慢性HBV感染者歧视测量量表简化版的研制

吾尔肯·朱马江; 林晓; 王莹; 郝元涛

doi:10.16462/j.cnki.zhjbkz.2021.06.017

慢性HBV感染者歧视测量量表简化版的研制

doi: 10.16462/j.cnki.zhjbkz.2021.06.017

1.
510080 广州，中山大学公共卫生学院医学统计学系
2.
510275 广州，中山大学全球卫生研究中心

基金项目:

国家科技重大专项 2018ZX10715004

广东省基础与应用基础研究基金 2020A1515110230

详细信息

通讯作者:
郝元涛，E-mail: haoyt@mail.sysu.edu.cn

中图分类号: R181;R395.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-16
- 修回日期: 2021-04-26
- 刊出日期: 2021-06-10

Development of a shortened version of the chronic hepatitis B virus infection-related stigma scale

1.
Department of Medical Statistic, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2.
Global Health Institute, Sun Yat-sen University, Guangzhou 510275, China

Funds:

National Science and Technology Major Project of China 2018ZX10715004

Guangdong Basic and Applied Basic Research Foundation 2020A1515110230

More Information

Corresponding author: HAO Yuan-tao, E-mail: haoyt@mail.sysu.edu.cn

摘要

摘要: 目的研制并评价慢性HBV感染者歧视测量量表(the chronic hepatitis B virus infection-related stigma scale, HBVSS)简化版。方法通过便利抽样的方法选取1 058名慢性HBV感染者进行调查，随机抽取其中529名被试对象作为训练样本，用经典测量理论和项目反应理论的方法进行条目筛选；剩下529名被试对象作为考核样本，用于评价简化版量表的心理测量学特性。结果每个维度保留了2个较优的条目(感知的羞辱维度保留了4个条目)，形成12条目的简化版量表(HBVSS-12)。HBVSS-12 Cronbach's α系数为0.903，各维度Cronbach's α系数介于0.670~0.856之间；验证性因子分析拟合度指标为：标准化残差均方和平方根=0.038，近似误差均方根=0.074，比较拟合指数=0.958，非规准适配指标=0.937；项目反应理论分析显示各条目区分度介于1.22~2.71之间，难度参数介于-3.24~3.15之间，条目平均信息量介于0.413~1.711之间。与原量表相比，HBVSS-12的各维度仍能保留56.23%~82.72%的信息量，总量表保留了73.20%的信息量。结论 HBVSS-12具有良好的信度、效度和项目质量，可以作为慢性HBV感染相关歧视研究的简单有效工具。
- 慢性乙型病毒性肝炎 /
- 歧视 /
- 项目反应理论 /
- 条目筛选 /
- 简化版
Abstract: Objective To develop and evaluate a shortened version of the chronic hepatitis B virus infection-related stigma scale (HBVSS). Methods A total of 1 058 people with chronic HBV-infections were administered by convenient sampling method in this study. The data of 529 subjects were randomly selected as a training sample for item screening by classical test theory and item response theory (IRT). The data of the remaining 529 subjects were used as a validation sample to evaluate the psychometric properties of the shortened version scale. Results 2 better items remained within each dimension (perceived stigma dimension remained 4 items) of the original HBVSS, a shortened version HBVSS-12 was formed. Cronbach'α of HBVSS-12 was 0.670-0.856 for each dimension and 0.903 for the total scale. Confirmatory factor analysis showed acceptable goodness-of-fit (standardized root mean square residual=0.038, root mean square error of approximation=0.074, comparative fit index=0.958 and Tucker-Lewis index=0.937). IRT discrimination parameters were estimated to be 1.22-2.71 and difficulty parameters, -3.24-3.15. Average item information ranged from 0.413-1.711. Compared with the original scale, the average information of HBVSS-12 was reserved from 56.23%-82.72% for each dimension and 73.20% for the total scale. Conclusion The HBVSS-12 showed good reliability, validity, and item quality, making it simple and effective for assessing chronic HBV infection-related stigma.
- Chronic viral hepatitis B /
- Stigma /
- Item response theory /
- Item screening /
- Shortened version

