{"id":26395,"date":"2023-03-06T13:05:31","date_gmt":"2023-03-06T10:05:31","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=26395"},"modified":"2023-03-21T13:48:08","modified_gmt":"2023-03-21T10:48:08","slug":"antibiyotik-algilari-olceginin-uyarlanmasi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/03\/06\/antibiyotik-algilari-olceginin-uyarlanmasi\/","title":{"rendered":"Anne ve Babalar\u0131n Antibiyotik Alg\u0131lar\u0131 \u00d6l\u00e7e\u011fi\u2019nin T\u00fcrk\u00e7eye Uyarlanmas\u0131"},"content":{"rendered":"

G\u0130R\u0130\u015e\u00a0<\/span><\/h2>\n

Ak\u0131lc\u0131 antibiyotik kullan\u0131m\u0131 (AAK); hastalar\u0131n klinik ihtiya\u00e7lar\u0131na uygun ila\u00e7lar\u0131, kendi bireysel gereksinimlerini kar\u015f\u0131layan dozlarda, yeterli bir s\u00fcre boyunca, kendilerine ve topluma en d\u00fc\u015f\u00fck maliyetle almalar\u0131n\u0131 gerektirir (1,2). Ak\u0131lc\u0131 olmayan antibiyotik kullan\u0131m\u0131 (AOAK) ise; antibiyotiklerin AAK prensipleri g\u00f6z \u00f6n\u00fcne al\u0131nmadan, uygunsuz veya a\u015f\u0131r\u0131 kullan\u0131m\u0131d\u0131r. AOAK d\u00fcnya genelinde yayg\u0131n olup \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunudur. AOAK i\u00e7in hasta ve hasta yak\u0131nlar\u0131 ile ili\u015fkili fakt\u00f6rler, hekime dan\u0131\u015fmadan antibiyotik kullanma, tedaviyi tamamlamak i\u00e7in gereken s\u00fcrede ilac\u0131 kullanmaya devam etmeme ve dozlar\u0131 atlamad\u0131r (3-5). AOAK, bireylerin tedavilerinin ba\u015far\u0131s\u0131zl\u0131\u011f\u0131na ve komplikasyonlar\u0131n art\u0131\u015f\u0131na neden olarak mikroorganizmalar\u0131n antimikrobiyal ajanlara kar\u015f\u0131 diren\u00e7 geli\u015ftirmesi sonucu mevcut tedavi se\u00e7eneklerini azaltarak toplumu da etkilemektedir (6,7).<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)\u2019n\u00fcn antibiyotik t\u00fcketimine ili\u015fkin raporuna g\u00f6re genel antibiyotik t\u00fcketimi g\u00fcnde 1000 ki\u015fi ba\u015f\u0131na 4.4 ila 64.4 tan\u0131mlanm\u0131\u015f g\u00fcnl\u00fck doz [\u201cdefined daily dose\u201d (DDD)] aras\u0131nda de\u011fi\u015fmektedir; k\u00fcresel boyutta toplam antibiyotik t\u00fcketimi 2000-2010 y\u0131llar\u0131 aras\u0131nda %30 artm\u0131\u015ft\u0131r (6,8,9). T\u00fcrkiye, antibiyotik t\u00fcketiminin ve antimikrobiyal direncin y\u00fcksek oldu\u011fu \u00fclkelerden biridir (5). DS\u00d6\u2019n\u00fcn 2016-2018 Antibiyotik T\u00fcketim Raporu\u2019na g\u00f6re, 2016 y\u0131l\u0131nda T\u00fcrkiye\u2019de bir g\u00fcnde 1000 ki\u015fiye d\u00fc\u015fen tan\u0131mlanm\u0131\u015f g\u00fcnl\u00fck doz 38.18 olarak a\u00e7\u0131klanm\u0131\u015ft\u0131r (6). \u00c7ocukluk \u00e7a\u011f\u0131, antibiyotiklerin s\u0131k kullan\u0131ld\u0131\u011f\u0131 d\u00f6nemlerdendir. Uygunsuz antibiyotik kullan\u0131m\u0131n\u0131n artmas\u0131 sonucunda \u00e7ocuklarda da yeti\u015fkinlere benzer \u015fekilde yan etkiler ortaya \u00e7\u0131kmakta ve antibiyotik direnci artmaktad\u0131r (10-14). Anne ve babalar\u0131n antibiyotiklerle ilgili yanl\u0131\u015f alg\u0131s\u0131, \u00e7ocuklarda AOAK\u2019ye neden olan temel fakt\u00f6rlerden biridir (13,15).<\/p>\n

