應用計畫行為理論預測第二型糖尿病患者之胰島素注射意圖

Application of Theory of Planned Behavior for the Prediction of Insulin Injection Intention among Patients with Type 2 Diabetes

張榮哲(Ing-Tiat Tiunn) ； 蕭雅純(Ya-Chun Hsiao)

《台灣家庭醫學雜誌》 26卷2期 (2016/06) Pp. 88-99

https://doi.org/10.3966/168232812016062602003

摘要

背景及目的：胰島素自我注射是第二型糖尿病的重要治療方法。然而，許多患者因為心因性胰島素抗拒(psychological insulin resistance, PIR)，拒絕胰島素治療，以致血糖控制不良。本研究目的乃探討影響第二型糖尿病患者接受胰島素治療與否之可能因素。方法：採用計畫行為理論(theory of planned behavior, TPB)為架構，同時測量胰島素治療評估量表(insulin treatment appraisal scale, ITAS)以進行比較。採自陳式問卷，橫斷研究設計，共163位研究時未使用胰島素之第二型糖尿病患者參與研究。結果：99位受試者(60.7%)不願意接受胰島素治療。比較拒絕及接受胰島素之受試者，於ITAS及TPB變項有顯著差異。階層迴歸分析結果，三個TPB變項（態度、主觀規範、覺知行為控制）均顯著預測胰島素治療之意圖，可解釋34.0%變異量。結論：本研究支持TPB可成功應用於解釋心因性胰島素抗拒，未來應能做為設計介入方案之依據。

關鍵字

計畫行為理論 ； 第二型糖尿病 ； 胰島素 ； 心因性胰島素抗拒

並列摘要

Background and Purpose: Insulin self-injection is an important treatment in the care of type 2 diabetes. However, psychological insulin resistance (PIR) has long been an obstacle for many patients to achieve optimal glycemic control. The purpose of this research is to identify the influencing factors in decision-making process of type 2 diabetic patients whether or not to undergo insulin therapy. Methods: We adopted the theory of planned behavior (TPB) as our theoretical basis. Besides, Insulin treatment appraisal scale (ITAS) was also used as an assessment for the purpose of comparison. A cross-sectional questionnaire study design was employed, and a total of 163 currently not using insulin type 2 diabetic patients participated in this research. Results: Ninty nine participants (60.7%) were unwilling to take insulin therapy. Between participants unwilling and willing to accept insulin, there were significant differences in ITAS and TPB variables. The hierarchical regression analysis revealed that all three TPB variables (attitude, subjective norm, perceived behavioral control) significantly predict intention to use insulin, which account for 34.0% variance of intention. Conclusion: The results of this research indicate that TPB is a useful framework in realizing PIR. It can also be adopted in the development of practical intervention.

並列關鍵字

insulin ； psychological insulin resistance ； theory of planned behavior ； type 2 diabetes mellitus

參考文獻

Danaei, G,Finucane, MM,Lu, Y(2011).National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants.Lancet.378,31-40.

Jiang, YD,Chang, CH,Tai, TY,Chen, JF,Chuang, LM(2012).Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000-2009 Nationwide Health Insurance database.J Formos Med Assoc.111,599-604.

Li, HY,Jiang, YD,Chang, CH,Chung, CH,Lin, BJ,Chuang, LM(2012).Mortality trends in patients with diabetes in Taiwan: a nationwide survey in 2000-2009.J Formos Med Assoc.111,645-50.

United Kingdom Prospective Diabetes Study=UKPDS(1998).Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).Lancet.352,837-53.

Stratton, IM,Adler, AI,Neil, HA(2000).Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.BMJ.321,405-12.