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表 1 训练样本和考核样本的统计描述及对比结果[n(%)]

Table 1. Descriptive statistics and comparison results of training and validation sample [n(%)]

基本特征	训练样本 (n=529)	考核样本 (n=529)	t/χ²/W值	P值	基本特征	训练样本 (n=529)	考核样本 (n=529)	t/χ²/W值	P值
年龄(x±s, 岁)	34.07±8.98	33.85±9.34	0.389	0.697	诊断			0.534	0.766
年龄组(岁)			0.100	0.752	无症状病毒携带者	40(7.7)	37(7.2)
18~＜36	323(61.1)	328(62.0)			慢性乙肝	414(79.3)	405(78.3)
≥36~60	206(38.9)	201(38.0)			乙肝肝硬化	68(13.0)	75(14.5)
性别			0.498	0.481	病情			269 412	0.675
男	433(81.9)	424(80.2)			轻度	310(59.0)	313(60.3)
女	96(18.1)	105(19.8)			中度	178(33.9)	171(32.9)
文化程度			0.642	0.423	重度	37(7.0)	35(6.7)
高中及以下	275(52.0)	288(54.4)			居住地			0.851	0.356
高中以上	254(48.0)	241(45.6)			城市/城镇	264(49.9)	249(47.1)
婚姻状况			0.370	0.543	农村	265(50.1)	280(52.9)
未婚	150(28.4)	159(31.1)			HBVSS得分(x±s, 分)
已婚	379(71.6)	370(69.9)			外在歧视	2.74±0.74	2.76±0.79	0.465	0.642
职业			4.080	0.130	负性自我评价	2.80±0.83	2.84±0.90	0.739	0.46
体力劳动者	238(45.0)	242(45.7)			感知的羞辱	2.89±0.77	2.90±0.83	0.249	0.803
脑力劳动者	249(47.1)	261(49.3)			保密病情	3.38±0.83	3.41±0.84	0.669	0.504
无业	42(7.9)	26(4.9)			继发歧视	2.26±0.72	2.29±0.80	0.712	0.477

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表 2 HBVSS条目筛选结果

Table 2. Item selection results of HBVSS

条目	基于GRM的IRT分析			CTT分析				被选入次数(次)	是否保留条目
条目	区分度参数a	难度/阈值参数b	θ∈(-3, 3)信息量平均值	相关系数r	Cronbach's α系数	标准偏差	CFA因子负荷	被选入次数(次)	是否保留条目
外在歧视					0.778
R1	1.21	-0.77~3.32	0.384	0.704	0.759	1.108 ^a	0.567	1	否
R2	0.89	-3.86~2.76 ^a	0.234	0.613	0.786	1.005	0.445	1	否
R3	1.48 ^a	-1.92~2.89	0.607 ^a	0.789 ^a	0.705 ^a	0.965	0.723 ^a	5	是
R4	1.34	-2.35~2.76 ^a	0.503	0.734	0.732	0.986	0.669	1	否
R5	2.15 ^a	-1.75~1.99	1.200^a	0.808 ^a	0.695 ^a	1.006 ^a	0.824 ^a	6	是
负性自我评价					0.785
N6	1.24	-1.89~2.45 ^a	0.444	0.784	0.745	1.169 ^a	0.622	2	否
N7	1.33	-2.25~2.05	0.509	0.792 ^a	0.732 ^a	1.137 ^a	0.648	3	否
N8	2.14 ^a	-1.98~1.98	1.186 ^a	0.802 ^a	0.708 ^a	1.008	0.801 ^a	5	是
N9	1.59 ^a	-1.70~2.78 ^a	0.678 ^a	0.748	0.744	0.948	0.691 ^a	4	是
感知的羞辱					0.883
P10	1.92	-1.87~2.67 ^a	0.939	0.696	0.876	0.905	0.664	1	否
P11	2.00	-1.96~2.58 ^a	0.998	0.731	0.871	0.912	0.691	1	否
P12	2.43 ^a	-1.92~2.13 ^a	1.447 ^a	0.799 ^a	0.861 ^a	0.955	0.773 ^a	6	是
P13	2.40 ^a	-2.09~1.73	1.404 ^a	0.818 ^a	0.858 ^a	1.021 ^a	0.775 ^a	6	是
P14	2.10 ^a	-1.87~2.13 ^a	1.148 ^a	0.780 ^a	0.864 ^a	0.994 ^a	0.731 ^a	7	是
P15	2.32 ^a	-2.03~1.64	1.315 ^a	0.794 ^a	0.863 ^a	1.086 ^a	0.745 ^a	6	是
P16	1.94	-2.03~1.64	0.983	0.758	0.871	1.124 ^a	0.690	1	否
保密病情					0.825
D17	1.24 ^a	-3.16~1.59	0.430 ^a	0.833 ^a	0.764 ^a	1.053 ^a	0.770 ^a	6	是
D18	1.13	-3.71~1.91 ^a	0.351	0.781	0.795	0.980	0.696	1	否
D19	1.12	-3.75~1.73 ^a	0.358	0.855 ^a	0.744 ^a	1.013	0.813 ^a	4	是
D20	1.36 ^a	-2.42~2.37	0.522 ^a	0.771	0.812	1.048 ^a	0.670	3	否
继发歧视					0.858
S21	1.55 ^a	-1.86~3.10 ^a	0.622 ^a	0.868	0.846	0.863 ^a	0.767	4	是
S22	1.46 ^a	-1.70~3.40 ^a	0.546 ^a	0.891 ^a	0.785 ^a	0.818^a	0.843 ^a	7	是
S23	1.32	-1.64~4.12	0.445	0.893 ^a	0.773 ^a	0.776	0.856 ^a	3	否
注：^a表示基于该参数值，所在条目被选入次数累计1次。

