고혈압 환자의 삶의 질 측정도구 개발

Development of Measurement Scale for the Quality of Life in Hypertensive Patients

  • 김건엽 (건양대학교 의과대학 예방의학교실) ;
  • 감신 (경북대학교 건강증진연구소 및 의과대학 예방의학교실) ;
  • 이상원 (대구가톨릭대학교 의과대학 예방의학교실) ;
  • 박기수 (포천중문의대 예방의학교실) ;
  • 채성철 (경북대학교 병원 순환기내과) ;
  • 천병렬 (경북대학교 건강증진연구소 및 의과대학 예방의학교실)
  • Kim, Keon-Yeop (Department of Preventive Medicine, College of Medicine, Konyang University) ;
  • Kam, Sin (Department of Preventive Medicine, School of Medicine and Health Promotion Research Center, Kyungpook National University) ;
  • Lee, Sang-Won (Department of Preventive Medicine, Catholic University of Daegu School of Medicine) ;
  • Park, Ki-Soo (Department of Occupational and Environmental Medicine, Pochun CHA University) ;
  • Chae, Shung-Chull (Division of Cardiology, Department of Internal Medicine, Kyungpook University Hospital) ;
  • Chun, Byung-Yeol (Department of Preventive Medicine, School of Medicine and Health Promotion Research Center, Kyungpook National University)
  • 발행 : 2005.03.01

초록

Objectives : To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. Methods : A sample of 1,115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests(Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. Results : The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant(p<0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. Conclusions : The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.

