14岁儿童的日均屏幕时间已显著超出推荐标准[3]。过度屏幕暴露对儿童健康的影响主要涉及在生理、心理及社会方面。在生理方面,长时间近距离注视屏幕导致视觉系统损伤,包括数字眼疲劳、干眼症及近视进展[4];屏幕蓝光抑制褪黑素分泌,降低睡眠质量与时长[5];同时,屏幕使用过度与儿童肥胖风险正相关,主要源于久坐行为增加及体力活动减少[6]。心理方面的影响主要表现为注意力不集中、抑制控制能力下降[7]、焦虑抑郁风险增加[8],以及大脑白质发育受阻,延缓语言发展[9]。对儿童社会功能方面的影响主要表现是长期接触不良媒体内容增加攻击性行为发生率[10],此外,面对面互动减少致使儿童社交技能发展受限,同伴关系质量下降[11]
目前,儿童屏幕暴露的评估工具主要有数字屏幕暴露问卷(Digital-Screen Exposure Questionnaire, DSEQ)用于评估儿童日常屏幕使用频率及环境因素,七分之七屏幕暴露问卷(Seven-in-Seven Screen Exposure Questionnaire)是一种专门用于学龄前儿童的工具,用于评估屏幕暴露问题性[12],SCREENS-Q关注屏幕媒体使用习惯及其影响[13]和儿童睡眠习惯问卷(Children’s Sleep Habits Questionnaire, CSHQ)侧重评估屏幕使用对认知和社交发展的影响[14]。这些工具虽为屏幕暴露研究提供了方法学基础,但主要局限于评估儿童个体的屏幕使用行为,较少关注照护者的影响。研究表明,儿童照护者因工作繁忙、屏幕素养不足等原因,往往难以有效管理儿童的屏幕使用,导致儿童接触屏幕时间远超适宜水平[15]。虽有研究指出家庭环境会影响儿童的屏幕使用模式,但缺乏专门评估照护者屏幕使用知信行水平的标准化工具。
知信行理论模式(Knowledge-Attitude-Practice Model, KAP)作为解释个人知识和信念如何影响健康行为的经典模型[16],为研究照顾者对儿童屏幕使用的影响提供了理论框架。因此,基于上述研究现状,本研究拟以KAP理论为基础编制儿童主要照护者屏幕暴露知信行问卷,整合家庭环境因素用于系统评估照护者在儿童屏幕使用管理中的知识、态度和行为,为制定针对性干预策略提供评估工具。本研究将有助于提升照护者的屏幕素养,为制定儿童屏幕使用的健康教育策略提供科学依据,帮助儿童形成良好的屏幕使用习惯,促进儿童的健康成长。
于2022年10月—2022年12月,通过方便抽样,在黑龙江省线上招募2~12岁儿童的主要照顾者作为研究对象,对问卷进行信、效度检验。根据纳入标准:①为儿童的主要照护者(每周照护时间≥28小时);②具有初中及以上文化程度;③知情同意参与研究。排除标准:①儿童患有严重疾病;②照护者存在认知障碍。正式调查的样本量应为量表条目数量的5~10倍[17],同时考虑10%的失访率,本研究选取290名适龄儿童的主要照顾者进行问卷调查。本研究已通过哈尔滨医科大学伦理审查委员会的伦理批准(伦理审批号:HMUDQ20250309002),研究对象均自愿签署知情同意书。
在中国知网、万方、PubMed、Web of Science等数据库中进行系统检索,中文检索词包括 “儿童、照护者、父母、屏幕暴露、屏幕使用、知信行、知识、态度、行为” ;英文检索词包括“Children、Caregivers 、Parents 、Screen Exposure、Screen Use、Knowledge、Attitude、Practice”,采用主题词与自由词相结合的检索策略,使用布尔逻辑运算符“AND”和“OR”构建检索式。检索时间为建库至2022年7月,共检索221篇文献。文献的筛选标准如下:纳入标准:①研究对象为18岁以下儿童及其照护者;②研究内容涉及儿童屏幕暴露的评估或干预;③发表语言为中文或英文;④研究类型为原创性研究。排除标准:①重复发表文献;②综述类文献。经过标题筛查、摘要阅读和全文评估,最终纳入59篇文献。基于KAP理论框架,由2名研究者对纳入的文献进行分析,独立提取文献中的相关条目。从知识、态度、行为3个方面围绕儿童屏幕使用的相关知识、家长对儿童屏幕使用的信念、态度及行为等方面构建问卷条目池。
