研究目的：

         本研究遵循条目池构建—量表初步编制—信效度检验—量表修改 完善的思路，研制居家社区衰弱老年人整合照护服务需求量表，以期为制定符合我国实际情况的衰弱老人照护政策、规范衰弱老人干预措施提供工具支持。

研究内容：

         一是构建居家社区衰弱老人照护服务需求量表条目池；二是初步编制居家社区衰弱老人照护服务需求量表，通过专家咨询对初步编制的量表进行调整修改；三是开展居家社区衰弱老人照护服务需求量表的试应用及信效度检验；四是根据量表信效度检验结果对量表进行进一步的修改，并提出未来量表完善的相关建议。

研究方法：

         本研究采用定性与定量相结合的方式进行量表研制。首先，通过文献分析法初步构建量表条目池，而后通过半结构化访谈法进一步补充量表条目池。其次，采用专家咨询法对初步编制的居家社区衰弱老年人整合照护服务需求量表进行咨询论证，并调整修改。在此基础上，首先采用便利抽样方法发放调查问卷，对量表进行语言文化调试。最后采用配额抽样与便利抽样相结合的方法进行现场调查，检验量表的信度和效度，对量表做出进一步的优化和完善。

研究结果：

1.居家社区衰弱老人照护服务需求量表的编制：

        通过文献研究分析提取18个国内外与老年人照护供给/需求较为相关的测量工具，结合半结构化访谈补充量表条目池，与专题小组讨论归纳总结，初步构建了包含4个维度40个条目的量表。通过德尔菲专家咨询法修改完善，形成了包含4个维度43个条目的量表。两轮专家积极性均为100%，专家权威系数平均值分别为0.91和0.92，专家对量表提出了较为科学专业的修改建议。最后通过量表的试应用及信效度检验，修改后最终形成了包括生理、心理、社会参与、环境支持4个一级维度34个测量条目的居家社区衰弱老人照护服务需求量表。

2.居家社区衰弱老人照护服务需求量表的信效度：

        量表条目分析P值均＜0.05，所有条目均具有较好的区分性。量表总体与生理、心理、环境支持维度的Cronbach's α系数均＞0.8，社会参与维度的Cronbach's α系数＞0.75，量表内部一致性信度较好。总表及各维度的折半信度均＞0.7，量表的折半信度较好。总表及各维度组内相关系数均＞0.8，且 P 值均＜0.001，量表整体变量间相关性强。探索性因子分析提取特征根＞1的因子6个，旋转后因子载荷量均＞0.4；验证性因子分析模型拟合指标结果为CMIN/DF=1.992，GFI=0.797，RMSEA=0.066，RMR=0.141，CFI=0.908，NFI=0.739，IFI=0.905，量表结构效度较好。量表 CR 值均＞0.7，AVE 值均＞0.5，聚合效度较好。任两个维度的 AVE 平方根值均大于其相关系数，量表的区分效度较好。

研究结论：

         本研究在量表研制中，严格按照标准流程进行条目筛选及信效度检验，确保了量表的编制较为科学可靠，最后形成的居家社区衰弱老人照护服务需求量表包括4个维度34个条目。同时在现场调查中，老年人对量表的填答时间平均在每份量表10~15分钟，患者较易理解条目内容，量表具有较好的现实操作性。

建议：

        进一步调整量表各维度的条目数量，丰富心理和社会参与维度的条目内容，如增加认知功能、应对压力能力等，提高需求评估的全面性。同时，采用客观指标和交叉验证条目以提升评估的精准性和有效性。此外，在量表的后续应用中根据地域差异调试量表，增加地方需求性条目并将评估结果转化为个性化照护计划，从而推动我国居家社区医养结合服务综合性发展。

Objective:

     This study followed a structured development process—including item pool construction, preliminary scale design, reliability and validity testing, and iterative refinement—to develop an Integrated Care Service Needs Assessment Scale for Frail Elderly in Home and Community Settings, aiming to provide a tool for formulating context-specific care policies and standardizing intervention measures tailored to China’s frail elderly population.

