Abstract: Objective　To develop a questionnaire with good reliability and validity to evaluate the demand of community health service for patients with chronic obstructive pulmonary disease （COPD） systematically.Methods　The questionnaire was based on the Omaha System.Literature review，group discussion and Delphi consultation were used to develop the initial questionnaire and a convenience sampling method was adopted to select patients with COPD in the Department of Respiration from 4 Grade Ⅲ Level A comprehensive hospitals in Tianjin from December 2016 to April 2017.A formal questionnaire was formed by using critical ratio （CR） method，correlation analysis，content validity index （CVI），exploratory factor analysis，retest reliability，and Cronbach's alpha coefficient to test its reliability and validity.Results　Through literature review，group discussion and expert consultation，the initial questionnaire was formed by 4 dimensions and 34 items.A total of 187 questionnaires was distributed and 177 valid questionnaires were collected，with an effective recovery rate of 94.7%.The results of the project analysis showed that the critical ratio value （CR value） of each item was 2.64 to 9.21 （P<0.05）．Except for A1 （reducing the medical service price related to COPD treatment in community hospitals），A3 （increasing the proportion of COPD drug reimbursement），and A4 （increasing the common drug type of COPD in community hospitals），the Pearson correlation coefficient of items and the total score （r value） were all >0.4.Content validity index of items （I-CVI） were 0.93-1.00，average content validity index of scale （S-CVI/Ave）=0.99.Four common factors were extracted after deleting one item in factor analysis，with a cumulative variance contribution rate of 55.76%.A total of 33 items of community health service demand questionnaire for patients with COPD was determined and divided into 4 dimensions：environmental requirements （9 items），psychosocial needs （6 items），physiological needs （6 items），and health-related behavior needs （12 items）．The overall test-retest reliability of the questionnaire was 0.88，of which each dimension was 0.76 to 0.90.The overall Cronbach's alpha coefficient of the questionnaire was 0.91，of which each dimension was 0.75 to 0.90.Conclusion　The community health service demand questionnaires for patients with COPD presents good reliability and validity.It can be served as an effective assessment tool for community health service agencies.

Key words: Pulmonary disease, chronic obstructive；Community health service；Omaha System；Questionnaire development；Reliability and validity

摘要： 目的　编制具有良好信效度且能全面评价慢性阻塞性肺疾病（COPD）患者社区卫生服务需求的调查问卷。方法　以奥马哈问题分类系统为理论框架，在文献回顾、小组讨论和德尔菲法的基础上得到初始问卷。于2016年12月—2017年4月采取方便抽样法，选取天津市4所综合性三级甲等医院呼吸科的COPD患者。对患者进行问卷调查，采用临界比值（CR）法、相关性分析、内容效度指数（CVI）、探索性因子分析、重测信度、Cronbach's α系数进行信效度检验，形成正式问卷。结果　通过文献回顾、小组讨论、专家咨询形成4个维度34个条目的初始问卷。共发放问卷187份，回收有效问卷177份，问卷的有效回收率为94.7%。项目分析结果表明，各条目临界比值（CR值）为2.64~9.21（P均<0.05），除A1（降低社区医院COPD治疗相关的医疗服务价格）、A3（增加COPD药品报销比例）、A4（增加社区医院COPD常用药物种类）外，各条目与总分Pearson相关系数（r值）均>0.4。条目水平的内容效度指数（I-CVI）为0.93~1.00，平均量表水平的内容效度指数（S-CVI/Ave）=0.99。因子分析删除1个条目后共提取4个公因子，累积方差贡献率为55.76%。最终确定COPD患者社区卫生服务需求调查问卷共计33个条目，分为4个维度，分别为环境需求（9个条目）、心理社会需求（6个条目）、生理需求（6个条目）、健康相关行为需求（12个条目）。问卷总重测信度为0.88，各维度重测信度为0.76~0.90。问卷总Cronbach's α系数为0.91，各维度Cronbach's α系数为0.75~0.90。结论　基于奥马哈系统编制的COPD患者社区卫生服务需求调查问卷具有良好的信度及效度，可以作为COPD患者社区卫生服务需求的评价工具。

关键词: 肺疾病, 慢性阻塞性；社区卫生服务；奥马哈系统；问卷编制；信效度检验