Anne ve babalar\u0131n antibiyotik alg\u0131lar\u0131n\u0131 de\u011ferlendirmek amac\u0131yla Alumran ve arkada\u015flar\u0131 taraf\u0131ndan Antibiyotikler i\u00e7in Ebeveyn Alg\u0131s\u0131 \u00d6l\u00e7e\u011fi [Parental Perceptions on Antibiotics (PAPA) Scale] gelis\u0327tirilmis\u0327tir (15-18). T\u00fcrkiye\u2019de ise anne ve babalar\u0131n antibiyotik alg\u0131lar\u0131n\u0131 \u00f6l\u00e7meye y\u00f6nelik ge\u00e7erli ve g\u00fcvenilir bir ara\u00e7 bulunmamaktad\u0131r. Bu aras\u0327t\u0131rman\u0131n amac\u0131, Antibiyotikler i\u00e7in Ebeveyn Alg\u0131s\u0131 \u00d6l\u00e7e\u011fi\u2019nin T\u00fcrk\u00e7eye uyarlanmas\u0131d\u0131r. Uyarlama a\u015famas\u0131nda \u00f6l\u00e7e\u011fin T\u00fcrk\u00e7e ismi Anne ve Babalar\u0131n Antibiyotik Alg\u0131lar\u0131 \u00d6l\u00e7e\u011fi ve k\u0131saltmas\u0131 ABANA olarak belirlendi.\u00a0<\/span><\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Bu ara\u015ft\u0131rma bir \u00f6l\u00e7ek ge\u00e7erlik \u00e7al\u0131\u015fmas\u0131d\u0131r. Ara\u015ft\u0131rman\u0131n evrenini, Denizli il merkezinde ilkokullarda \u00f6\u011frenim g\u00f6ren \u00f6\u011frencilerin anne veya babalar\u0131 olu\u015fturmaktad\u0131r. \u00d6l\u00e7ek uyarlama \u00e7al\u0131\u015fmalar\u0131nda \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcn\u00fcn belirlenmesi i\u00e7in \u00e7e\u015fitli \u00f6neriler bulunmaktad\u0131r. Comrey ve Lee (19), 50\u2019nin \u201c\u00e7ok zay\u0131f\u201d, 100\u2019\u00fcn \u201czay\u0131f\u201d, 200\u2019\u00fcn \u201corta\u201d, 300\u2019\u00fcn \u201ciyi\u201d, 500\u2019\u00fcn \u201c\u00e7ok iyi\u201d ve 1000\u2019in \u201cm\u00fckemmel\u201d oldug\u0306unu vurgulamaktad\u0131r. Kline (20), \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcn\u00fcn madde say\u0131s\u0131n\u0131n 10 kat\u0131; Bryman ve Cramer (21) ise be\u015f ya da 10 kat\u0131 olmas\u0131n\u0131n uygun oldu\u011funu bildirmektedir. Ara\u015ft\u0131rma \u00f6rneklemi i\u00e7in Denizli \u0130l Merkezi\u2019ndeki d\u00fc\u015f\u00fck ve y\u00fcksek sosyoekonomik seviyeyi temsil eden iki ilkokul k\u00fcme \u00f6rneklem y\u00f6ntemi ile se\u00e7ildi; se\u00e7ilen okullardaki t\u00fcm uygun \u00f6\u011frencilere ula\u015f\u0131lmas\u0131 planland\u0131. Denizli Pamukkale Vak\u0131fbank \u0130lkokulu (n=738) ve Okul Yapt\u0131rma ve Ya\u015fatma Derne\u011fi \u0130lkokulu (n=693)\u2019nda \u00f6\u011frenim g\u00f6ren toplam 1431 \u00f6\u011frenciden 162\u2019si yabanc\u0131 uyruklu olmas\u0131, 90\u2019\u0131 ise ara\u015ft\u0131rma kriterlerini sa\u011flamamas\u0131 nedeniyle ara\u015ft\u0131rmaya dahil edilmedi. Anket formu anne veya babas\u0131 taraf\u0131ndan yan\u0131tlanan t\u00fcm \u00f6\u011frenciler ara\u015ft\u0131rmaya dahil edildi. Yabanc\u0131 uyruklu olma (n=162) d\u0131\u015f\u0131ndaki ara\u015ft\u0131rmaya dahil edilmeme nedenleri ve s\u0131kl\u0131klar\u0131; anket formunda anne ve baban\u0131n birlikte i\u015faretleme yapmas\u0131 (n=28), \u00f6l\u00e7ek sorular\u0131n\u0131n %20\u2019sinden fazlas\u0131na yan\u0131t verilmemi\u015f olmas\u0131 (n=25), anne ve baba d\u0131\u015f\u0131ndaki di\u011fer ki\u015filer taraf\u0131ndan i\u015faretleme yap\u0131lmas\u0131 (n=20) ve \u00e7ocu\u011fun anne veya babas\u0131 oldu\u011funun belirtilmemesidir (n=17). Ula\u015f\u0131lmas\u0131 hedeflenen \u00f6rneklem say\u0131s\u0131, d\u00fc\u015f\u00fck sosyoekonomik b\u00f6lgeden 534 (%45.3) ve y\u00fcksek sosyoekonomik b\u00f6lgeden 645 (%54.7) olmak \u00fczere toplam 1179 (%100) ki\u015fi olarak belirlendi. Ara\u015ft\u0131rmada 1008 (%85.5) ki\u015fiye ula\u015f\u0131ld\u0131.<\/p>\n

Veri toplama arac\u0131 olarak; ailenin demografik ve sosyoekonomik \u00f6zelliklerini sorgulayan 10 ve sa\u011fl\u0131k ile ilgili \u00f6zelliklerini sorgulayan be\u015f soru olmak \u00fczere toplamda 15 soruluk anket formu ile 31 \u00f6nermeden olu\u015fan ve PAPA \u00f6l\u00e7e\u011finden uyarlanan ABANA \u00d6l\u00e7e\u011fi kullan\u0131ld\u0131. PAPA \u00d6l\u00e7e\u011fi; 2014 y\u0131l\u0131nda Alumran ve arkada\u015flar\u0131 taraf\u0131ndan geli\u015ftirilen, be\u015f alt boyuttan olu\u015fan ve 31 madde i\u00e7eren bir \u00f6l\u00e7ektir. Anne ve babalara, \u201ckesinlikle kat\u0131lm\u0131yorum<\/i>\u201d, \u201ckat\u0131lm\u0131yorum<\/i>\u201d, \u201ckarars\u0131z\u0131m<\/i>\u201d, \u201ckat\u0131l\u0131yorum<\/i>\u201d, \u201ckesinlikle kat\u0131l\u0131yorum<\/i>\u201d veya \u201chi\u00e7bir zaman<\/i>\u201d, \u201cnadiren<\/i>\u201d, \u201cbazen<\/i>\u201d, \u201cs\u0131k s\u0131k<\/i>\u201d, \u201cher zaman<\/i>\u201d \u015feklinde yan\u0131tlar\u0131n verildi\u011fi 5\u2019li Likert \u00f6l\u00e7e\u011finde sorular sorulur; yan\u0131tlara s\u0131ras\u0131yla birden be\u015fe kadar puan verilir (15-18). \u00d6l\u00e7e\u011fin bir kesme noktas\u0131 bulunmamaktad\u0131r. \u00d6l\u00e7ekten al\u0131nan puan\u0131n artmas\u0131 ki\u015finin daha iyi antibiyotik alg\u0131s\u0131na sahip oldu\u011funu g\u00f6stermektedir. ABANA \u00d6l\u00e7eg\u0306i, PAPA \u00d6l\u00e7e\u011fi ile uyumlu olarak; bilgi ve inan\u00e7lar (10 madde), davran\u0131\u015flar (5 madde), bilgi arama (7 madde), uyum (5 madde) ve antibiyotik direnci hakk\u0131nda fark\u0131ndal\u0131k (4 madde) olmak \u00fczere be\u015f alt boyuttan olu\u015fmaktad\u0131r. \u00d6zg\u00fcn \u00f6l\u00e7e\u011fin Cronbach alfa i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131 0.78\u2019dir.\u00a0<\/span><\/span><\/p>\n

