Development and reliability and validity testing of the Pulmonary Tuberculosis Symptom Cluster Scale

doi:10.19982/j.issn.1000-6621.20250080

Abstract

Abstract:

Objective: To develop the Pulmonary Tuberculosis Symptom Cluster Scale and to evaluate its psychometric properties, including reliability and validity. Methods: Guided by the Symptom Experience Model, the preliminary version of the scale was constructed through a comprehensive process involving literature review, semi-structured interviews with patients diagnosed with pulmonary tuberculosis (PTB), expert consultation via the Delphi method, and a pilot study. Subsequently, a cross-sectional survey was conducted among 162 hospitalized PTB patients at the Third People’s Hospital of Shenzhen. Item analysis, exploratory factor analysis (EFA), and internal consistency testing were employed to assess the reliability and construct validity of the scale. Results: The developed Pulmonary Tuberculosis Symptom Cluster Scale contains 17 items, covering four symptom clusters: systemic, gastrointestinal, respiratory, and psychological. The cumulative variance contribution rate was 65.058%. The scale’s Cronbach’s α coefficient was 0.837, the split-half reliability was 0.705. The content validity index of the scale was 0.840, with individual item content validity indices ranging from 0.801 to 1.000. Conclusion: The Pulmonary Tuberculosis Symptom Cluster Scale developed in this study has good reliability and validity, and can be used for the assessment of symptom clusters in tuberculosis patients.

Key words: Tuberculosis, pulmonary, Pathological conditions, signs and symptoms, Questionnaires, Evaluation studies

CLC Number:

R521

Kong Hanhan, Chen Zijiao, Zeng Jianfeng, Wu Dan, Tang Lin, Wen Min. Development and reliability and validity testing of the Pulmonary Tuberculosis Symptom Cluster Scale[J]. Chinese Journal of Antituberculosis, 2025, 47(8): 1062-1067. doi: 10.19982/j.issn.1000-6621.20250080

Figures/Tables 3

References 32

[1]	尤黎明, 吴瑛. 内科护理学. 6版. 北京: 人民卫生出版社, 2017.
[2]	蒋宇, 李月, 刘忆冰, 等. 青年初治肺结核患者病耻感现状及影响因素分析. 中华现代护理杂志, 2023, 29(10):1333-1337. doi:10.3760/cma.j.cn115682-20220819-04055.
[3]	孟婷, 陈敬芳, 邓国防, 等. 结核病患者心理脆弱及焦虑抑郁状态相关研究进展. 结核与肺部疾病杂志, 2024, 5(6):583-589. doi:10.19983/j.issn.2096-8493.2024131.
[4]	王功琪, 徐小燕, 何龑. 初治肺结核患者的生活质量现况调查. 解放军护理杂志, 2018, 35(24):29-33. doi:10.3969/j.issn.1008-9993.2018.24.007.
[5]	张博. 肺结核患者低蛋白营养状况对抗结核治疗影响的调查分析. 青岛: 青岛大学, 2021.
[6]	王春雷, 金韬, 赵鹏鹏, 等. 江苏省淮安市耐多药肺结核患者服药依从性及影响因素分析. 中国防痨杂志, 2022, 44(10):1057-1062. doi:10.19982/j.issn.1000-6621.20220214.
[7]	Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4):270-282. doi:10.1097/00002820-200507000-00005.
[8]	佟佳益, 王宇, 郑改改, 等. 慢性心力衰竭症状群管理个性化推荐平台的构建及应用. 护理研究, 2024, 38(12):2202-2207. doi:10.12102/j.issn.1009-6493.2024.12.025.
[9]	张卫, 耿小平, 章新琼, 等. 症状群管理:症状管理的新视角. 医学与哲学, 2016, 37(2):5-7, 19. doi:10.12014/j.issn.1002-0772.2016.01b.02.
[10]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017 肺结核诊断. 结核与肺部疾病杂志, 2024, 5(4): 376-378. doi:10.19983/j.issn.2096-8493.2024022.
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计. 中华护理杂志, 2010, 45(4):378-380. doi:10.3761/j.issn.0254-1769.2010.04.037.
[12]	Armstrong TS. Symptoms experience: a concept analysis. Oncol Nurs Forum, 2003, 30(4):601-606. doi:10.1188/03.ONF.601-606. pmid: 12861321
[13]	吴明隆. 问卷统计分析实务:SPSS操作与应用. 重庆: 重庆大学出版社, 2010.
[14]	Dheda K, Perumal T, Moultrie H, et al. The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions. Lancet Respir Med, 2022, 10(6):603-622. doi:10.1016/S2213-2600(22)00092-3. pmid: 35338841
[15]	Thomas BE, Shanmugam P, Malaisamy M, et al. Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review. PLoS One, 2016, 11(1):e147397. doi:10.1371/journal.pone.0147397.
[16]	姜晓颖, 宋艳华, 王玉莹, 等. 270例肺结核患者生命质量评价及影响因素分析. 中国防痨杂志, 2020, 42(1):66-73. doi:10.3969/j.issn.1000-6621.2020.01.015.
[17]	刘冉, 赵艳君, 周燕燕, 等. 肺结核合并糖代谢紊乱患者的生活质量现状及影响因素. 职业与健康, 2019, 35(24):3369-3373.
[18]	柴春维, 石亮, 董立明, 等. 抗结核治疗中发热的临床特征及原因分析. 中国药物与临床, 2021, 21(4):648-650. doi:10.11655/zgywylc2021.04.043.
[19]	Lin Q, Chen J, Yu T, et al. Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis. Clin Respir J, 2023, 17(7):663-671. doi:10.1111/crj.13653. pmid: 37406999
[20]	刘晓莉, 杜金霞, 雷丽梅, 等. 肺结核患者失眠与病耻感的相关性研究. 重庆医学, 2023, 52(4):629-632. doi:10.3969/j.issn.1671-8348.2023.04.028.
[21]	Susanto TD, Widysanto A, Cipta DA, et al. Anxiety and depression level of patients with multidrug-resistant tuberculosis (MDR-TB) in two hospitals in Banten province, Indonesia. Dialogues Health, 2023,2:100115. doi:10.1016/j.dialog.2023.100115.
[22]	孔含含, 刘畅, 操静, 等. 老年肺结核病人病耻感现状及影响因素研究. 全科护理, 2023, 21(30):4195-4199. doi:10.12104/j.issn.1674-4748.2023.30.004.
[23]	高磊, 梁雅雪, 刘盛盛, 等. 144例老年利福平耐药肺结核患者治疗转归及影响因素分析. 中国防痨杂志, 2024, 46(7):799-807. doi:10.19982/j.issn.1000-6621.20240096.
[24]	Fu L, Hu Y, Lu Z, et al. Validation of the Simplified Chinese Version of the Memorial Symptom Assessment Scale-Short Form Among Cancer Patients. J Pain Symptom Manage, 2018, 56(1):113-121. doi:10.1016/j.jpainsymman.2018.03.024.
[25]	Wu X, Xie J, Lin X, et al. Translation and validation of chinese version of MDASI immunotherapy for early-phase trials module: a cross-sectional study. BMC Nurs, 2023, 22(1):176. doi:10.1186/s12912-023-01217-9. pmid: 37217922
[26]	Ascencio Huertas L, Allende Pérez SR, Peña Nieves A. Assessment of emotional distress in palliative care: Edmonton Symptom Assessment System-revised (ESAS-r) vs Distress Thermometer. Palliat Support Care, 2024, 22(2):258-264. doi:10.1017/S1478951523001530.
[27]	顾芳臣, 林征, 尚星辰, 等. 炎症性肠病患者症状群评估量表的编制及信效度检验. 中华护理杂志, 2020, 55(12):1819-1824. doi:10.3761/j.issn.0254-1769.2020.12.011.
[28]	孟菲. 痛风患者症状群评估量表的编制及应用研究. 青岛: 青岛大学, 2023.
[29]	Nejati V, Estaji R, Balanzá-Martínez V, et al. Development of a checklist for cognitive assessment requirements (CARE) based on a Delphi consensus study. Sci Rep, 2025, 15(1):3146. doi:10.1038/s41598-025-87380-2.
[30]	田甘露, 陈泽阳, 何文英. 终末期肝病症状评估量表的编制及信效度检验. 护理研究, 2024, 38(8):1330-1335. doi:10.12102/j.issn.1009-6493.2024.08.003.
[31]	万雅莉, 刘云访, 陈怿, 等. 护理人员传染病突发事件防控能力问卷编制及信效度检验. 中华护理杂志, 2023, 58(5):536-543. doi:10.3761/j.issn.0254-1769.2023.05.004.
[32]	吴蒙, 袁竺方, 游旅, 等. 脑卒中症状群评估量表的编制及信效度检验. 护理学杂志, 2024, 39(3):10-13. doi:10.3870/j.issn.1001-4152.2024.03.010.

