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Article(id=1241522924142777006, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308086, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1691251200000, receivedDateStr=2023-08-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731496, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731496, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731496, creator=13701087609, updateTime=1773931731496, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=865, endPage=870, ext={EN=ArticleExt(id=1241522924499292853, articleId=1241522924142777006, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Development and evaluation of influenza vaccine hesitation scale for people aged 60 and above, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To develop the influenza vaccine hesitation scale for the elderly aged 60 and above and evaluate its applicability.

Methods

Based on the Chinese version of the parents’ hesitation scale for children’s influenza vaccination, combined with the characteristics of the elderly population, the influenza vaccine hesitation scale for the elderly aged 60 and above was developed, and the reliability and validity of the scale were evaluated.

Results

The scale finally included 3 dimensions and 14 items, the score of the total scale was 32.82 ±7.99, and the correlation coefficient between each item and the score of the total scale was between 0.20 and 0.87 (all P < 0.05). Exploratory factor analysis showed that the Kaiser-Meyer-Olkin （KMO） value of the scale was 0.916 (χ2approximation = 14 315.26, P<0.05). Confirmatory factor analysis showed that the cumulative variance contribution rate of 14 common factors was 80.6%, GFI=0.909, IFI=0.961, TLI=0.952, and CFI=0.961,indicating that the overall fitness and structural validity of the model were good. Taking whether the elderly were vaccinated with influenza vaccine or not in the influenza season in 2022, the total vaccine hesitation score and the scores of “confidences”,“risk” and “support” were significantly correlated with the school standard (all P < 0.05). The Cronbach’s α coefficient of the scale was 0.859, indicating that the internal consistency reliability of the scale was high.

Conclusion

The influenza vaccine hesitation scale for the elderly developed in this study is good in reliability, validity and applicable stability, which can be used to evaluate the hesitation level of influenza vaccine in people aged 60 and above.

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目的

开发60岁及以上老年人流感疫苗犹豫量表，并评估其适用性。

方法

基于中文版家长针对儿童接种流感疫苗的犹豫量表，结合老年人群特征，开发60岁及以上老年人流感疫苗犹豫量表，并通过现场实测评估量表的信度效度。

结果

本量表最终确定3个维度和14个条目，总量表得分（32.82±7.99）分，各条目与总量表得分之间的相关系数在0.20～0.87之间（均P<0.05）。探索性因子分析显示，量表的KMO值为0.916，Bartlett球形检验有统计学意义（χ2近似值=14 315.26，P<0.05）；验证性因子分析显示，14个条目的因子荷载均>0.60，3个公因子累计方差贡献率为80.6%，GFI=0.909、IFI=0.961、TLI=0.952和CFI=0.961，表明模型整体适配度和结构效度较好。以2022年度老年人流感季是否接种流感疫苗作为效标，量表的总疫苗犹豫得分以及“信心”“风险”“支持”各维度得分与校标均有显著性关联（均P<0.05）。量表的Cronbach α系数为0.859，表明量表的内部一致性信度较高。

结论

本研究开发的老年人流感疫苗犹豫量表在信度、效度及适用稳定性上均较好，可用于评估60岁及以上老年人流感疫苗犹豫水平。

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孟晓军，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=NwnsfuneeXKlY34cmh2kzQ==, magXml=HoyPv1/4+ZZrXJIU8UhQbQ==, pdfUrl=null, pdf=pBdrxb/JkqjODlnX0Wc/Wg==, pdfFileSize=722433, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=LPYDx5ph+MpQKYNwE86gIA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=b6g8dKqplJIj9F+N3DS1Fg==, mapNumber=null, authorCompany=null, fund=null, authors=

张克兴与周玉静为共同第一作者

张克兴（1991—），男，硕士，主管医师，研究方向：免疫规划；

周玉静（1993—），女，硕士，主管医师，研究方向：免疫规划；

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张克兴（1991—），男，硕士，主管医师，研究方向：免疫规划；

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周玉静（1993—），女，硕士，主管医师，研究方向：免疫规划；

