【作者】 王丽君；

【导师】 戴耀华；

【作者基本信息】 北京协和医学院 ， 儿科学， 2014， 博士

【摘要】 [目的]0-2岁是儿童生长发育的“窗口期”,此期父母的养育质量直接关系到儿童期甚至成年后的发展结局。目前国内0～2岁儿童养育测评工具极少,且仅从孤立的角度出发对养育加以测量；从国外直接引进的育儿量表跨文化差异性较大。故本研究的目的是：①编制适合中国国情的、能全面评价0-2岁儿童养育质量的评价量表；②分别采取两种提取共同因素的方法,探索更适合于编制育儿评价量表的方法；③验证研究假设,即0-2岁儿童父母育儿评估量表(PAT)得分会影响儿童多方面的神经心理发育及体格发育。[方法]采用逻辑法构建0-2岁儿童父母养育测量维度及PAT条目库,通过一般性筛选和试验性测试筛选条目,建立PAT初稿并进行预试(n=284)。在提取因素阶段分别采用2种方法编制2个量表：第一种方法采用探索性因素分析法进行项目分析,提取共同因素,编出若干同质量表。第二种方法即采用逻辑法,即由专家将婴幼儿养育的定义操作化为若干个维度,并把相关的条目归到对应的养育维度,每个维度即形成一个因素。如果多于2/3的专家认为某一条目不对应于任何一个因素,则删除该条目。然后进行大规模正式调查(n=607),利用正式调查的数据用验证性因素分析法进行模型评估及信效度检验。其中校标关联效度检验选择0～6岁儿童神经心理发育量表作为效标,计算PAT各个因素及总量表得分与0～6岁儿童神经心理发育量表的5个领域分值及年龄别体重的偏相关系数。[结果]根据专题小组讨论内容及专家咨询结果,结合国内外有关文献描述及已有的婴幼儿养育量表,编制了含有78个条目的PAT条目库。通过条目筛选,形成含有50个条目的PAT初稿。通过项目分析及探索性因素分析生成特征根>1的因素9个,结合碎石图最终提取7个因素,形成PAT Ⅰ测试版。专家采用逻辑法提出0～2岁儿童养育测量的10个维度,并通过条目评价,形成PATⅡ测试版。通过模型评估和模型修正,确立PAT Ⅰ(共含有7个因素、34个条目)和PATⅡ(共含有8个因素、36个条目)。两个量表模型结构均拟合良好,内在一致性信度、重测信度及内容效度、结构效度均较好。PATⅠ因素关注、父母陪伴、养育关系与儿童神经心理发育呈正相关,因素健康/安全与儿童的年龄别体重呈正相关,效标关联效度欠满意；且有些条目在意义上似乎和所归属的因素没有任何相关性。PATⅡ因素育儿观念、关注、亲子关系、语言刺激、外出活动与儿童神经心理发育呈正相关,因素喂养、安全与儿童的年龄别体重呈正相关,效标关联效度较满意。[结论]获得了较为满意的0～2岁儿童父母育儿评估量表即PATⅡ,该量表可以作为评价中国0～2岁儿童父母养育质量的有用工具。与采用探索性因素分析法相比,采用逻辑法编制育儿评估量表可能更容易建立若干同质量表,更利于提高育儿评估量表的效标效度。更多还原

【Abstract】 ObjectivesIt is well recognized that the period from birth to two years of age is a "critical window" for the promotion of optimal growth, health, neuropsychological and behavioral development. The parenting quality of infants and toddlers is one of the most important potential contributors to early childhood development and is crucial in influencing a range of health and social outcomes across the lifecourse. There was not too much valid and reliable scales for assessing parenting of infants/toddlers, even less within China. Researchers in China often borrowed well developed parenting scale from abroad, diretedly in research. Limitations in the current domestic parenting scales were as the following:1) Parenting differs across cultures and by socioeconomic status. It is not always suitable to assess parents of China using items in the western developed scales.2) Existing parenting assessment tool are usually measuring an isolated angle of parenting and can hardly show the whole picture.The present study aimed at1)developing a parenting assessment tool (PAT) for parents of children aged zero to2years to assess parenting quality within the Chinese socio-cultural context,2)exploring a much better method between factor-analytic methods of scale development and the derivation of conceptually designed subscales,3)examining a priori hypothesized relationships between parenting and children’s outcomes.MethodsThe development of the parenting assessment tool for Chinese parents of infants/toddlers fell into three basic stages. Stage1was item development, or the generation of individual items. Through a thorough review of the literature, experts consultation and focus group discussion, we developed the theoretical definition of the construct of parenting of infants and toddlers. The definition was then used as a guide for the development of items. Then the deductively generated items were subjected to a sorting process that served as a pretest, permitting the deletion of items that were deemed to be conceptually inconsistent.Stage2was scale development, or the manner in which items are combined to form scales. Data for this stage(n=284) were gathered from5cities. Two approaches were used to determine PAT subscales. The first approach was exploratory factor analysis. Another was deductive approach, aiming at developing subscales that were conceptually meaningful. Items were grouped together based on theoretical connectivity rather than statistical analyses. Firstly18experts developed10dimensions of PAT. Then the experts evaluated the degree to which each item was representative of the parenting dimension. Items that were not catigorized within a dimension by at least two-thirds of the judges were removed. This process resulted in the retention of48items.Stage3was scale evaluation, or the psychometric examination of the new measure. In order to confirm the properties of two scales, a second data collection was conducted(n=607) in ten cities. Confirmatory factor analysis was used to evaluate the latent structure of two scales and to modify the models when necessary. Then we assessed the psychometric properties of the scales including Cronbach’s alpha coefficient, split-half reliability, test-retest reliability, content validity, construct validity, and criterion-related validity. To examine the relationship between parenting and children’s outcomes, partial correlations were calculated between PAT subscales scores and children’s development scores.ResultsBased on a review of the literature, experts consultation and focus group discussion,78items were developed. Twenty-eight items were deleted that were deemed to be conceptually inconsistent.Factor analysis revealed9factors with Eigenvalues greater than1.0. By the scree test, the scree plot of EFA suggests that a7-factor model might be most suitable in this dataset based on a substantial decrease in Eigenvalues. Based on this result, we proposed a7-factor model named PAT I. Results of the confirmatory factor analysis suggested that one additional item should be deleted from the scale. After the removal of this item, the7-factor model provided good fit.Experts developed10dimensions of PAT. Factor9and factor10has an alpha below a minimal acceptable level (0.50), so these two factors were not included in this study. Based on this result, we proposed a8-factor model named PAT Ⅱ. Results of the confirmatory factor analysis suggested that two additional items should be deleted from the scale. After the removal of these two items, the8-factor model provided good fit.Cronbach’s alpha coefficient of these two models was0.818and0.845respectively, Guttman split-half reliability was0.752and0.816respectively, test-retest reliability was0.951and0.918respectively, correlation coefficients between total and factors were from0.525to0.769and from0.561to0.704respectively. With respect to criterion-related validity, most subscales of PAT Ⅱ and less than half subscales of PAT Ⅰ were positively and significantly related to children’s specific development.ConclusionBoth scales showed good psychometric properties and fitted the data well. Some items of PAT Ⅰ seemed not conceptively consistent with its scale derived based only on the results of factor analysis. Simply because items load on the same factor does not mean that they necessarily measure the same theoretical construct. PAT Ⅱ was more closely related to children’s development outcomes, so it could be used as an effective tool to assess parenting quality of infants and toddlers in China. Compared to factor-analytic methods, the application of deductive approach would help derive conceptually designed subscales, hence the criterion-related validity is improved as well.更多还原