我国城市0-6岁儿童家庭内意外伤害风险评估工具的研制和应用

Unintentional injury is a global public health problem which seriously threats child’s health and safety and is the leading cause of child morality and disability. In China, most studies on child unintentional injury were cross-sectional survey and there lacks intervention trials and scientific evaluation tools. The proposed study, which aims to develop an evaluation tool to measure the risk of child unintentional injury, is necessary and urgent. On the basis of Bronfenbrenner’s ecological system theory, theoretical framework will be established, namely, a risk-evaluation system of in-home unintentional injury among children aged 0-6. Classic and modern measure theory will be applied in the process of item pool establishment, item selection and psychometric assessment on scale, in order to develop 3 evaluation tools including parental supervision scale, in-home environment safety scale and child injury-related risky behavior scale. After scale development, risk factors of unintentional injury will be screened and risk evaluation model will be established through discriminant analysis and percentile method in order to recognize children at high risk. Eventually, an integrate risk-evaluation system of in-home unintentional injury among children combined with theory, methodology and assessment will be built. The study can provide ideas and systematic methodology for other researches on injury prevention, and construct a scientific foundation for the implementation of targeted and evidence-based child unintentional injury prevention and control in the future.

意外伤害是严重威胁儿童健康和安全的全球性公共卫生问题，是儿童死亡和致残的首位原因。我国儿童意外伤害研究多为现况调查，缺乏干预性研究和科学的评估工具。本项目以研制我国儿童意外伤害风险评估工具为目标，具有必要性和紧迫性。本项目基于Bronfenbrenner生态系统理论，形成0-6岁儿童家庭内意外伤害风险评估体系的理论框架。综合运用经典测量理论与现代测量理论的统计方法，从建立条目池、条目筛选到量表的计量心理学特征考核，形成包含家长监管、居家环境安全和儿童伤害风险行为三个分量表的评估工具。在工具构建基础上，筛选意外伤害危险因素；并通过判别分析、百分位数法，建立风险评估模型，识别高危人群。从而建立理论、方法与评估相结合的系统的儿童意外伤害风险评估体系。本项目可为其他伤害研究提供研究思路和系统的方法学支持，为有针对性的开展基于证据的儿童意外伤害预防与控制提供科学依据。

意外伤害是严重威胁儿童健康和安全的全球性公共卫生问题，是儿童死亡和致残的首位原因。我国儿童意外伤害研究多为现况调查，缺乏干预性研究和科学的评估工具。本项目以研制我国儿童意外伤害风险评估工具为目标，基于Bronfenbrenner生态系统理论，构建0-6岁儿童家庭内意外伤害风险评估体系的理论框架，形成包含家长监管特征、居家环境安全和儿童伤害风险行为三个分量表的评估工具。综合运用经典测量理论与现代测量理论的统计方法，进行条目筛选和量表的计量心理学特征考核。其中家长监管特征量表一共包含易伤性、预防性、命运观、监管价值观、保护观、风险容忍、自我效能、监管者状态、儿童活动类型等9个维度，共38个条目。问卷的Cronbach’s α 系数为0.838 ，Spearman-Brown分半信度系数为0.670 ；区分效度结果显示，伤害组和非伤害组评估总分之间差别有统计学意义（t=-2.806，P=0.006）。验证性因子分析结果显示：χ2/df值为3.804，拟合指数CFI为0.863、规范拟合指数NFI为0.824，增值拟合指数IFI为0.864，近似误差均方根RMSEA为0.051。家庭环境安全评估量表最终包含54个条目，6个维度。量表整体的一致性信度系数为0.882；内容效度可。城市0-6岁儿童家庭内意外伤害儿童危险行为量表一共包括9个维度，56个条目。问卷的Cronbach’s α 系数为0.939 ，Spearman-Brown分半信度系数为0.882。区分效度结果显示伤害组和非伤害组评估总分之间差别有统计学意义（t=-7.863，P＜0.01）。验证性因子分析结果显示：χ2/df值为4.573，拟合指数CFI为0.771、规范拟合指数NFI为0.726，增值拟合指数IFI为0.772，近似误差均方根RMSEA为0.058。本项目可为其他伤害研究提供研究思路和系统的方法学支持，为有针对性的开展基于证据的儿童意外伤害预防与控制提供科学依据。