基于条目池,经课题组充分讨论形成初始问卷。问卷包含两个部分内容,第一部分为儿童屏幕暴露基本情况调查,包括儿童首次使用屏幕月龄、屏幕类型、日均屏幕时间、屏幕内容及屏幕动机共5个条目;第二部分为儿童照护者屏幕暴露知信行评估,包括知识、态度和行为3个维度,共24个条目。其中知识维度(8个条目)包括屏幕使用指南认知、健康影响认识等;态度维度(8个条目)包括对儿童屏幕使用的观念、管理意愿等;行为维度(8个条目)主要包括照护者对屏幕使用的具体管理策略和监督方式等。
采用德尔菲法(Delphi Method)进行专家函询。采用目的抽样方法选择专家,专家纳入标准:①副高级及以上职称;②从事护理学、儿科学、心理学及精神医学等相关专业工作;③工作经验5年及以上;④具有问卷编制经验:⑤自愿参加本研究。最终确定15名专家。采用本研究编制的初始问卷进行专家函询,函询问卷包括问卷填写说明、专家基本情况调查表、专家判断依据及熟悉程度评估表等,条目重要性采用Likert 5级评分法,条目相关性采用Likert 4级评分法。本研究共进行两轮专家函询,每轮函询间隔2周。函询问卷以纸质版问卷或邮件的形式发送给各位专家,第一轮专家函询后,对专家意见进行整理和总结,经课题组讨论后,对部分条目进行删改,修改后的量表条目被整理形成第二版专家函询问卷再次发送给专家,进一步结合专家建议,对条目进行增减及修改,直至专家建议达成一致。采用专家的权威系数(Cr)、专家意见协调程度判断专家函询结果的准确性,一般认为Cr>0.7时函询结果准确性良好[18]。条目筛选的标准是保留重要性赋值均数≥4.0分且变异系数≤0.25的条目[19],此外结合专家修改建议,对条目的表述进行优化,形成儿童屏幕暴露问卷(预试问卷)。
为确保问卷质量,在正式调查之前进行了预调查。采用目的抽样法,于2022年9月在黑龙江省通过线上招募适龄儿童的主要照护者。照护者纳排标准同前,最终纳入100名儿童主要照护者。采用儿童屏幕暴露问卷(预试问卷)对其进行预调查,进行可读性评估。课题组根据预调查结果对问卷进行以下优化:调整措辞不当或理解困难的条目;优化条目顺序,确保逻辑性;完善填答说明等,形成问卷正式版。
通过问卷星平台,发放儿童照护者屏幕暴露问卷(正式版),设置IP地址限制,防止重复填答,设置必答项提醒防止漏填。问卷采用Likert 5级评分法,行为维度条目7、8、9采用反向计分。问卷得分越高,说明照顾者对儿童屏幕使用的知识越了解、态度越好,对儿童屏幕使用的管理行为越适当。问卷收回后,双人核对并剔除规律作答、填写信息不真实等无效问卷。
本研究使用描述性分析对专家函询结果和问卷数据调查结果进行统计,采用频数和百分比描述计数资料,对于符合正态分布的计量资料采用均数±标准差表示、采用t检验或方差分析进行数据分析。检验水准α=0.05。本研究使用Excel 2021和SPSS 26.0软件进行数据的录入和分析。
综合经典测验理论下的4种条目筛选方法[20],条目拟删除标准:①相关系数法:各条目与问卷总分之间的相关系数<0.3,各条目与本维度得分的相关系数<0.4;②因子分析法:因子载荷值<0.4,公因子包含条目数<3;③Cronbach α系数法:去除某一条目后Cronbach α系数增加;④区分度:高分组(前27%)和低分组(后27%)进行独立样本t检验,各条目得分差异无统计学意义。若条目满足4种筛选方法中的任意3种,即可考虑删除[21]
据专家对问卷条目重要性等评分,采用内容效度指数(Content validity index,CVI)对内容效度进行评价。内容效度主要用于测量问卷实测内容与所测内容间的吻合度,CVI是应用最广泛的指标[20]。按照条目与主题关联程度采用1~4级评分法,1=不相关,4=非常相关,计算评分为3或4的专家概率,得到相应的内容效度。一般认为应达到,条目水平的内容效度指数(Item-Level Content Validity Index, I-CVI)>0.78,量表水平的内容效度指数(Scale-Level Content Validity Index, S-CVI)>0.80,均值S-CVI(Scale-Level Content Validity Index/Average, S-CVI/Ave)>0.9[22]