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Chinese Journal of Public Health, 2019, 35(3): 313-316., articleTitle=Confirmatory factor analysis on an infectious disease-specific health literacy scale for Chinese residents, refAbstract=null)], funds=[Fund(id=1241678331087745833, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, awardId=FZXK2021010, language=CN, fundingSource=无锡市发展学科建设项目(FZXK2021010), fundOrder=null, country=null), Fund(id=1241678331448455983, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, awardId=BJ2023097, language=CN, fundingSource=无锡市卫生健康委中青年拔尖人才项目(BJ2023097), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241678288943378793, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, xref=1., ext=[AuthorCompanyExt(id=1241678288951767404, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678288943378793, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Wuxi Xinwu District Center for Disease Control and Prevention, Wuxi, Jiangsu 214002, China), AuthorCompanyExt(id=1241678288955961708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678288943378793, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.无锡市新吴区疾病预防控制中心，江苏 无锡 214002)]), AuthorCompany(id=1241678289253757302, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, xref=2., ext=[AuthorCompanyExt(id=1241678289278923126, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678289253757302, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.江阴市疾病预防控制中心，江苏 江阴 214434)]), AuthorCompany(id=1241678289849348476, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, xref=3., ext=[AuthorCompanyExt(id=1241678289857737085, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678289849348476, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.无锡市梁溪区疾病预防控制中心)]), AuthorCompany(id=1241678290340082053, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, xref=4., ext=[AuthorCompanyExt(id=1241678290356859272, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678290340082053, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.无锡市疾病预防控制中心（南京医科大学附属无锡疾病预防控制中心），江苏 无锡 214023)]), AuthorCompany(id=1241678292357542290, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, xref=5., ext=[AuthorCompanyExt(id=1241678292365930899, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, companyId=1241678292357542290, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.无锡市滨湖区疾病预防控制中心)])], figs=[ArticleFig(id=1241678324959867617, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=EN, label=Figure 1, caption=Structural equation model for confirmatory factor analysis (standardized), figureFileSmall=rK6vvk8yr1xz80s/ff0wTw==, figureFileBig=VqVR9tSlYObn/xsw1aXmvw==, tableContent=null), ArticleFig(id=1241678325337354980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=CN, label=图1, caption=验证性因子分析的结构方程模型（标准化）, figureFileSmall=rK6vvk8yr1xz80s/ff0wTw==, figureFileBig=VqVR9tSlYObn/xsw1aXmvw==, tableContent=null), ArticleFig(id=1241678326293656305, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=EN, label=Table 1, caption=

Influenza vaccine hesitancy scale for people aged 60 years and over

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目
信心C1接种流感疫苗对我的健康很重要
C2接种流感疫苗是保护我不得流感及其并发症的好办法
C3流感疫苗是有效的
C4我接种流感疫苗对我身边其他人的健康也很重要
C5医疗卫生机构提供的流感疫苗对我有益
C6我所了解到的关于流感疫苗的信息是可靠可信的
C7关于是否要接种流感疫苗，我听从医务人员的建议
风险R8我担心接种流感疫苗可能会导致我得流感
R9我担心接种流感疫苗会产生严重的副作用
R10我担心接种流感疫苗可能会对我的长期健康产生影响
R11我认为自身感染流感的风险不高
支持S12我的家人支持我接种流感疫苗
S13我能够承担接种流感疫苗的费用
S14我去接种点接种流感疫苗很方便
), ArticleFig(id=1241678327019270898, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=CN, label=表1, caption=

60岁及以上老年人流感疫苗犹豫量表

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目
信心C1接种流感疫苗对我的健康很重要
C2接种流感疫苗是保护我不得流感及其并发症的好办法
C3流感疫苗是有效的
C4我接种流感疫苗对我身边其他人的健康也很重要
C5医疗卫生机构提供的流感疫苗对我有益
C6我所了解到的关于流感疫苗的信息是可靠可信的
C7关于是否要接种流感疫苗，我听从医务人员的建议
风险R8我担心接种流感疫苗可能会导致我得流感
R9我担心接种流感疫苗会产生严重的副作用
R10我担心接种流感疫苗可能会对我的长期健康产生影响
R11我认为自身感染流感的风险不高
支持S12我的家人支持我接种流感疫苗
S13我能够承担接种流感疫苗的费用
S14我去接种点接种流感疫苗很方便
), ArticleFig(id=1241678327686165238, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=EN, label=Table 2, caption=