키워드

참고문헌

  1. Read JL. The new area of quality of life assessment. In: Quality of Life Assessment; key issues in the 1990s, edited by Wallker SR and Rosser RM. Kluwer Academy Publishers, 1993
  2. Read JL. The new area of quality of life assessment. In: Quality of Life Assessment; key issues in the 1990s, edited by Wallker SR and Rosser RM. Kluwer Academy Publishers, 1993
  3. 한림의대 가정의학교실. 삶의 질 측정의 이론과 실제. 고려의학; 1999
  4. Wiklund IK. Hypertension. In: Quality of life and pharmacoeconomics in clinical trials, 2nd edition edited by Spilker B. Lippincott-Raven Publishers, 1996
  5. Lawrence WF, Fryback DG, Martin PA, Klein R, Klein BEK. Health status and hypertension: a population-based study. J Clin Epidemiol 1996; 49(11): 1239-1245 https://doi.org/10.1016/S0895-4356(96)00220-X
  6. Park KM, Kim HS, Kim KS, Shin HC, Park ES. The comparison of quality of life between hypertensive patients and normal control subjects. J Korean Acad Fam Med 1992; 13(3): 240-245 (Korean)
  7. Shim JY, Lee JK, Kim SY, Won JW, Sun WS, Park HK, Shin HC. The development of korean related quality of life scale. J Korean Acad Fam Med 1999; 20(10): 1197-1208 (Korean)
  8. Kim SY, Shim JY, Won JW, Sun WS, Park HK, Lee JK. The development of Korean health related quality of life scale; Testing reliability and validity. J Korean Acad Fam Med 2000; 21(3): 382-394 (Korean)
  9. Min SK, Kim KI, Suh SY, Kim DK. Development fo korean version of world health organization quality of life scale(WHOQOL). J Korean Neuropsych Assoc 2000; 39(1): 78-88 (Korean)
  10. Shin HC, Kim CH, Jo BR, Won JW, Song SW, Park YK, Yun YH, Jeong SP. Development of the korean health status measure for the elderly. J Korean Acad Fam Med 2002; 23(4): 440-457 (Korean)
  11. Prisant LM, Alpert BS, Robbins CB, Berson AS, Hayer M, Cohen ML, Sheps SG. American National Standard for nonautomated shphygmomanometers : Summary report. Am J Hyperte 1995; 8(2): 210-213 https://doi.org/10.1016/0895-7061(94)00175-B
  12. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, Neal B, Rodgers A, Ni Mhurchu C, Clark T. 1999 World Health Organization - International Society of Hypertension Guidelines for the Management of Hypertension; Guidelines Subcommittee. J Hyperten 1999; 17(2): 151-183
  13. Bae JM, Jeong EK, Yoo TW, Huh BY, Kim CH. A quick measurement of stress in outpatient clinic setting. J Korean Acad Fam Med 1992; 13(10): 809-820 (Korean)
  14. Katz S. Assessing self-maintenance; activities of daily living, mobility and instrumental activities of daily living. J Am Geriat Soc 1989;31(12): 721-727
  15. Kwon YC, Park JH. Korean version of Mini- Mental State Examination(MMSE-K), Part I: Development of the test for the elderly. J Korean Neuropsychia Assoc 1989; 28(1): 125-135 (Korean)
  16. Juniper EF, Guyatt GH, Jaeschke R. How to evelop and validate a new health-related uality of life instrument. In: Quality of life and pharmacoeconomics in clinical trials, 2nd edition edited by Spilker B. Lippincott-Raven Publishers, 1996
  17. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey(SF-36): I. Conceptual framework and item selection. Med Care 1992; 30(6): 473-483 https://doi.org/10.1097/00005650-199206000-00002
  18. McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-item short-form health survey(SF-36): III. Test of data quality, scaling assumption, and reliability across diverse patient groups. Med Care 1994; 32(1): 40-66 https://doi.org/10.1097/00005650-199401000-00004
  19. McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health survey(SF- 36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31(3): 247-263 https://doi.org/10.1097/00005650-199303000-00006
  20. Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care 1999; 37(2): 126-139 https://doi.org/10.1097/00005650-199902000-00003
  21. Siegrist J, Junge A. Conceptual and methodological problems in research on the quality of life in clinical medicine. Soc Sci Med 1989; 29(3): 463-468 https://doi.org/10.1016/0277-9536(89)90295-5
  22. Schipper H, Clinch JJ, Olweny CLM. Quality of life studies: definition and conceptual issues. In: Quality of life and pharmacoeconomics in clinical trials, 2nd edition edited by Spilker B. Lippincott-Raven Publishers, 1996
  23. Spilker B. Introduction. In: Quality of life and pharmacoeconomics in clinical trials, 2nd edition edited by Spilker B. Lippincott-Raven Publishers, 1996
  24. 한국심리학회 편. 심리검사-제작 및 사용 지침서. 중앙적성출판사, 1998
  25. Goldberg D. The detection of psychiatric illness by questionnaire. Oxford, Oxford University Press, 1972
  26. Parkerson GR, Gehlbach SH, Wagner EH, James SA, Clapp NE, Muhlbaier LH. The Duke-UNC Health Profile : An adult health status instrument for primary care. Med Care 1981; 19(8): 806-828 https://doi.org/10.1097/00005650-198108000-00002
  27. Essink-Bot ML, Krabbe PFM, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures: The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA Charts, and the EuroQol Instrument. Med Care 1997; 35(5): 522-537 https://doi.org/10.1097/00005650-199705000-00008
  28. Bullinger M, Power MJ, Aaronson NK, Cella DF, Anderson RT. Creating and evaluating cross-cultural instrument. In: Quality of life and pharmacoeconomics in clinical trials, 2nd edition edited by Spilker B. Lippincott-Raven Publishers, 1996
  29. 성태제. 문항제작 및 분석의 이론과 실제. 학지사, 1996
  30. Gandek B, Ware JE, Aaronson NK, Alonso J, Apolone G, Bjorner J, Brazier J, Bullinger M, Fukuhara S, Kaasa S, Leplege A, Sullivan M. Tests of data quality, scaling assumption, and reliability of the SF-36 in eleven countries: results from the IQOLA project. J Clini Epidemiol 1998; 51(11): 1149-1158 https://doi.org/10.1016/S0895-4356(98)00106-1
  31. Helmstadter GC. Principles of psychological measurement. New York, Appleton-Century- Crofts, 1964
  32. Ware JE. Measuring patients' views: the optimum outcome measure. BMJ 1993; 306(6890): 1429-1430 https://doi.org/10.1136/bmj.306.6890.1429
  33. Nunnaly JC, Bernstein IR. Psychometric theory, 3rd edition. New York, McGraw-Hill, 1994
  34. McDowell. Measuring health, 1st edition. New York, Oxford university press, 1996
  35. 성태제. 타당도와 신뢰도(개정판). 학지사, 2002
  36. 김기영, 전명식. SAS 인자분석. 자유아카데미, 1990
  37. 이순묵. 요인분석의 기초. 교육과학사, 2000
  38. Park JH, Kwon YC. Standardization of Korean version of Mini-Mental State Examination (MMSE-K) for use in the elderly, Part II: Diagnostic validity. J Korean Neuropsychia Assoc 1989; 28(3): 508-512 (Korean)
  39. Ware JE. Standards for validating health measures: definition and content. J Chronic Dis 1987; 40(6): 473-480 https://doi.org/10.1016/0021-9681(87)90003-8
  40. Bridges-Webb C. Assessing health status in general practice. Med J Austr 1992; 157(5): 321-325
  41. Perneger TV, Leplege A, Etter JF, Rougemont A. Validation of a French-language version of the MOS 36-Item Short Form Health Survey(SF-36) in young healthy adults. J Clini Epidemiol 1995; 48(8): 1051-1060 https://doi.org/10.1016/0895-4356(94)00227-H
  42. Cohen J. Statistical power analysis for the behavioral sciences, 2nd edition. Hillsdale, Erlbaum, 1988
  43. 여운승. 사회과학과 마케팅을 위한 다변량행동조사. 민영사, 2000
  44. AERA, APA & NCME. Standard for Education and psychological test and manuals. Washington DC, American Psychological Association, 1999
  45. 이순묵. 공변량 구조분석. 성원사, 1990
  46. Koh SB, Chang SJ, Kang MG, Cha BS, Park JK. Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean J Prev Med 1997; 30(2): 251-266 (Korean)