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表 3 HBVSS和HBVSS-12的平均信息量及信度

Table 3. Average information and reliability comparison of HBVSS and HBVSS-12

维度	θ∈(-3, 3)平均信息量			Cronbach's α系数
维度	HBVSS	HBVSS-12	差异(%)	HBVSS	HBVSS-12
外在歧视	2.927	1.646	1.281(43.77)	0.778	0.670
负性自我评价	2.817	2.330	0.487(17.28)	0.785	0.750
感知的羞辱	8.234	6.153	2.080(25.26)	0.883	0.856
保密病情	1.662	1.010	0.653(39.27)	0.825	0.757
继发歧视	1.613	1.289	0.324(20.10)	0.858	0.800
总量表	18.343	13.428	4.915(26.80)	0.926	0.903

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表 4 HBVSS-12的IRT分析

Table 4. Results of parameter estimation using IRT in HBVSS-12

条目	a(s_x)	b₁(s_x)	b₂(s_x)	b₃(s_x)	b₄(s_x)	θ∈(-3, 3)信息量平均值
1	1.60(0.14)	-1.81(0.19)	-0.23(0.09)	1.03(0.12)	2.80(0.30)	0.693
2	1.88(0.15)	-1.92(0.18)	-0.30(0.08)	0.83(0.10)	2.14(0.20)	0.953
3	2.40(0.18)	-1.68(0.14)	-0.39(0.06)	0.48(0.07)	1.67(0.14)	1.397
4	1.91(0.16)	-1.42(0.14)	0.16(0.07)	1.14(0.11)	2.52(0.25)	0.933
5	2.57(0.20)	-1.62(0.14)	-0.26(0.06)	0.59(0.07)	1.92(0.16)	1.565
6	2.56(0.19)	-1.81(0.16)	-0.57(0.07)	0.23(0.06)	1.59(0.12)	1.547
7	2.71(0.20)	-1.66(0.13)	-0.24(0.06)	0.67(0.07)	1.90(0.15)	1.711
8	2.34(0.18)	-1.87(0.16)	-0.48(0.07)	0.27(0.07)	1.53(0.13)	1.331
9	1.22(0.12)	-3.24(0.34)	-1.62(0.18)	-0.59(0.12)	1.55(0.20)	0.413
10	1.49(0.13)	-2.87(0.28)	-1.44(0.15)	-0.42(0.09)	1.45(0.16)	0.597
11	1.51(0.14)	-1.68(0.18)	0.43(0.10)	1.74(0.17)	3.15(0.37)	0.606
12	1.62(0.14)	-1.43(0.16)	0.56(0.09)	1.74(0.16)	2.82(0.33)	0.683