探索性因子分析(Exploratory factor analysis, EFA)是使用最为广泛的结构效度测量方法,主成分分析法是EFA中常用的提取因子的方法。抽样适合性检验(Kaiser-Meyer-Olkin, KMO检验)和巴特莱特球性检验用于检验是否适合进行主成分分析,EFA中,KMO值>0.7适合进行因子分析[23],某条目在其中一个因子上载荷值>0.4,而在其他因子上载荷值较低,保留条目;某条目同时在两个或多个因子上载荷值>0.4,且差值<0.2,考虑删除;本研究采取内容效度和EFA进行效度检验。
Cronbach α系数是目前最常用的检验问卷信度的指标,取值在0~1之间,一般认为Cronbach α系数>0.7,则问卷的内部一致性较好[19]
本研究邀请了15位专家进行德尔菲函询,两次函询时间间隔10~14天,响应函询的有13位专家。儿童神经发育障碍领域医生4人,心理专业医生2人,护理学专业教师6人;其中副教授(副高级)职称6人,教授(正高级)职称7人;5~10年工作经验4人,11~20年工作经验9人。
本研究中,2轮专家函询有效回收率分别为86.667%、100%;专家的权威系数由专家对问题的判断依据和专家对问题的熟悉程度两个因素决定,本研究中,专家权威系数为0.960;专家的协调程度通常用变异系数和肯德尔和谐系数表示,本研究变异系数<0.25,两轮肯德尔和谐系数分别为0.231和0.313。
经过2轮专家咨询,共删除1个条目,“孩子使用屏幕时会接触到不良信息”。修改1个条目,将“您了解观看非儿童类……影响儿童认知”修改为“您了解观看非儿童类……不利于儿童对事物的认识和理解”;新增包括“您了解儿童每次使用屏幕的适宜时间(20~30 min为宜)”“您了解儿童在使用屏幕时眼睛应与屏幕保持适当距离(如眼睛与手机保持30 cm左右,与电脑保持60 cm左右,与电视保持1.5 m以上等)”“您了解儿童过度使用屏幕会对视力产生不利影响”“孩子看完屏幕,有窗台远眺保护视力的良好习惯”“孩子使用屏幕时,您会让孩子保持正确的姿势”在内的5个条目,最终形成包含3个维度28个条目的初始问卷。
共向儿童照顾者发放问卷100份,回收问卷100份,有效回收率为100%。预调查结果显示,照顾者认为问卷条目无难以理解、意思不清楚的语句,因此,问卷条目无需修改、增加或删除。
采用问卷星线上发放290份问卷进行调查,回收有效问卷270份,有效回收率93%。270名儿童照顾者中多数年龄在31~40岁(50.370%),各年龄段儿童占比均衡,样本具有代表性,具体见表1。儿童的屏幕暴露情况见表2
根据相关系数法,条目5、25、26和27与问卷总分之间的相关系数<0.3,条目5、25和26与本维度得分的相关系数<0.4,予以删除;根据因子分析法,条目5和25因子载荷值<0.4予以删除;根据Cronbach α系数法,去除条目5、24和25后Cronbach α系数增加;根据高分组(前27%)和低分组(后27%)进行独立样本t检验,条目25、26得分差异无统计学意义,予以删除。经条目筛选办法选中,并结合课题组讨论,共删除条目5和25共2个条目,形成正式问卷。
本研究中,I-CVI的范围为0.850~1.000,S-CVI=0.808,S-CVI/Ave=0.982。该问卷内容效度指标均符合要求,无需删除条目。
本研究中KMO值为0.862、巴特莱特球性检验(χ2=3768.011,P<0.01),表明适合做因子分析。利用主成分分析法,提取特征值大于1的因子,采用最大方差法进行旋转,累积方差贡献率为63.346%,条目的因子载荷均>0.4,共提取出5个因子,各维度提取的公因子个数分别为知识维度2个、态度维度1个、行为维度2个,各维度的累积方差贡献率范围为58.216%~65.826%。其中K1~K5属于因子4,命名为“屏幕使用基本知识”,体现儿童照护者对屏幕使用时间、距离等基本知识的了解程度;K6~K10属于因子2,命名为“健康风险认知”,反映照护者对屏幕暴露导致儿童情绪行为等问题的认知水平;A1~A7属于因子1,命名为“屏幕管理态度”,反映照护者在儿童屏幕使用内容、时间、姿势等方面的态度,体现其在儿童屏幕暴露管理中的责任感;P1~P6属于因子3,命名为“积极行为介入”,体现照护者对儿童屏幕使用的积极管理行为;P7~P9属于因子5,命名为“放任式行为”,反映照护者对儿童屏幕使用的放任行为。如表3所示。