Ara\u015ft\u0131rma 15 \u015eubat-15 Ekim 2018 tarihleri aras\u0131nda tamamland\u0131. Anket formlar\u0131 \u00f6\u011fretmenler taraf\u0131ndan \u00e7ocuklara da\u011f\u0131t\u0131larak velilerine ula\u015ft\u0131rmalar\u0131 istendi; formlar\u0131n belirlenen s\u00fcre sonunda \u00f6\u011fretmenlere geri teslim edilmesi kat\u0131l\u0131mc\u0131 onam\u0131 olarak kabul edildi. Ara\u015ft\u0131rma i\u00e7in Pamukkale \u00dcniversitesi T\u0131p Fak\u00fcltesi Giri\u015fimsel Olmayan Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 30 Ocak 2018 tarih ve 03 karar numaras\u0131yla onay al\u0131nd\u0131 ve Denizli \u0130l Milli E\u011fitim M\u00fcd\u00fcrl\u00fc\u011f\u00fc gerekli kurumsal izinleri verdi. \u00d6l\u00e7e\u011fi geli\u015ftiren ara\u015ft\u0131rmac\u0131lar ile de yaz\u0131l\u0131 (e-posta ile) ileti\u015fim kurularak \u00f6l\u00e7e\u011fin T\u00fcrk\u00e7eye uyarlanmas\u0131 ile ilgili gerekli izin al\u0131nd\u0131.\u00a0<\/span><\/p>\n

\u00d6zg\u00fcn dildeki bir \u00f6l\u00e7e\u011fi hedeflenen dile \u00e7evirirken; tek y\u00f6nl\u00fc \u00e7eviri, grup \u00e7evirisi ve geri \u00e7eviri olmak \u00fczere \u00fc\u00e7 yakla\u015f\u0131m kullan\u0131l\u0131r. \u00c7al\u0131\u015fmam\u0131zda tercih edilen geri \u00e7eviri y\u00f6nteminde \u00f6l\u00e7ek \u00f6nce \u00f6zg\u00fcn dilden kullan\u0131lacak dile \u00e7evrilmekte; ard\u0131ndan \u00e7eviri her iki dili de bilen \u00e7evirmen ya da \u00e7evirmenlerce kaynak dile geri \u00e7evrilmektedir. Geri \u00e7eviri metni \u00f6zg\u00fcn \u00f6l\u00e7ekle kar\u015f\u0131la\u015ft\u0131r\u0131larak gerekli de\u011fi\u015fiklikler ve d\u00fczeltmeler yap\u0131lmaktad\u0131r. Bu y\u00f6ntem zaman al\u0131c\u0131 olmas\u0131na kar\u015f\u0131n, \u00f6l\u00e7e\u011fin k\u00fclt\u00fcrel e\u015fitli\u011fini sa\u011flamak i\u00e7in d\u00fcnyada en \u00e7ok tercih edilen y\u00f6ntemdir (22,23).\u00a0<\/span><\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> ABANA \u00d6l\u00e7e\u011fi Dil Uyarlamas\u0131<\/p><\/div>\n

\u00d6l\u00e7ek iyi derecede \u0130ngilizce bilen, konu ile ilgili sa\u011fl\u0131k alan\u0131nda \u00e7al\u0131\u015fan \u00fc\u00e7 uzman taraf\u0131ndan, birbirinden ba\u011f\u0131ms\u0131z olarak T\u00fcrk\u00e7eye \u00e7evrildi. Bu \u00fc\u00e7 ayr\u0131 \u00e7eviri, ara\u015ft\u0131rmac\u0131lar taraf\u0131ndan ortakla\u015ft\u0131r\u0131ld\u0131. Ortakla\u015ft\u0131r\u0131lan T\u00fcrk\u00e7e formun anla\u015f\u0131l\u0131rl\u0131\u011f\u0131yla ilgili T\u00fcrk\u00e7e e\u011fitimi b\u00f6l\u00fcm\u00fcnden bir uzman\u0131n g\u00f6r\u00fc\u015f\u00fc al\u0131nd\u0131. Ortakla\u015ft\u0131r\u0131lan metin T\u00fcrk\u00e7e ve \u0130ngilizceyi iyi bilen iki uzman taraf\u0131ndan \u00f6zg\u00fcn dili olan \u0130ngilizceye geri \u00e7evrildi ve bu \u00e7eviri, \u00f6l\u00e7e\u011fin \u00f6zg\u00fcn formu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Bu a\u015famada, \u00f6zg\u00fcn \u00f6l\u00e7ek ifadelerine g\u00f6re herhangi bir anlam de\u011fi\u015fikli\u011fi olmad\u0131\u011f\u0131 belirlendi ve de\u011fi\u015fikli\u011fe gereksinim duyulmad\u0131 (\u015eekil 1).\u00a0<\/span><\/span><\/p>\n