Pearson correlation analysis of the scores of each dimension and of each item with total scale scores

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分相关性
最小值最大值均值±标准差偏度偏度标准误峰度峰度标准误rP值
总量表147032.82±7.990.220.060.810.11
维度
信心73514.42±5.761.070.062.190.110.87<0.05
风险42011.88±3.760.170.06-0.090.110.36<0.05
支持3156.51±2.320.870.061.880.110.71<0.05
条目
C1152.09±0.931.020.061.320.110.80<0.05
C2152.07±0.911.000.061.390.110.82<0.05
C3152.08±0.900.970.061.430.110.81<0.05
C4152.07±0.890.990.061.490.110.82<0.05
C5152.03±0.861.110.062.030.110.83<0.05
C6152.01±0.851.140.062.220.110.81<0.05
C7152.07±0.951.210.061.660.110.70<0.05
R8152.90±1.160.150.06-0.800.110.25<0.05
R9152.92±1.080.090.06-0.590.110.38<0.05
R10152.85±1.090.200.06-0.650.110.39<0.05
R11153.21±1.07-0.220.06-0.560.110.20<0.05
S12152.16±0.860.950.061.370.110.66<0.05
S13152.22±0.921.080.061.270.110.59<0.05
S14152.14±0.911.170.061.600.110.58<0.05
), ArticleFig(id=1241678328281756415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=CN, label=表2, caption=

各维度和各条目得分及其与总量表得分的Pearson相关分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分相关性
最小值最大值均值±标准差偏度偏度标准误峰度峰度标准误rP值
总量表147032.82±7.990.220.060.810.11
维度
信心73514.42±5.761.070.062.190.110.87<0.05
风险42011.88±3.760.170.06-0.090.110.36<0.05
支持3156.51±2.320.870.061.880.110.71<0.05
条目
C1152.09±0.931.020.061.320.110.80<0.05
C2152.07±0.911.000.061.390.110.82<0.05
C3152.08±0.900.970.061.430.110.81<0.05
C4152.07±0.890.990.061.490.110.82<0.05
C5152.03±0.861.110.062.030.110.83<0.05
C6152.01±0.851.140.062.220.110.81<0.05
C7152.07±0.951.210.061.660.110.70<0.05
R8152.90±1.160.150.06-0.800.110.25<0.05
R9152.92±1.080.090.06-0.590.110.38<0.05
R10152.85±1.090.200.06-0.650.110.39<0.05
R11153.21±1.07-0.220.06-0.560.110.20<0.05
S12152.16±0.860.950.061.370.110.66<0.05
S13152.22±0.921.080.061.270.110.59<0.05
S14152.14±0.911.170.061.600.110.58<0.05
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Exploratory factor analysis of influenza vaccine hesitancy scale in elderly people aged 60 years and over

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条目荷载特征根方差贡献率
（%）		累计方差贡献率（%）
信心6.14443.88943.889
C10.901———
C20.915———
C30.912———
C40.907———
C50.920———
C60.900———
C70.810———
风险2.93920.99664.885
R80.828———
R90.931———
R100.928———
R110.712———
支持2.20515.75380.638
S120.659———
S130.790———
S140.819———
), ArticleFig(id=1241678329217086220, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=CN, label=表3, caption=

60岁以上老年人流感疫苗犹豫量表探索性因子分析

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条目荷载特征根方差贡献率
（%）		累计方差贡献率（%）
信心6.14443.88943.889
C10.901———
C20.915———
C30.912———
C40.907———
C50.920———
C60.900———
C70.810———
风险2.93920.99664.885
R80.828———
R90.931———
R100.928———
R110.712———
支持2.20515.75380.638
S120.659———
S130.790———
S140.819———
), ArticleFig(id=1241678329842037522, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=EN, label=Table 4, caption=

Results of fitness test of the overall model of influenza vaccine hesitation scale for elderly people aged 60 years and over