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参考文献(29)

[1]	Liu J, Liang W, Jing W, et al. Countdown to 2030: eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238. DOI: 10.2471/BLT.18.219469.
[2]	Devin RS, Ivane G, Mindie HN, et al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study[J]. Lancet Gastroenterol Hepatol, 2018, 3(6): 383-403. DOI: 10.1016/S2468-1253(18)30056-6.
[3]	刘珏, 刘民. 我国实现WHO 2030消除乙型肝炎目标的进展与挑战[J]. 中华流行病学杂志, 2019, 40(6): 605-609. DOI: 10.3760/cma.j.issn.0254-6450.2019.06.001. Liu J, Liu M. Progress and challenges in achieving the WHO goal on 'Elimination of Hepatitis B by 2030' in China[J]. Chin J Epidemiol, 2019, 40(6): 605-609. DOI: 10.3760/cma.j.issn.0254-6450.2019.06.001.
[4]	Mokaya J, McNaughton AL, Burbridge L, et al. A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection-a systematic review[J]. Wellcome Open Res, 2018, 3: 29. DOI: 10.12688/wellcomeopenres.14273.2.
[5]	王慧, 孟美芬, 范卢明. 乙型肝炎病人病耻感的研究进展[J]. 全科护理, 2017, 15(7): 791-793. DOI: 10.3969/j.issn.1674-4748.2017.07.008. Wang H, Meng MF, Fan LM. Research progress of stigma in patients with hepatitis B[J]. Chinese General Practice Nursing, 2017, 15(7): 791-793. DOI: 10.3969/j.issn.1674-4748.2017.07.008.
[6]	杨彩霞, 谷灿, 朱柏宁, 等. 慢性乙型肝炎病人病耻感的研究进展[J]. 全科护理, 2017, 15(17): 2066-2068. DOI: 10.3969/j.issn.1674-4748.2017.17.007. Yang CX, Gu C, Zhu BN, et al. Research progress of stigma in patients with chronic hepatitis B[J]. Chinese General Practice Nursing, 2017, 15(17): 2066-2068. DOI: 10.3969/j.issn.1674-4748.2017.17.007.
[7]	Smith-Palmer J, Cerri K, Sbarigia U, et al. Impact of Stigma on People Living with Chronic Hepatitis B[J]. Patient Relat Outcome Meas, 2020, 11: 95-107. DOI: 10.2147/PROM.S226936.
[8]	冯丽芬, 谢俊强, 邹霞, 等. 慢性乙肝病毒感染者歧视测量量表信效度的初步研究[J]. 中华行为医学与脑科学杂志, 2012, 21(4): 370-372. DOI: 10.3760/cma.j.issn.1674-6554.2012.04.028. Feng LF, Xie JQ, Zou X, et al. Preliminary study on validity and reliability of the chronic HBV-infections related stigma scale[J]. Chin J Behav Med & Brain Sci, 2012, 21(4): 370-372. DOI: 10.3760/cma.j.issn.1674-6554.2012.04.028.
[9]	梁首勤, 潘寒寒, 王洁. 慢性乙型肝炎病人焦虑抑郁情绪与病耻感的相关性研究[J]. 全科护理, 2020, 18(19): 2322-2326. DOI: 10.12104/j.issn.1674-4748.2020.19.005. Liang SQ, Pan HH, Wang J. Study on correlation between anxiety and depression and stigma in patients with chronic hepatitis B[J]. Chinese General Practice Nursing, 2020, 18(19): 2322-2326. DOI: 10.12104/j.issn.1674-4748.2020.19.005.
[10]	黄芳芳, 尹志勤. 育龄期慢性乙肝病毒感染者歧视测量及抑郁性认知的研究[J]. 数理医药学杂志, 2019, 32(9): 1343-1346. DOI: 10.3969/j.issn.1004-4337.2019.09.035. Huang FF, Yin ZQ. Study on discrimination measurement and depressive cognition in reproductive age patients with chronic hepatitis B virus infection[J]. Journal of Mathematical Medicine, 2019, 32(9): 1343-1346. DOI: 10.3969/j.issn.1004-4337.2019.09.035.