Kapsam ge\u00e7erlili\u011fi i\u00e7in, farkl\u0131 kurumlarda \u00e7al\u0131\u015fan ve alanlar\u0131nda uzman 12 ki\u015fi belirlenerek g\u00f6r\u00fc\u015flerine ba\u015fvuruldu. T\u00fcrk\u00e7e formda yer alan sorular\u0131n i\u00e7erik olarak uygunlu\u011funa ili\u015fkin uzman g\u00f6r\u00fc\u015fleri, haz\u0131rlanan bir uzman de\u011ferlendirme formu kullan\u0131larak topland\u0131. Uzman de\u011ferlendirme formunda; ara\u015ft\u0131rmay\u0131 tan\u0131tan ve uzmandan beklentileri a\u00e7\u0131klayan k\u0131sa bir bilgilendirme yaz\u0131s\u0131, \u00f6l\u00e7e\u011fin yap\u0131s\u0131yla ilgili kuramsal \u00f6zet bilgiler ve her bir maddenin i\u00e7erik a\u00e7\u0131s\u0131ndan bulunduklar\u0131 fakt\u00f6rlere uygunlu\u011funa ili\u015fkin de\u011ferlendirmelerin yap\u0131laca\u011f\u0131 bir de\u011ferlendirme k\u0131sm\u0131 bulunmaktayd\u0131. Uzman g\u00f6r\u00fc\u015flerinin sa\u011fl\u0131kl\u0131 bir \u015fekilde de\u011ferlendirilebilmesi i\u00e7in kapsam ge\u00e7erlilik indeksi kullan\u0131ld\u0131. Kapsam ge\u00e7erlilik indeksi (KG\u0130), herhangi bir maddeye ili\u015fkin \u201colduk\u00e7a uygun<\/i>\u201d ve \u201c\u00e7ok uygun<\/i>\u201d g\u00f6r\u00fc\u015f\u00fcn\u00fc belirten uzman say\u0131s\u0131n\u0131n (NG<\/sub>), maddeye ili\u015fkin g\u00f6r\u00fc\u015f belirten toplam uzman say\u0131s\u0131na (N) b\u00f6l\u00fcnmesi ile elde edilir (KG\u0130=NG<\/sub>\/N). Uzmanlardan, maddelerin \u00f6l\u00e7ekte yer ald\u0131klar\u0131 fakt\u00f6r i\u00e7in uygunlu\u011funa ili\u015fkin yan\u0131tlar\u0131n\u0131, \u201cuygun de\u011fil<\/i>\u201d, \u201cbiraz uygun<\/i>\u201d, \u201colduk\u00e7a uygun<\/i>\u201d, \u201c\u00e7ok uygun\u201d \u015feklinde 4\u2019l\u00fc Likert derecelendirme \u00f6l\u00e7e\u011fine uygun olarak vermeleri istendi ve her bir yan\u0131ta s\u0131ras\u0131yla birden d\u00f6rde kadar puan verildi. ABANA \u00d6l\u00e7e\u011fi kapsam ge\u00e7erlili\u011fi i\u00e7in on iki uzman de\u011ferlendirme yapt\u0131\u011f\u0131ndan kabul edilebilir en d\u00fc\u015f\u00fck de\u011fer 0.56\u2019d\u0131r (24). De\u011ferlendirmelerin ard\u0131ndan, uzmanlar\u0131n \u00f6nerileri do\u011frultusunda gerekli de\u011fi\u015fiklikler yap\u0131ld\u0131.<\/p>\n

\u00d6l\u00e7e\u011fin T\u00fcrk\u00e7e versiyonunun \u00f6n denemesi ilkokulda \u00f6\u011frenim g\u00f6ren \u00e7ocu\u011fu olan Pamukkale \u00dcniversitesi T\u0131p Fak\u00fcltesi idari personeli \u00fczerinde uyguland\u0131. Maddelerin okunabilirli\u011fi, anla\u015f\u0131lmayan yer olup olmad\u0131\u011f\u0131, \u00f6l\u00e7e\u011fin uygulanma s\u00fcresi ve \u00f6l\u00e7\u00fcmlerin yap\u0131lmas\u0131 hakk\u0131nda veriler elde edildi; gerekli d\u00fczeltmeler yap\u0131larak \u00f6l\u00e7e\u011fe son hali verildi. \u00d6n uygulaman\u0131n verileri ara\u015ft\u0131rma d\u0131\u015f\u0131nda b\u0131rak\u0131ld\u0131.<\/p>\n

Verilerin analizinde SPSS (Statistical Package for the Social Sciences) versiyon 17.0 program\u0131 (IBM Corp., Armonk, ABD) ve LISREL istatistik yaz\u0131l\u0131m\u0131 versiyon 8.80 (Scientific Software International Inc., ABD) kullan\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 istatistikler; say\u0131, y\u00fczde, ortalama ve standart sapma ile verildi. Yap\u0131 ge\u00e7erlili\u011fi i\u00e7in dog\u0306rulay\u0131c\u0131 fakt\u00f6r analizi (DFA) kullan\u0131ld\u0131. Uyum indeksleri olarak x2<\/sup>p de\u011feri, x2<\/sup>\/sd, \u201croot mean square error of approximation\u201d (RMSEA), \u201cstandardized root mean squared residual\u201d (SRMR), \u201cgoodness-of-fit index\u201d (GFI), \u201ccomparative fit index\u201d (CFI) ve non-normed fit index\u201d (NNFI) raporland\u0131. G\u00fcvenilirlik Cronbach alfa i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 ve test-tekrar test y\u00f6ntemi ile s\u0131nand\u0131. I\u0307statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n
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Tablo 1.<\/strong> Demografik ve Sosyoekonomik \u00d6zellikler<\/p><\/div>\n