, figureFileSmall=null, figureFileBig=null, tableContent=
统计检验量适配的标准或临界值模型检验结果
χ2P>0.05P<0.05
χ2/v<2（良好），<3（普通），<5（可以接受）8.268
RMSEA<0.08（<0.05优良，<0.08良好）0.087
GFI>0.90.909
AGFI>0.90.871
IFI>0.90.961
TLI>0.90.952
CFI>0.90.961
), ArticleFig(id=1241678330332771100, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924142777006, language=CN, label=表4, caption=

60岁以上老年人流感疫苗犹豫量表整体模型适配度检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
统计检验量适配的标准或临界值模型检验结果
χ2P>0.05P<0.05
χ2/v<2（良好），<3（普通），<5（可以接受）8.268
RMSEA<0.08（<0.05优良，<0.08良好）0.087
GFI>0.90.909
AGFI>0.90.871
IFI>0.90.961
TLI>0.90.952
CFI>0.90.961
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60岁及以上老年人流感疫苗犹豫量表编制与评估
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张克兴 1 , 周玉静 2 , 毛雯倩 1 , 邱凌晨 3 , 朱悦 4 , 刘宏 5 , 朱嘉文 4 , 沈元 4 , 孟晓军 4
现代预防医学 | 基层卫生服务 2024,51(5): 865-870
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现代预防医学 | 基层卫生服务 2024, 51(5): 865-870
60岁及以上老年人流感疫苗犹豫量表编制与评估
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张克兴1, 周玉静2, 毛雯倩1, 邱凌晨3, 朱悦4, 刘宏5, 朱嘉文4, 沈元4, 孟晓军4
作者信息
  • 1.无锡市新吴区疾病预防控制中心，江苏 无锡 214002
  • 2.江阴市疾病预防控制中心，江苏 江阴 214434
  • 3.无锡市梁溪区疾病预防控制中心
  • 4.无锡市疾病预防控制中心（南京医科大学附属无锡疾病预防控制中心），江苏 无锡 214023
  • 5.无锡市滨湖区疾病预防控制中心

    • 张克兴（1991—），男，硕士，主管医师，研究方向：免疫规划；

    周玉静（1993—），女，硕士，主管医师，研究方向：免疫规划；

通讯作者:

孟晓军，E-mail:
Development and evaluation of influenza vaccine hesitation scale for people aged 60 and above
Ke-xing ZHANG1, Yu-jing ZHOU2, Wen-qian MAO1, Ling-chen QIU3, Yue ZHU4, Hong LIU5, Jia-wen ZHU4, Yuan SHEN4, Xiao-jun MENG4
Affiliations
  • Wuxi Xinwu District Center for Disease Control and Prevention, Wuxi, Jiangsu 214002, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202308086
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摘要
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目的

开发60岁及以上老年人流感疫苗犹豫量表，并评估其适用性。

方法

基于中文版家长针对儿童接种流感疫苗的犹豫量表，结合老年人群特征，开发60岁及以上老年人流感疫苗犹豫量表，并通过现场实测评估量表的信度效度。

结果

本量表最终确定3个维度和14个条目，总量表得分（32.82±7.99）分，各条目与总量表得分之间的相关系数在0.20～0.87之间（均P<0.05）。探索性因子分析显示，量表的KMO值为0.916，Bartlett球形检验有统计学意义（χ2近似值=14 315.26，P<0.05）；验证性因子分析显示，14个条目的因子荷载均>0.60，3个公因子累计方差贡献率为80.6%，GFI=0.909、IFI=0.961、TLI=0.952和CFI=0.961，表明模型整体适配度和结构效度较好。以2022年度老年人流感季是否接种流感疫苗作为效标，量表的总疫苗犹豫得分以及“信心”“风险”“支持”各维度得分与校标均有显著性关联（均P<0.05）。量表的Cronbach α系数为0.859，表明量表的内部一致性信度较高。

结论

本研究开发的老年人流感疫苗犹豫量表在信度、效度及适用稳定性上均较好，可用于评估60岁及以上老年人流感疫苗犹豫水平。

老年人  /  疫苗犹豫  /  量表  /  评估
Objective

To develop the influenza vaccine hesitation scale for the elderly aged 60 and above and evaluate its applicability.

