目的：编制社区成年人呼吸系统健康状况测评量表（CARSHAS），为评估社区成年人呼吸系统健康水平提供一种简明经济、快速有效的测评工具。方法2015年3月，以呼吸系统疾病的常见临床表现和致病因素为理论依据，通过广泛地查阅相关文献，制定初期量表，经过专家评议形成预调查量表———CARSHAS -Ⅰ。2015年4月，采用目的抽样法选取保定市120例社区成年人为预调查对象。采用 CARSHAS -Ⅰ对预调查对象进行预调查，共发放问卷120份，回收有效问卷117份，有效回收率为97.5%。对回收的有效问卷进行数据分析，形成 CARSHAS -Ⅱ，并增加1个总体评价条目，用于计算量表的效标效度。2015年6—11月，采用目的抽样法选取保定市、石家庄市、沧州市和赤峰市610例社区成年人为调查对象。采用 CARSHAS -Ⅱ对调查对象进行调查，共发放问卷610份，回收有效问卷579份，有效回收率为94.9%。对回收的有效问卷进行探索性因子分析，从而形成 CARSHAS。采用随机数字表法从大样本调查回收的有效问卷中选取450份，进行 CARSHAS 的验证性因子分析。利用大样本调查回收的有效问卷分析CARSHAS 的信效度。结果采用主成分分析、最大方差正交旋转法对579份有效问卷的数据进行探索性因子分析，结果显示，KMO 值为0.963，Bartlett 球形检验值为12832.530（df =325，P <0.001），表明数据适宜进行因子分析。在未限定因子个数的条件下进行因子提取，根据碎石图和特征值>1.000的标准，得到3个因子，分别命名为易感因素、严重的呼吸系统不良表现、轻度的呼吸系统不良表现，累积方差贡献率为67.220%。因此，最终形成了3个维度、26个条目的 CARSHAS。验证性因子分析结果显示，χ2/ df =2.252，近似误差均方根=0.053，拟合优度指数=0.909，比较拟合指数=0.967，规准适配指数=0.942，增值适配指数=0.967，非规准适配指数=0.959。CARSHAS 总体内容效度指数（CVI）为0.936，各条目的 CVI 为0.667~1.000。CARSHAS 各维度得分间相关系数为0.531~0.792，各维度得分与 CARSHAS 总得分之间的相关系数为0.743~0.945（P <0.01）。总体评价条目得分与 CARSHAS 总得分之间的相关系数为0.558，P <0.01。轻度的呼吸系统疾病表现维度、严重的呼吸系统疾病表现维度、易感因素维度、CARSHAS 条目间平均相关系数（ MIIC）分别为0.633、0.645、0.579、0.521，其 Cronbach′s α系数分别为0.873、0.948、0.941、0.965。结论 CARSHAS 具有良好的信度和效度，可以简明经济、快速有效地评估社区成年人呼吸系统的健康水平，为今后在社区开展大范围地呼吸系统健康防护的行为干预和健康教育的效果评价提供了一种良好的测评工具。%Objective To develop a Community Adult Respiratory System Health Assessment Scale(CARSHAS)so as to provide a simple,economic,rapid and effective assessment tool for measuring the adult respiratory system health level in the community. Methods In March 2015,we formulated an initial scale based on the common clinical manifestations and pathogenic factors of respiratory diseases and extensive consultation of the relevant literature,and developed it to be a pre - survey questionnaire———CARSHAS - Ⅰ based on experts′ advices. In April 2015,CARSHAS - Ⅰ was used to preliminarily investigate the 120 community adults in Baoding selected by the objective sampling method. A total of 120 questionnaires were sent out and 117 effective questionnaires were recovered with the effective recovery rate of 97. 5%. Based on analyzing the data of the effective questionnaires,we formed CARSHAS - Ⅱ with an added overall evaluation item for calculating the criterion validity of the scale. From June to November 2015,610 community adults in Baoding,Shijiazhuang,Cangzhou and Chifeng were selected as the subjects by the objective sampling method. CARSHAS - Ⅱ was adopted to investigate them. Totally 610 questionnaires were passed out and 579 effective questionnaires were recovered. The effective recovery rate was 94. 9% . After exploratory factor analysis of the effective questionnaires,CARSHAS had been formed. By random number table method,450 of the 579 effective questionnaires were selected to complete the confirmatory factor analysis of CARSHAS. The reliability and validity of CARSHAS were analyzed with the 579 effective questionnaires. Results By the principal component analysis and maximum variance orthogonal rotation,the 579 effective questionnaires were used for exploratory factor analysis,the result showed that the KMO value was 0. 963,and the Bartlett sphere test value was 12 832. 530(df = 325,P < 0. 001). So these data could be used for factor analysis. After factor extraction under the condition of not limiting the number of factors based on the scree plot and standard of characteristic value > 1. 000,3 factors were extracted,which were named as the susceptible factor,the severe adverse manifestation of respiratory system and the mild adverse manifestation of respiratory system. The cumulative variance contribution rate was 67. 220%. Finally,CARSHAS included 3 dimensions and 26 items. The results of confirmatory factor analysis showed that χ2 / df = 2. 252,RMSEA = 0. 053,GFI = 0. 909,CFI = 0. 967,NFI = 0. 942,IFI = 0. 967,TLI = 0. 959. The content validity index(CVI)of CARSHAS was 0. 936 and the CVI of each item was 0. 667 ~ 1. 000. The correlation coefficients between the scores of each dimension were 0. 531 - 0. 792. The correlation coefficients between the scores of each dimension and the total score of CARSHAS were 0. 743 - 0. 945(P < 0. 01). The correlation coefficient between the score of the overall evaluation item and the total score of CARSHAS was 0. 558(P < 0. 01). The MIIC of the dimension of mild adverse manifestation of respiratory system,the dimension of severe adverse manifestation of respiratory system,the dimension of susceptible factor and CARSHAS was 0. 633,0. 645,0. 579,0. 521,respectively. Cronbach′s α coefficient of them was 0. 873,0. 948,0. 941 and 0. 965, respectively. Conclusion CARSHAS has good reliability and validity and can be used to economically,quickly and effectively assess the adult respiratory system health level in the community. It is a good assessment tool for effect evaluation of the future wide range of respiratory system health protective behavior intervention and health education for adults in the community.
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