Ara\u015ft\u0131rmaya dahil edilen \u00e7ocuklar\u0131n ya\u015f ortalamas\u0131 8.5\u00b11.2 olup %50.6\u2019s\u0131 erkekti. \u00c7ocuklar\u0131n %50.9\u2019u y\u00fcksek sosyoekonomik b\u00f6lge ilkokulunda \u00f6\u011frenim g\u00f6rmekteydi. Kat\u0131l\u0131mc\u0131lar\u0131n %68.8\u2019i anneydi; annelerin ya\u015f ortalamas\u0131 35.7\u00b15.0 ve babalar\u0131n ya\u015f ortalamas\u0131 39.4\u00b15.2 idi. Annelerin %51.2\u2019si, babalar\u0131n %56\u2019s\u0131 lise ve \u00fczeri \u00f6\u011frenim d\u00fczeyine sahipti. Ailelerin %76.3\u2019\u00fcn\u00fcn en uzun s\u00fcre ile ya\u015fad\u0131\u011f\u0131 yerle\u015fim birimi il merkezi olup 58.6\u2019s\u0131 gelirinin giderine e\u015fit oldu\u011funu bildirdi; %55.4\u2019\u00fc iki \u00e7ocu\u011fa sahipti. Ailelerin %21.6\u2019s\u0131n\u0131n ailesinde sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 bulunmaktayd\u0131 (Tablo 1).\u00a0<\/span><\/span><\/p>\n

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Tablo 2.<\/strong> Anne ve Babalar\u0131n Antibiyotik Alg\u0131lar\u0131 \u00d6l\u00e7e\u011fi Maddelerinin Kapsam Ge\u00e7erlilik \u0130ndeksleri<\/p><\/div>\n

ABANA \u00d6l\u00e7e\u011fi\u2019nde yer alan 31 maddenin her birinin KG\u0130 de\u011feri 0.56\u2019dan y\u00fcksek oldu\u011fu i\u00e7in uzmanlar\u0131n g\u00f6r\u00fc\u015fleri aras\u0131nda uyum oldu\u011fu belirlendi ve maddelerde de\u011fi\u015fiklik yap\u0131lmamas\u0131na karar verilerek \u00f6l\u00e7ek bu haliyle uyguland\u0131 (Tablo 2).\u00a0<\/span><\/p>\n

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Tablo 3.<\/strong> Anne ve Babalar\u0131n Antibiyotik Alg\u0131lar\u0131 \u00d6l\u00e7e\u011fi T\u00fcrk\u00e7e Formunun* Uyum \u0130ndeksi De\u011ferleri ve Uyum \u0130ndekslerinin S\u0131n\u0131r De\u011ferleri<\/p><\/div>\n

A\u00e7\u0131klay\u0131c\u0131 fakt\u00f6r analizi (AFA); yurt d\u0131\u015f\u0131nda ge\u00e7erlik ve g\u00fcvenilirli\u011fi kan\u0131tlanm\u0131\u015f bir \u00f6l\u00e7e\u011fin T\u00fcrk\u00e7eye uyarlanma s\u00fcrecinde yer almamakla birlikte \u00f6l\u00e7ek\/test geli\u015ftirme s\u00fcrecindeki i\u015flem basamaklar\u0131ndan biridir (25). G\u00fcvenilirlik analizleri, a\u00e7\u0131klay\u0131c\u0131 ve do\u011frulay\u0131c\u0131 fakt\u00f6r analizi sonu\u00e7lar\u0131 g\u00f6z \u00f6n\u00fcnde bulundurularak, \u201cGe\u00e7mi\u015fte, daha iyi hissetti\u011fi i\u00e7in \u00e7ocu\u011fuma antibiyotik vermeyi b\u0131rakt\u0131m<\/i>\u201d \u00f6nermesini i\u00e7eren \u00f6l\u00e7e\u011fin 26. maddesi davran\u0131\u015flar yerine uyum alt boyutuna al\u0131nd\u0131 ve olu\u015fturulan \u00f6l\u00e7ek T\u00fcrk\u00e7e form olarak adland\u0131r\u0131ld\u0131. T\u00fcrk\u00e7e form i\u00e7in be\u015f fakt\u00f6rl\u00fc modele g\u00f6re DFA yap\u0131ld\u0131 ve uyum istatistikleri incelendi. Analiz sonucundaki kare de\u011feri (\u03c72=1910.25, sd=422, p<\/i>=0.000) istatistiksel olarak anlaml\u0131 d\u00fczeyde olup \u03c72\/sd oran\u0131 4.52 ve di\u011fer uyum indeksi de\u011ferleri SRMR=0.06, GFI=0.90, RMSEA=0.06, CFI=0.95, NNFI=0.93 olarak saptand\u0131. Birinci d\u00fczey do\u011frulay\u0131c\u0131 fakt\u00f6r analizinin ard\u0131ndan \u00f6zg\u00fcn \u00f6l\u00e7e\u011fin ikinci d\u00fczey do\u011frulay\u0131c\u0131 fakt\u00f6r analizi yap\u0131ld\u0131. Analiz sonucundaki kare de\u011feri (\u03c72=1931.25, sd=427, p=0.000) istatistiksel olarak anlaml\u0131 d\u00fczeyde, \u03c72\/sd oran\u0131 4.52 ve di\u011fer uyum indeksi de\u011ferleri SRMR=0.06, GFI=0.90, RMSEA=0.06, CFI=0.95, NNFI=0.93 olarak saptand\u0131. \u00d6l\u00e7e\u011fin uyum indeksi de\u011ferlerinin iyi ya da m\u00fckemmel d\u00fczeyde oldu\u011fu tespit edildi (Tablo 3).<\/p>\n