Methods

Based on the Chinese version of the parents’ hesitation scale for children’s influenza vaccination, combined with the characteristics of the elderly population, the influenza vaccine hesitation scale for the elderly aged 60 and above was developed, and the reliability and validity of the scale were evaluated.

Results

The scale finally included 3 dimensions and 14 items, the score of the total scale was 32.82 ±7.99, and the correlation coefficient between each item and the score of the total scale was between 0.20 and 0.87 (all P < 0.05). Exploratory factor analysis showed that the Kaiser-Meyer-Olkin （KMO） value of the scale was 0.916 (χ2approximation = 14 315.26, P<0.05). Confirmatory factor analysis showed that the cumulative variance contribution rate of 14 common factors was 80.6%, GFI=0.909, IFI=0.961, TLI=0.952, and CFI=0.961,indicating that the overall fitness and structural validity of the model were good. Taking whether the elderly were vaccinated with influenza vaccine or not in the influenza season in 2022, the total vaccine hesitation score and the scores of “confidences”,“risk” and “support” were significantly correlated with the school standard (all P < 0.05). The Cronbach’s α coefficient of the scale was 0.859, indicating that the internal consistency reliability of the scale was high.

Conclusion

The influenza vaccine hesitation scale for the elderly developed in this study is good in reliability, validity and applicable stability, which can be used to evaluate the hesitation level of influenza vaccine in people aged 60 and above.

