慢性病患者疾病自我調節歷程之質性研究

The Self Regulation Process of Patients with Chronic Illness: Qualitative research

李季芳(Chi-Fang Lee)

指導教授 ： 陳秀蓉

國立臺灣師範大學/教育學院/教育心理與輔導學系/碩士(2015年)

https://doi.org/10.6345/NTNU202205453

摘要

慢性病的治療除了藥物之外，也仰賴患者在日常生活中進行自我照顧。本研究採用自我調節理論為基礎，以高血壓與糖尿病患者為代表，欲探索慢性病患者的疾病自我調節歷程含有哪些有利或不利適應的重要因素，因此，本研究目的包含下列3項：（1）以患者的角度，探索其疾病自我調節歷程中的重要元素及各元素間相互的影響關係。（2）透過歸納不同患者之疾病自我調節歷程，發現慢性病患者之疾病自我調節的可能類型。（3）由不同疾病自我調節的類型，進一步探索促進及阻礙慢性病適應的關鍵，以及造成轉變的條件。
為了個別且深入瞭解患者的生病經驗，本研究以半結構式訪談16位高血壓與糖尿病患者，蒐集其疾病知覺與所引發的調適行動等質性資料，之後透過紮根理論分析方法，將資料編碼歸類後，經主軸分析、過程分析及跨個案分析，歸納出慢性病患者疾病自我調節歷程之內涵。
研究結果顯示：（1）每一位研究參與者在疾病調節歷程中皆含有疾病症狀、疾病解釋參照、疾病認知表徵、情緒表徵、調節目標、因應行動及行動結果與評估等7項元素。（2）疾病認定與疾病時程會影響調節目標的設定，而疾病調節目標又會與疾病後果與控制信念作用，產生10種不同的疾病調節歷程類型。（3）疾病調節元素影響結果的適應性或不適應性，且有階層關係，在高階層次缺乏適當調節元素，患者在後續層次也會較偏離慢性病良好適應所需之特質，導致不良的適應結果。此外，每一層次的回饋皆可能修正較高階層次的偏差。（4）患者會因知覺到新的疾病症狀或疾病解釋參照訊息不同而轉換調節歷程之類型。
經由探討慢性病患者在疾病自我調適歷程中之重要元素以及調節歷程的類型，本研究提出一廣泛了解慢性病患者疾病調節經驗之架構，此架構將可提供臨床工作者瞭解與評估慢性病患者的疾病調節歷程相關因素之參考，並以此為根據，擬定適當的介入計畫。

關鍵字：慢性病、自我調節、質性研究、疾病表徵、調節目標

關鍵字

慢性病 ； 自我調節 ； 質性研究 ； 疾病表徵 ； 調節目標

並列摘要

The treatment of chronic illness involves not only medication, but also proper self-care activities conducted by patients on a daily basis. The aim of this study was to explore what are the key factors that facilitates or impedes adjustment in patients with chronic illness in their illness self-regulation process. The Self-regulation Theory was used as the theoretical foundation for the current study. Representative cases were selected from patients living with hypertension and diabetes. The purposes of this research were: (1) To explore what key factors were involved in the illness self- regulation process from the perspectives of patients with chronic illness, and how these factors identified were interrelated and interacted. (2) From data-driven to explore the types of illness self- regulation by categorizing the varying forms of regulation processes reported by patients . (3) Based on the types identified, to further find what are the key factors that facilitate or impede chronic illness adjustment and in what conditions transformations may occur.
In order to have an in-depth understanding of each patients' unique experiences in their illness, this study conducted semi-structure interviews with sixteen patients living with either hypertension or diabetes. Qualitative data were collected regarding the patients’ perceptions on illness and actions they took for adjustments. Interview transcripts and verbatim were analyzed with the grounded theory method through a procedure of coding, categorization, axial analysis, process analysis and cross-case analysis. In the end of the inductive analysis, the self-regulation processes in patients living with chronic illness were presented.
It was revealed in the results that: (1) Seven elements were indistinguishably seen among all participants with regard to illness self- regulation process; that is illness symptoms, illness interpretation references, illness cognitive representations, emotional representations, goals of regulation, coping actions, and action outcome and appraisals. (2) Illness identity and timeline representations formed different goals for illness regulation, which would further interact with the illness consequence and controllability, which contributed to ten different types of self-regulation process of chronic patients. (3) The adaptive verse maladaptive outcome are influenced by elements in illness self- regulation. These elements could be understood on a hierarchical structure. Without appropriate elements at the higher levels / in the early stages, the patients would have adjustment difficulties in the later stage as the critical characteristics associated with better adjustment to chronic illness were insignificant. Moreover, feedbacks in each level are likely to amend aberrations of higher level. (4) Patient will change their regulation types because of perceiving new illness symptoms or different illness interpretation references. Regulation types might be changed among patients if they perceived new symptoms of illness or new information about illness interpretation references.
This study proposed a hierarchical illness self-regulation model to look at patients’ experiences in illness regulations. This framework could serve as a reference for clinical assessments and evaluations in working with chronic patients regarding the process and factors related to illness regulations. If possible, intervention plans are also expected to be developed on the basis of this framework.

Keywords: chronic illness, self-regulation, qualitative research, illness representation, regulation goals

並列關鍵字

chronic illness ； self-regulation ； qualitative research ； illness representation ； regulation goals

參考文獻

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215.

中文部分

內政部統計處（2000）。中華民國八十九年老人狀況調查報告。臺北市：行政院內政部統計處。

江文慈（2012）。大學生人際互動情緒表達壓抑的探究。教育心理學報，43（3），657-679。

行政院衛生署（2008）。2005-2008 國人血漿血糖異常之狀況。取自臺灣營養健康狀況變遷調查網站：http://nahsit.nhri.org.tw/node/19，2015年1月5日。