[11]	杜艳华, 娄小平, 白霞. 青年慢性乙肝患者病耻感现状及影响因素分析[J]. 糖尿病天地, 2020, 17(2): 164-166. https://cdmd.cnki.com.cn/Article/CDMD-10459-1020045866.htm Du YH, Lou XP, Bai X. Status and influencing factors of stigma in young patients with chronic hepatitis B[J]. Diabetes World, 2020, 17(2): 164-166. https://cdmd.cnki.com.cn/Article/CDMD-10459-1020045866.htm
[12]	汤月玲, 胡婷婷, 王国丽. 慢性乙型肝炎住院患者感知乙肝歧视的调查分析[J]. 实用临床护理学电子杂志, 2019, 4(33): 67. https://www.cnki.com.cn/Article/CJFDTOTAL-SLHL201933060.htm Tang YL, Hu TT, Wang GL. Investigation on perception of hepatitis B stigma among inpatients with chronic hepatitis B[J]. Electronic Journal of Practical Clinical Nursing Science, 2019, 4(33): 67. https://www.cnki.com.cn/Article/CJFDTOTAL-SLHL201933060.htm
[13]	孙方彪. 慢性乙型肝炎患者焦虑抑郁情绪与病耻感的相关性[J]. 辽宁医学杂志, 2019, 33(6): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-LNYX201906020.htm Sun FB. Correlation between anxiety, depression and stigma in patients with chronic hepatitis B[J]. Medical Journal of Liaoning, 2019, 33(6): 54-57. https://www.cnki.com.cn/Article/CJFDTOTAL-LNYX201906020.htm
[14]	Chen L, Yue P, Lamb KV, et al. Stigma in HBV-infected pregnant women in disclosed situations: current status, influencing factors, and impacts on the quality of life[J]. Appl Nurs Res, 2020, 56: 151347. DOI: 10.1016/j.apnr.2020.151347.
[15]	洪春霞, 魏钦令, 程敏锋, 等. 慢性肝炎患者病耻感及其对交往焦虑、一般自我效能感的影响[J]. 中华行为医学与脑科学杂志, 2011, 20(9): 809-811. DOI: 10.3760/cma.j.issn.1674-6554.2011.09.014. Hong CX, Wei QL, Cheng MF, et al. Illness-related stigma and its effect on interaction anxiousness and general self-efficacy in outpatients with chronic viral hepatitis[J]. Chin J Behav Med & Brain Sci, 2011, 20(9): 809-811. DOI: 10.3760/cma.j.issn.1674-6554.2011.09.014.
[16]	刘明波, 周瑾岚. 大学生对乙肝患者受歧视的认知状况调查[J]. 中国学校卫生, 2010, 31(11): 1385-1386. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201011047.htm Liu MB, Zhou JL. Investigation on college students' cognition of stigma against hepatitis B patients[J]. Chin J Sch Health, 2010, 31(11): 1385-1386. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201011047.htm
[17]	Cotler SJ, Cotler S, Xie H, et al. Characterizing hepatitis B stigma in Chinese immigrants[J]. J Viral Hepat, 2012, 19(2): 147-152. DOI: 10.1111/j.1365-2893.2011.01462.x.
[18]	Wright K, Naar-King S, Lam P, et al. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth[J]. J Adolesc Health, 2007, 40(1): 96-98. DOI: 10.1016/j.jadohealth.2006.08.001.
[19]	Kalichman SC, Simbayi LC, Cloete A, et al. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale[J]. AIDS Care, 2009, 21(1): 87-93. DOI: 10.1080/09540120802032627.
[20]	中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010年版)[J]. 中华肝脏病杂志, 2011, 19(1): 13-24. DOI: 10.3760/cma.j.issn.1007-3418.2011.01.007. Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B (2010 version)[J]. Chin J Hepatol, 2011, 19(1): 13-24. DOI: 10.3760/cma.j.issn.1007-3418.2011.01.007.