Elderly  /  Vaccine hesitation  /  Scale  /  Evaluation
张克兴, 周玉静, 毛雯倩, 邱凌晨, 朱悦, 刘宏, 朱嘉文, 沈元, 孟晓军. 60岁及以上老年人流感疫苗犹豫量表编制与评估. 现代预防医学, 2024 , 51 (5) : 865 -870 . DOI: 10.20043/j.cnki.MPM.202308086
Ke-xing ZHANG, Yu-jing ZHOU, Wen-qian MAO, Ling-chen QIU, Yue ZHU, Hong LIU, Jia-wen ZHU, Yuan SHEN, Xiao-jun MENG. Development and evaluation of influenza vaccine hesitation scale for people aged 60 and above[J]. Modern Preventive Medicine, 2024 , 51 (5) : 865 -870 . DOI: 10.20043/j.cnki.MPM.202308086
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流感是由流感病毒引起的一种急性呼吸道传染病，人群普遍易感，但孕妇、儿童、老年人、慢性基础性疾病患者等高危人群，患流感后出现严重疾病和死亡的风险较高[1]。据WHO统计，每年季节性流感在全球导致300～500万重症病例，死亡高达65万人[2]。研究表明，我国老年人罹患流感直接医疗费用高至19 349元，平均住院成本是其他成年人的2倍[3]。接种流感疫苗是预防流感最经济最有效的措施，WHO免疫战略咨询专家组（SAGE）认为老年人是流感疫苗接种的优先群体[4]。第七次全国人口普查结果显示，2020年我国≥60岁的老年人为2.6亿，数量庞大[5]。然而，我国老年人群流感疫苗接种率仍处于较低水平[6]，其中“疫苗犹豫”是影响老年人接种流感疫苗的重要因素[7]。
目前，国内尚无针对老年人流感疫苗犹豫的成熟量表，既往针对老年人流感疫苗犹豫的研究主要通过心理学量表进行评估，评估的结果具有较大局限性，因此迫切需要研制符合本地区实际情况的老年人流感犹豫量表，精准识别老年人群疫苗犹豫原因，并进行针对性干预，对防止疫苗延迟或拒绝接种及流感疫情控制至关重要。本研究基于中文版的家长对儿童接种流感疫苗的犹豫量表[8]，结合老年人群特点，开发针对60岁及以上老年人流感疫苗犹豫的量表，并对量表的信度和效度进行系统评估。
1　资料与方法
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1.1　构建指标集
通过文献检索，收集国内外有关流感疫苗犹豫的文献，归纳汇总流感疫苗犹豫原因，制定流感疫苗犹豫量表指标集，涵盖疫苗的有效性、安全性、对疫苗的认知、自身基础性疾病、家人医院等支持环境、健康教育、疫苗费用和自身行动方便性等，总计40条有效条目。然后，结合国内流感疫苗接种政策和老年人群体特征，将上述条目进行归类合并为20条。为保证量表符合标准量表的条目表述，本研究在中文版家长对儿童接种流感疫苗的犹豫量表的基础上进行修订和增删，在原始量表“信心”“风险”两个维度的基础上，增加“支持”维度，形成初始量表框架。
1.2　遴选指标
采用专家名义小组法，邀请10名免疫规划领域专家从量表各条目表达的清晰程度、语言和内容相关性等方面对初始量表各条目进行评议，保留内容效度指数（CVI）≥80%的条目，并根据评议结果对量表进行修改完善。选取24名60岁及以上老年人针对初始量表的适用性进行现场测评，并根据现场测评情况再次对初始量表进行修订，确保初始量表适用于老年人群。最终确定初始量表指标包含信心、风险和支持3个维度和14个条目，其中信心维度包含7个条目（C1～C7），风险维度包含4个条目（R8～R11），支持维度包含3个条目（S12～S14）。见表1。
1.3　编制初始量表
采用Likert 5级评分法编制初始量表，量表包括卷首语、个人基本信息和题项C1～C7、R8～R11和S12～S14。每个题项下列出“非常不同意、不同意、不确定、同意和非常同意”5个选项，C1～C7和S12～S14两个维度每个条目的选项按顺序分别赋予5、4、3、2和1分，R8～R11每个条目的选项按顺序分别赋予1、2、3、4和5分，最终计算每个调查对象的所有题项的总得分，分数越高表示疫苗犹豫程度越高。
1.4　现场验证调查
1.4.1　调查对象
2023年5月1—31日期间，在无锡市通过方便抽样的方法选取60岁及以上老年人为调查对象。纳入标准：（1）年龄≥60周岁；（2）本市居住时长≥6个月；（3）具有一定表达能力和理解能力。排除标准：（1）患有精神性疾病；（2）存在认知功能或者沟通交流障碍。本研究经无锡市疾病预防控制中心伦理委员会审查并批准实施（伦理学审查批号：202305），在研究对象签署知情同意书后，开展匿名问卷调查，确保隐私得到充分保护。
1.4.2　样本量计算
根据样本量计算公式[9]，，参考既往文献[10]报道的我国老年人流感疫苗犹豫发生率：π=37.2%，取允许相对误差为10%[11]，则允许绝对误差δ=10%×37.2%=0.037 2，μα=1.96，deff=2，计算得到现场调查样本量为1 298人。