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Tablo 4.<\/strong> T\u00fcrk\u00e7e ve \u00d6zg\u00fcn Formlar\u0131n Alt Boyutlar\u0131n\u0131n \u0130\u00e7 Tutarl\u0131l\u0131k Katsay\u0131lar\u0131<\/p><\/div>\n

\u00d6zg\u00fcn formun alt boyutlar\u0131na uyularak s\u0131nanan i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 alt boyutlar i\u00e7in 0.55 ile 0.86 aras\u0131nda de\u011fi\u015fmekte olup t\u00fcm \u00f6l\u00e7ek i\u00e7in 0.79 olarak bulundu. Davran\u0131\u015flar alt boyutundan yer alan 26. madde \u00e7\u0131kar\u0131ld\u0131\u011f\u0131nda bu alt boyutun i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131n\u0131n 0.55\u2019ten 0.78\u2019e y\u00fckseldi\u011fi g\u00f6r\u00fcld\u00fc; 26. madde davran\u0131\u015flar alt boyutundan uyum alt boyutuna al\u0131narak olu\u015fturulan T\u00fcrk\u00e7e formun i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 yeniden s\u0131nand\u0131. T\u00fcrk\u00e7e forma ait alt boyutlar\u0131n i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131n\u0131n 0.63 ile 0.86 aras\u0131nda de\u011fi\u015fmekte oldu\u011fu ve t\u00fcm \u00f6l\u00e7e\u011fin i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131n\u0131n ise 0.79 oldu\u011fu tespit edildi (Tablo 4).\u00a0<\/span><\/p>\n

T\u0131p literat\u00fcr\u00fcnde toplam \u00f6rneklem say\u0131s\u0131n\u0131n yakla\u015f\u0131k %10\u2019u b\u00fcy\u00fckl\u00fc\u011f\u00fcndeki bir gruba tekrar test yap\u0131lmas\u0131n\u0131n \u00f6rnekleri mevcuttur (26). ABANA \u00d6l\u00e7e\u011fi i\u00e7in de test-tekrar test uygulamas\u0131 98 kat\u0131l\u0131mc\u0131 ile ger\u00e7ekle\u015ftirildi. Ka\u011f\u0131t ve kalem kullan\u0131larak yap\u0131lan testlerde ikinci uygulaman\u0131n iki hafta sonra yap\u0131lmas\u0131 \u00f6nerilmektedir (27). Bu \u00f6neriye uygun olarak iki hafta arayla elde edilen ABANA \u00d6l\u00e7e\u011fi puan ortalamalar\u0131 s\u0131ras\u0131yla 122.07\u00b114.73 ve 123.43\u00b114.32 olarak tespit edilmi\u015f olup istatistiksel olarak anlaml\u0131 d\u00fczeyde ili\u015fki saptanmad\u0131 (p=0.879). Birinci ve ikinci \u00f6l\u00e7\u00fcmlerde elde edilen \u00f6l\u00e7ek puanlar\u0131 aras\u0131nda ise pozitif y\u00f6nde g\u00fc\u00e7l\u00fc ili\u015fki bulundu (r=0.88, p<\/i><0.001).\u00a0<\/span><\/span><\/p>\n