[21]	臧运洪, 赵守盈, 陈维, 等. 用项目反应理论修订父母同伴依恋量表[J]. 贵州师范大学学报(自然科学版), 2012, 30(2): 22-27. DOI: 10.3969/j.issn.1004-5570.2012.02.005. Zang YH, Zhao SY, Chen W, et al. Modifying parents peer attachment scale with item response theory[J]. Journal of Guizhou Normal University (Natural Sciences), 2012, 30(2): 22-27. DOI: 10.3969/j.issn.1004-5570.2012.02.005.
[22]	涂冬波, 蔡艳. 信息函数在标准参照测验中的应用研究[J]. 江西师范大学学报(自然科学版), 2005, 29(2): 167-172. DOI: 10.3969/j.issn.1000-5862.2005.02.021. Tu DB, Cai Y. Research on application of information function in criterion-referenced test[J]. Journal of Jiangxi Normal University (Natural Sciences Edition), 2005, 29(2): 167-172. DOI: 10.3969/j.issn.1000-5862.2005.02.021.
[23]	Choi SW, Gibbons LE, Crane PK. lordif: an R package for detecting differential item functioning using iterative hybrid ordinal Logistic regression/item response theory and monte carlo simulations[J]. J Stat Softw, 2011, 39(8): 1-30. DOI: 10.18637/jss.v039.i08.
[24]	Amtmann D, Liljenquist KS, Bamer A, et al. Development and validation of the University of Washington caregiver stress and benefit scales for caregivers of children with or without serious health conditions[J]. Qual Life Res, 2020, 29(5): 1361-1371. DOI: 10.1007/s11136-019-02409-0.
[25]	林岳卿, 方积乾. 世界卫生组织生存质量老年人量表简化版的研制[J]. 中国临床心理学杂志, 2011, 19(1): 27-30. DOI: 10.16128/j.cnki.1005-3611.2011.01.021. Lin YQ, Fang JQ. Development of a short form of WHOQOL-OLD[J]. Chin J Clin Psychol, 2011, 19(1): 27-30. DOI: 10.16128/j.cnki.1005-3611.2011.01.021.
[26]	Ye ZJ, Liang MZ, Zhang HW, et al. Psychometric properties of the Chinese version of resilience scale specific to cancer: an item response theory analysis[J]. Qual Life Res, 2018, 27(6): 1635-1645. DOI: 10.1007/s11136-018-1835-2.
[27]	Smit EB, Bouwstra H, van der Wouden J C, et al. Development of a patient-reported outcomes measurement information system (PROMIS) short form for measuring physical function in geriatric rehabilitation patients[J]. Qual Life Res, 2020, 29(9): 2563-2572. DOI: 10.1007/s11136-020-02506-5.
[28]	路桃影, 吴大嵘. 简短版量表研究中条目筛选方法概述[C]//中国中西医结合学会循证医学专业委员会. 第七届中医/中西医结合循证医学方法研讨会会议材料. 广州: 中国中西医结合学会, 2013: 95-102. Lu TY, Wu DR. Item selection methods in the scale short-form development study: an overview[C]//The Evidence-based Medicine Specialty Committee of Chinese Association of Integrative Medicine. Materials of 7th symposium on evidence-based Chinese medicine/integrative medicine. Guangzhou: Chinese Association of Integrative Medicine, 2013: 95-102.
[29]	韩耀风, 郝元涛, 方积乾. 项目反应理论及其在生存质量研究中的应用[J]. 中国卫生统计, 2006, 23(6): 562-565. DOI: 10.3969/j.issn.1002-3674.2006.06.032. Han YF, Hao YT, Fang JQ. Item response theory and its application in quality of life research[J]. Chin J Health Statistics, 2006, 23(6): 562-565. DOI: 10.3969/j.issn.1002-3674.2006.06.032.