本研究中的Cronbach α系数,整体问卷为0.892,知识、态度、行为维度分别为0.886、0.884、0.738。问卷整体及各维度的信度良好。
问卷以KAP理论为框架,通过查阅相关指南和文献、课题组讨论、德尔菲专家函询筛选条目,充分保证了问卷条目的科学性及内容的适切性。通过预试验,采用经典测验理论下的4种条目筛选方法(相关系数法、因子分析法、Cronbach α系数法、区分度)初步筛选条目,保证了条目的敏感性。此外,还通过内容效度和EFA来确保问卷结构的有效性和科学性。
本研究2轮专家函询后,S-CVI和I-CVI均>0.8且S-CVI/Ave>0.9,可见问卷的内容效度较好。如果累积方差贡献率>40%,则证明问卷效度良好[24],在本研究中累积方差贡献率>60%,各维度的累积方差贡献率>50%,说明问卷的结构效度好。本研究问卷整体的Cronbach α系数>0.8,说明该问卷具有较好的信度。
通过本问卷了解儿童屏幕暴露的情况以及照顾者对儿童屏幕使用的知识、态度和行为状况,对于制定科学有效的儿童屏幕使用干预措施具有重要意义。本研究初步编制了儿童照护者屏幕暴露问卷,符合问卷编制的过程及要求,问卷信效度良好,可作为调查照顾者对儿童屏幕使用的知识、态度、行为水平的评估工具。未来需要进一步扩大样本量,以验证该问卷的可靠性和有效性。此外,还可以根据不同年龄段、不同文化背景和不同地区的儿童和照顾者的特点,对问卷进行进一步的修订和改进,使其更加符合实际需要,更加适用于不同的研究场景。
本研究编制的儿童照护者屏幕暴露知信行问卷信效度良好,可作为照护者对儿童屏幕使用的知识、态度及行为状况的评估工具。本研究也存在一些不足之处,首先本研究采用的是方便抽样法,在研究对象的选择上可能存在一定偏倚,致使问卷的普适性有待进一步验证。其次,问卷主要关注了儿童屏幕使用不当带来的影响,对恰当使用屏幕的益处有待进一步挖掘。今后的研究应在不同地域开展,通过扩大样本量来进一步完善问卷信效度。
  • 大庆市哲学社会科学规划研究项目(DSGB2024067)
  • 教育部人文社会科学研究规划基金(21YJAZH046)
参考文献 引证文献
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2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202412272
  • 接收时间:2024-12-16
  • 首发时间:2026-03-16
  • 出版时间:2025-07-25
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  • 收稿日期:2024-12-16
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大庆市哲学社会科学规划研究项目(DSGB2024067)
教育部人文社会科学研究规划基金(21YJAZH046)
作者信息
    1.哈尔滨医科大学大庆校区护理学院,黑龙江 大庆 163000
    2.浙江省肿瘤医院

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
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
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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