\u0130RDELEME<\/h2>\n

Anne ve Babalar\u0131n Antibiyotik Alg\u0131lar\u0131 \u00d6l\u00e7eg\u0306i T\u00fcrk\u00e7e formunun, anne ve babalar\u0131n antibiyotik alg\u0131lar\u0131n\u0131 \u00f6l\u00e7mede ge\u00e7erli ve g\u00fcvenilir bir \u00f6l\u00e7\u00fcm arac\u0131 oldu\u011fu saptand\u0131. Be\u015f fakt\u00f6rl\u00fc modelin birinci d\u00fczey do\u011frulay\u0131c\u0131 fakt\u00f6r analizi sonu\u00e7lar\u0131na g\u00f6re uyum indeksi de\u011ferleri \u201ciyi\u201d ya da \u201cm\u00fckemmel\u201d d\u00fczeydedir. T\u00fcrk\u00e7e forma ait be\u015f fakt\u00f6rl\u00fc modelin birinci d\u00fczey DFA\u2019s\u0131nda \u03c72\/sd de\u011feri 4.52 olarak bulundu. Bu oran\u0131n \u00fc\u00e7\u00fcn alt\u0131nda olmas\u0131 \u201cm\u00fckemmel\u201d, be\u015fin alt\u0131nda olmas\u0131 \u201ciyi\u201d uyuma i\u015faret etmektedir (28, 29). Model \u201ciyi\u201d d\u00fczeyde uyum g\u00f6sterdi. Modelin di\u011fer uyum indeksi de\u011ferleri; RMSEA=0.06, SRMR=0.06, GFI=0.90, CFI=0.95 ve NNFI=0.93\u2019t\u00fcr. RMSEA ve SRMR, 0 ile 1 aras\u0131nda de\u011fer almakla birlikte 0.05\u2019e e\u015fit ya da k\u00fc\u00e7\u00fck olan de\u011ferler \u201cm\u00fckemmel\u201d uyumu g\u00f6sterirken (28, 30-32); 0.08 ve alt\u0131ndaki de\u011ferler \u201ciyi\u201d d\u00fczeyde uyum olarak kabul edilmektedir (33-37). Be\u015f fakt\u00f6rl\u00fc model, RMSEA (0.06) ve SRMR (0.06) de\u011ferlerine g\u00f6re \u201ciyi\u201d d\u00fczeyde uyum g\u00f6stermektedir. Mutlak uyum indekslerinden GFI\u2019n\u0131n 0.95 ve \u00fczeri olmas\u0131 \u201cm\u00fckemmel\u201d uyumu (28, 38); 0.90-0.95 aras\u0131 olmas\u0131 \u201ciyi\u201d uyumu g\u00f6stermektedir (39). Be\u015f fakt\u00f6rl\u00fc model i\u00e7in bulunan GFI de\u011feri (0.90) \u201ciyi\u201d d\u00fczeyde uyumu g\u00f6stermektedir. Artmal\u0131 uyum indeksleri olan; CFI ve NNFI de\u011ferlerinin 0.95\u2019in \u00fcst\u00fcnde olmas\u0131 \u201cm\u00fckemmel\u201d uyumu; 0.90-0.95 aras\u0131nda olmas\u0131 ise \u201ciyi\u201d uyumu g\u00f6stermektedir (28, 31, 33, 35, 40, 41). Be\u015f fakt\u00f6rl\u00fc model i\u00e7in hesaplanan CFI (0.95) ve NNFI (0.93) de\u011ferleri s\u0131ras\u0131yla \u201cm\u00fckemmel\u201d ve \u201ciyi\u201d d\u00fczeydedir. Be\u015f fakt\u00f6rl\u00fc modelin ikinci d\u00fczey DFA sonu\u00e7lar\u0131 \u03c72\/sd=4.52, RMSEA=0.06, SRMR=0.06, GFI=0.90, CFI=0.95 ve NNFI=0.93 olup uyum indeksleri \u201ciyi\u201d ya da \u201cm\u00fckemmel\u201d d\u00fczeydedir. \u0130kinci d\u00fczey fakt\u00f6r analizi sonu\u00e7lar\u0131n\u0131n yeterlili\u011fi, kullan\u0131lan \u00f6l\u00e7\u00fcm arac\u0131ndan elde edilen fakt\u00f6r puanlar\u0131na ek olarak toplam bir puan\u0131n \u00e7\u0131kar\u0131lmas\u0131na ili\u015fkin kan\u0131t olarak g\u00f6r\u00fclmektedir (29).<\/span><\/p>\n

\u00d6zg\u00fcn formda davran\u0131\u015flar alt boyutunda bulunan 26. maddenin \u00e7\u0131kar\u0131lmas\u0131 sonucu bu alt boyutun i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131n\u0131n \u00f6nemli \u00f6l\u00e7\u00fcde y\u00fckselmesi sebebiyle T\u00fcrk\u00e7e \u00f6l\u00e7ekte 26. madde, davran\u0131\u015flar alt boyutunda uyum alt boyutuna al\u0131nd\u0131 ve bunun sonucunda g\u00fcvenilirli\u011fi \u00f6zg\u00fcn \u00f6l\u00e7e\u011fe g\u00f6re daha y\u00fcksek bulundu. G\u00fcvenilirlik kapsam\u0131nda hesaplanan i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 alt boyutlar i\u00e7in s\u0131ras\u0131yla; Bilgi ve \u0130nan\u00e7lar= 0.86, Davran\u0131\u015flar=0.78, Bilgi Arama=0.84, Uyum=0.75, ADHF=0.63 olup t\u00fcm \u00f6l\u00e7ek i\u00e7in i\u00e7 tutarl\u0131l\u0131k 0.79 olarak saptand\u0131. \u00d6zg\u00fcn \u00f6l\u00e7e\u011fin geli\u015ftirilme a\u015famas\u0131nda saptanan i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131 0.78\u2019dir. Alt boyutlar\u0131n i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 ise s\u0131ras\u0131yla; Bilgi ve \u0130nan\u00e7lar=0.84, Davran\u0131\u015flar=0.77, Bilgi Arama=0.83, Uyum=0.77, ADHF=0.46 \u015feklindedir (18). T\u00fcrk\u00e7e form ve alt boyutlar\u0131n\u0131n i\u00e7 tutarl\u0131l\u0131k katsay\u0131lar\u0131 \u00f6zg\u00fcn forma g\u00f6re y\u00fcksektir. Yaln\u0131zca uyum alt boyutunun i\u00e7 tutarl\u0131l\u0131k katsay\u0131s\u0131 \u00f6zg\u00fcn \u00f6l\u00e7e\u011fe g\u00f6re minimal d\u00fczeyde d\u00fc\u015f\u00fck bulundu. Test-tekrar test g\u00fcvenilirli\u011fi i\u00e7in 98 kat\u0131l\u0131mc\u0131dan iki hafta arayla elde edilen antibiyotik alg\u0131 puan\u0131 ortalamalar\u0131 aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde fark saptanmamas\u0131 ve al\u0131nan puanlar aras\u0131nda pozitif y\u00f6nde g\u00fc\u00e7l\u00fc ili\u015fki bulunmas\u0131, \u00f6l\u00e7e\u011fin zamana ba\u011fl\u0131 de\u011fi\u015fkenlik g\u00f6stermedi\u011fine i\u015faret etmektedir.<\/span><\/p>\n