特征	人数(名)
性别
男性	7
女性	15
年龄组(岁)
38~40	8
41~50	11
>50	3
职称
正高级	7
副高级	8
中级	7
学历
博士	2
硕士	4
本科	16
工作年限(年)
15~19	11
20~30	8
>30	3
专业领域
临床医疗	8
临床护理	8
护理管理	6
合计	22

条目	因子1	因子2	因子3	因子4
体质量减轻	0.822^a	0.095	0.177	0.038
食欲减退	0.681^a	0.209	0.270	0.179
盗汗	0.662^a	0.289	0.298	0.091
发热	0.607^a	-0.082	-0.068	0.142
疲乏/乏力	0.596^a	0.286	0.078	0.248
咳嗽	-0.015	0.945^a	0.057	0.019
咳痰	0.059	0.918^a	-0.064	0.111
呼吸困难/气促	0.066	0.898^a	0.086	0.071
胸闷	0.184	0.876^a	0.106	0.090
咯血	-0.065	0.768^a	-0.078	0.123
胸痛	0.001	0.588^a	0.059	0.258
呕吐	0.141	0.063	0.937^a	0.125
恶心	0.160	0.150	0.894^a	0.107
腹胀	0.247	0.061	0.565^a	0.203
睡眠不安	0.350	0.073	0.273	0.699^a
焦虑	0.235	0.015	0.230	0.695^a
抑郁	0.189	0.015	0.224	0.560^a
特征值	5.610	2.588	2.018	1.495
方差贡献率(%)	31.166	14.377	11.211	8.304
累积方差贡献率(%)	31.166	45.543	56.754	65.058

是否出现过以下症状	没有	如有,多久出现一次				如有,有多严重					如有,对您造成多大的困扰
是否出现过以下症状	没有	偶尔	有时	经常	总是	一点也不	轻度	中度	重度	非常严重	完全没有	轻度	中度	重度	非常严重
体质量减轻
食欲减退
盗汗
发热
疲乏/乏力
咳嗽
咳痰
呼吸困难/气促
胸闷
咯血
胸痛
呕吐
恶心
腹胀
睡眠不安
焦虑
抑郁
其他