1.4.3　调查方法
由调查员开展面对面问卷调查，对量表进行现场实测。现场调查的质量控制措施包括通过问卷设置逻辑校验，确保数据无逻辑性错误；调查员经统一培训合格后参与调查，且问卷由调查员现场询问后进行填写，防止老年人因操作不当等问题导致错填、漏填等问题；问卷收集后，进行数据审核及清理，发现问题及时联系调查对象进行修正和完善。
1.5　量表评估
采用题总相关法对量表进行条目分析，根据量表各条目得分与总量表得分的Pearson相关系数r，删除相关系数<0.2的条目。通过探索性因子分析和验证性因子分析，评估问卷的结构效度。其中探索性因子分析采用KMO适宜性检验和Bartlett球形检验，当KMO值>0.6和Bartlett球形检验结果P<0.05时，适宜进行探索性因子分析。探索性因子分析主要是对量表结构进行分析，从代表性角度来筛选条目，一般认为条目在对应公因子上的因子载荷需>0.4，累计总方差贡献率需>40%，条目适用[9]。验证性因子分析运用结构方程模型，验证量表的因子结构模型是否与实际收集的数据相符合，评价模型的适配程度，检验量表的结构效度[12]。评价指标为：χ2值以及χ2/v、渐进残差均方和平方根（RMSEA）、拟合优度指数（GFI）、调整后适配度指数（AGFI）、递增拟合指数（IFI）、相对拟合指数（CFI）、TLI指数。当χ2/v≤3.0、RMSEA≤0.08、GFI≥0.9、AGFI≥0.9、IFI≥0.9、CFI≥0.9和TLI≥0.9，表明模型拟合程度较为理想。采用独立样本t检验进行校标关联度验证，本研究以2022年度流感季老年人是否接种流感疫苗作为效标，检验疫苗犹豫得分与流感疫苗接种的关联。采用Cronbach α系数检验量表内部一致性信度，当Cronbach α系数>0.75时反映量表的内部一致性良好，当Cronbachα系数<0.4则表示内部一致性较差。
1.6　统计学分析
采用Epidata 3.0软件建立和整理现场调查数据库，采用SPSS 22.0软件和AMOS 25.0软件进行描述性统计学分析和量表的信度效度评价。双侧检验，检验水准为α=0.05。
2　结果
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2.1　一般情况
共现场调查1 906人，其中男性占46.69%（890/1 906）；60～69岁的占50.37%（960/1 906），70～79岁的占39.61%（755/1 906）；职业为保安或保洁的占3.78%（72/1 906），为退休在家的占57.82%（1 102/1 906），为退休返聘的占4.62%（88/1 906）；文化程度为初中（中专）及以下的占78.12%（1 489/1 906）；家庭月收入<5 000元的占43.97%（838/1 906），5 000～10 000元的占35.68%（680/1 906）。
2.2　量表条目相关性
1 906名老年人群中，总量表得分（32.82±7.99）分，“信息”维度得分（14.42±5.76）分，“风险”维度得分（11.88±3.76）分，“支持”维度得分（6.51±2.32）分，14个条目得分在2.01～3.21分之间，各条目得分与总量表得分之间相关系数在0.20～0.87之间（均P<0.05），各条目得分与总量表得分之间相关系数均≥0.2，表明各条目得分与总量表得分相关性较强，所有条目均保留。见表2。
2.3　量表效度评价
量表结构效度分析中，对14个题项进行探索性因子分析，其中KMO值为0.916，Bartlett球形检验有统计学意义（χ2近似值=14 315.26，P<0.05）；因子荷载矩阵进行最大方差正交旋转结果提示，该量表可提取信心、风险、支持3个公因子，因子结构清晰合理。14个条目的因子荷载均>0.659，3个公因子累计方差贡献率为80.6%，量表的结构效度较好。见表3。
结构效度分析中，对量表的因子结构模型进行验证性分析，结果显示，评价指标中GFI=0.909、IFI=0.961、TLI=0.952、CFI=0.961，表明模型整体适配度较为理想，量表具有较好的结构效度，见表4、图1。
量表效标效度评价中，以2022年度流感季老年人是否接种流感疫苗作为效标，独立样本t检验结果显示，总疫苗犹豫得分（t=-2.732，P<0.05）、“信心”得分（t=-2.686，P<0.05）、“风险”得分（t=-2.825，P<0.05）和“支持”得分（t=-4.069，P<0.05）与校标均有显著性关联，表明量表整体内容用于老年人流感疫苗接种犹豫评价的校标关联效度较好。
2.4　量表信度评价
本量表信度分析中，Cronbach α系数为0.859，各条目项目删除后的Cronbach α系数均大于0.75，表明量表内部一致性信度较高。
3　讨论
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目前，国内针对流感疫苗犹豫的量表多以研究家长对儿童接种疫苗的态度为主，相关量表较为成熟。本研究基于中文版家长对儿童接种流感疫苗的犹豫量表，结合老年人群特征，开发编制了60岁及以上老年人流感疫苗犹豫量表。现场实测结果显示，量表的整体信度、效度和稳定性良好，能够较好地测量60岁及以上老年人流感疫苗接种犹豫状况，可供其他地区开展相关研究进行参考。