Bu ara\u015ft\u0131rma, anne ve babalar\u0131n antibiyotik alg\u0131lar\u0131n\u0131 \u00f6l\u00e7meye y\u00f6nelik geli\u015ftirilmi\u015f bir \u00f6l\u00e7e\u011fin T\u00fcrk\u00e7e uyarlamas\u0131n\u0131n yap\u0131ld\u0131\u011f\u0131 ilk ara\u015ft\u0131rmad\u0131r. Ara\u015ft\u0131rma i\u00e7in ba\u015fka bir toplumda ge\u00e7erlili\u011fi ve g\u00fcvenilirli\u011fi kan\u0131tlanm\u0131\u015f bir \u00f6l\u00e7ek kullan\u0131ld\u0131. \u00d6l\u00e7e\u011fin dil uyarlamas\u0131n\u0131n uygun bi\u00e7imde tamamlanmas\u0131n\u0131n ard\u0131ndan psikometrik \u00f6zellikleri birden fazla y\u00f6ntem ile s\u0131nand\u0131. \u0130\u00e7erik (kapsam) ge\u00e7erlili\u011fi; \u00f6l\u00e7e\u011fi olu\u015fturan maddelerin \u00f6l\u00e7\u00fclmek istenen konu, kavram ya da yap\u0131 ile ilgili \u00f6l\u00e7mede ne derece yeterli oldu\u011funun ve \u00f6l\u00e7\u00fcm arac\u0131n\u0131n konu ile ilgisi olmayan maddeler i\u00e7ermedi\u011finin ifade edilmesidir. \u00c7o\u011funlukla \u00f6l\u00e7ek geli\u015ftirme \u00e7al\u0131\u015fmalar\u0131nda yap\u0131lmas\u0131 gereken bir i\u015flem olmakla birlikte, uyarlama \u00e7al\u0131\u015fmalar\u0131nda da uygulanabilece\u011fini belirten yay\u0131nlar bulunmaktad\u0131r (42, 43). \u00c7al\u0131\u015fmam\u0131zda oldu\u011fu gibi, i\u00e7erik ge\u00e7erli\u011fini uzman g\u00f6r\u00fc\u015flerine ba\u015fvurarak saptamak etkili bir yakla\u015f\u0131md\u0131r.\u00a0<\/span><\/p>\n

Ara\u015ft\u0131rman\u0131n k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 kent merkezinde planlanm\u0131\u015f olmas\u0131 nedeniyle \u00f6rnekleminin k\u0131rda ya\u015fayan anne ve babalar\u0131 i\u00e7ermemesidir. Antibiyotik Direnci Hakk\u0131nda Fark\u0131ndal\u0131k alt boyutu g\u00fcvenilirli\u011finin kabul edilebilir alt s\u0131n\u0131ra yak\u0131n olmas\u0131 ikinci bir s\u0131n\u0131rl\u0131l\u0131k olarak belirtilebilir. Ancak t\u00fcm \u00f6l\u00e7e\u011fin ge\u00e7erlilik analizlerinin olumlu olmas\u0131 nedeniyle uyarlamada s\u00f6z konusu alt boyutun korunmas\u0131na karar verildi; \u00e7al\u0131\u015fmam\u0131z\u0131 takip edecek ara\u015ft\u0131rmalar\u0131n bu bilgi \u0131\u015f\u0131\u011f\u0131nda yorumlanmas\u0131 uygun olacakt\u0131r.<\/p>\n

Sonu\u00e7 olarak; \u00e7al\u0131\u015fmam\u0131zda ABANA \u00d6l\u00e7e\u011fi\u2019nin ge\u00e7erli ve g\u00fcvenilir bir \u00f6l\u00e7\u00fcm arac\u0131 oldu\u011fu g\u00f6sterildi. \u00d6zg\u00fcn formun davran\u0131\u015f alt boyutunda yer alan 26. maddeye T\u00fcrk\u00e7e formun uyum alt boyutunda yer verilebilir. \u00d6l\u00e7e\u011fin farkl\u0131 \u00f6rneklemlerde tekrar s\u0131nanmas\u0131 genellenebilirli\u011fini sa\u011flayacakt\u0131r. Antibiyotik alg\u0131s\u0131 ile ilgili var olan durumun belirlenebilmesi i\u00e7in yeni ara\u015ft\u0131rmalara gereksinim vard\u0131r.<\/p>\n

Antibiyotik alg\u0131s\u0131 konusunda \u00e7al\u0131\u015fma yapmak isteyen ara\u015ft\u0131r\u0131c\u0131lar ABANA \u00d6l\u00e7e\u011fi\u2019ne ve ABANA \u00d6l\u00e7e\u011fi Kullan\u0131m K\u0131lavuzu\u2019na makalenin eklerinden ula\u015fabilir.<\/i><\/p>\n

Ek 1: ABANA \u00d6l\u00e7e\u011fi<\/i><\/b><\/span><\/a><\/i><\/p>\n

Ek 2: ABANA \u00d6l\u00e7e\u011fi Kullan\u0131m K\u0131lavuz<\/i><\/b><\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e\u00a0 Ak\u0131lc\u0131 antibiyotik kullan\u0131m\u0131 (AAK); hastalar\u0131n klinik ihtiya\u00e7lar\u0131na uygun ila\u00e7lar\u0131, kendi bireysel gereksinimlerini kar\u015f\u0131layan dozlarda, yeterli bir s\u00fcre boyunca, kendilerine ve topluma en d\u00fc\u015f\u00fck maliyetle almalar\u0131n\u0131 gerektirir (1,2). Ak\u0131lc\u0131 olmayan antibiyotik kullan\u0131m\u0131 (AOAK) ise; antibiyotiklerin AAK prensipleri g\u00f6z \u00f6n\u00fcne al\u0131nmadan, uygunsuz veya a\u015f\u0131r\u0131 kullan\u0131m\u0131d\u0131r. AOAK d\u00fcnya genelinde yayg\u0131n olup \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunudur. AOAK […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5637,3882,3686,5638,5639],"class_list":["post-26395","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-antimikrobiyal-ajanlar","tag-bilgi","tag-davranis","tag-gecerlilik","tag-guvenilirlik"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26395","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=26395"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26395\/revisions"}],"predecessor-version":[{"id":26848,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/26395\/revisions\/26848"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=26395"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=26395"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=26395"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}