Contents:

     Firstly, construct an item pool for the needs assessment scale of care services for frail elderly in home and community settings; secondly, develop a preliminary version of the needs assessment scale for care services for frail elderly in home and community settings, and adjust and revise it through expert consultation; then, conduct a pilot application and reliability and validity testing of the needs assessment scale for care services for frail elderly in home and community settings; finally, further revise the scale based on the results of the reliability and validity testing, and propose relevant suggestions for future scale improvement.

Methods:

     This study combines qualitative and quantitative methods for scale development. Firstly, a literature analysis is conducted to initially construct the item pool, which is then supplemented through semi-structured interviews. Secondly, expert consultation is used to evaluate and refine the preliminary scale. Based on this, a questionnaire is distributed using convenience sampling for language and cultural adaptation of the scale. Finally, a quota sampling combined with convenience sampling method is used for on-site surveys to test the scale's reliability and validity, leading to further optimization and refinement.

Results:

1.Development of the Needs Assessment Scale for Care Services for Frail Elderly in Home and Community Settings

     Through literature review, 18 measurement tools related to elderly care supply/demand were extracted. Combined with semi-structured interviews and focus group discussions, a preliminary scale with 4 dimensions and 40 items was constructed. After Delphi expert consultation, the scale was refined to include 4 dimensions and 43 items. Expert participation was 100% in both rounds, with average expert authority coefficients of 0.91 and 0.92. Experts provided scientific and professional suggestions for scale modification. Finally, after pilot application and reliability and validity testing, the scale was refined to include 34 measurement items across 4 first-level dimensions: physical, psychological, social participation, and environmental support.

2.Reliability and Validity of the Needs Assessment Scale for Care Services for Frail Elderly in Home and Community Settings

     All scale items had P-values < 0.05, indicating good discrimination. The overall scale and the physical, psychological, and environmental support dimensions had Cronbach's α coefficients > 0.8, while the social participation dimension had a Cronbach's α coefficient > 0.75, indicating good internal consistency reliability. The split-half reliability for the overall scale and each dimension was > 0.7. The intraclass correlation coefficients for the overall scale and each dimension were > 0.8, with P-values < 0.001, indicating strong correlations between overall variables. Exploratory factor analysis extracted 6 factors with eigenvalues > 1, and factor loadings after rotation were all > 0.4. Confirmatory factor analysis model fit indices were CMIN/DF=1.992, GFI=0.797, RMSEA=0.066, RMR=0.141, CFI=0.908, NFI=0.739, IFI=0.905, indicating good construct validity. The scale's CR values were all > 0.7, and AVE values were all > 0.5, indicating good convergent validity. The square roots of the AVE values for any two dimensions were greater than their correlation coefficients, indicating good discriminant validity.

Conclusion:

     In this study, during the development of the scale, we strictly adhered to the standard procedures for item screening and reliability and validity testing to ensure that the scale was compiled in a relatively scientific and reliable manner. The finalized Care Service Needs Scale for Frail Elderly in Home and Community Settings comprises 4 dimensions with 34 items. Meanwhile, in the field survey, the average time taken by the elderly to complete each scale was 10 - 15 minutes. The elderly found the items relatively easy to understand, indicating that the scale has good practical operability.

Recommendations:

     Further adjust the number of items in each dimension of the scale and enrich the content of items in the psychological and social participation dimensions, such as adding items related to cognitive function and stress coping ability, to enhance the comprehensiveness of needs assessment. Meanwhile, utilize objective indicators and cross-validation items to improve the accuracy and effectiveness of the assessment. In addition, during the subsequent application of the scale, adapt it according to regional disparities, incorporate locally relevant items, and transform the assessment results into personalized care plans, thereby promoting the comprehensive development of integrated medical and elderly care services in home and community settings in China.