美国针对校园流感疫苗犹豫量表的验证性研究发现，原始量表中“信心”和“风险”两个维度具有良好的信度和效度，与家长拒绝为儿童接种流感疫苗有显著性关联[13]。国内中文版家长针对儿童接种流感疫苗的犹豫量表，是在美国的量表基础上汉化完善的，经现场测评具有较好的信度和效度[8]。本研究在该量表的基础上，将原始量表中的相关表述、内容进行了修订和完善，使之符合老年人群特点和国内流感疫苗接种政策要求。英国一项研究表明，老年人对疫苗安全性和有效性的信心程度与疫苗犹豫密切相关[14]。国内的一项研究也发现老年人群存在流感疾病发生风险和严重性认识不足的现象，在重度疫苗犹豫的老年人中更加显著[15]。因此，本研究保留了原始量表中的“信心”和“风险”维度，且评估结果表明修订量表中的“信心”和“风险”两个维度的信度和效度均较好，与老年人流感疫苗犹豫存在显著关联。
社会支持环境是老年人疫苗决策行为的重要因素，社会支持环境包括文化、制度、家庭等社会因素，是个体决策不可避免的因素[16]。一项meta分析显示，实施免费接种的地区流感疫苗接种率为33.3%，高于收费地区的12.4%[17]。北京市一项研究显示，外出障碍的老人的接种率显著低于无住所外出障碍的老人，过去一年每月去门诊就医≥1次的老人流感疫苗接种率显著高于过去一年从未或很少去门诊就医的老人[18]。另外一项研究发现，与晚辈共同居住的老年人接种率为43.7%，低于不与晚辈共同居住的52.4%[19]。因此，针对老年人流感疫苗犹豫的评估量表应纳入社会和家庭支持环境维度，以使得量表更加符合老年人的群体特征。本研究中量表的实测结果显示，“支持”维度各条目得分与量表总得分相关性较高，在对应公因子上的因子载荷大于0.4，累计总方差贡献率为80%，得分与校标存在显著关联，该维度下3个条目均被保留，表明本量表中增加“支持”维度是合理的，在评估老年人流感疫苗犹豫程度方面具有实际意义。
研究表明，因子负荷量介于0.50～0.95，表示模型基本适配[20]。本研究探索性因子分析中各条目因子载荷量介于0.66～0.93，全部测量变量均在此范围之内，可认为模型的基本适配度较好。同时本量表也满足保留因子载荷量大于0.4、不同因子载荷量相差大于0.2的要求[21]，这与另外一项研究的结果相似[22]。同时，采用主成分提取法和方差最大正交旋转法的分析结果显示，各个条目因子载荷量介于0.61～0.86，也说明本量表具有良好的结构效度。
本研究存在局限性。首先本研究中各拟合优度指标中，χ2和χ2/v均未达到适配的标准。分析原因可能在于，χ2值受样本量影响较大，当样本量较大时，影响检验水准[23]。同时，χ2自由度比值（χ2/v）由于使用χ2值作为分子，因此该统计量值仍然受到样本量影响，当样本量过大时，自由度值也不足以对χ2值进行校正[24]。本研究样本量为953人，接近1 000人，不宜使用χ2、χ2/v作为适配的指标。其次，本量表RMSEA和AGFI也未达到公认的标准，但有研究认为在判别模型是否可以接受时，应参考其他适配统计量，进行综合判断[25]。本研究采取方便抽样的方法选取调查对象，样本具有一定偏性。受研究设计限制，本研究未对量表的外部效度进行评测，需在后续的研究中予以补充完善。
综上所述，本研究开发的量表整体的效度和信度较高，能够准确测量老年人群流感疫苗接种犹豫水平，可作为老年人群流感疫苗犹豫水平的有效测量工具，也可为相关研究提供量表编制的参考依据。
基金
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  • 无锡市发展学科建设项目(FZXK2021010)
  • 无锡市卫生健康委中青年拔尖人才项目(BJ2023097)
文献
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202308086
  • 接收时间：2023-08-06
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-08-06
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无锡市发展学科建设项目(FZXK2021010)
无锡市卫生健康委中青年拔尖人才项目(BJ2023097)
作者信息
    1.无锡市新吴区疾病预防控制中心，江苏 无锡 214002
    2.江阴市疾病预防控制中心，江苏 江阴 214434
    3.无锡市梁溪区疾病预防控制中心
    4.无锡市疾病预防控制中心（南京医科大学附属无锡疾病预防控制中心），江苏 无锡 214023
    5.无锡市滨湖区疾病预防控制中心

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孟晓军，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
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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