Community Diabetic Patients' Cognition, Illness Experience and Self-Care Behavior
Date Issued
2004
Date
2004
Author(s)
Lai, Wen-An
DOI
zh-TW
Abstract
Aims Type 2 diabetes is becoming more prevalent in Taiwan. To maximize the benefits of medical treatment, diabetic patients need continuously adherent to physicians’ recommendations and improve their self-care in daily life. Providing sufficient knowledge, helping patients to cope with emotional stress and improving patients’ quality of self-care, are important measures to good diabetes management. The aim of my study is to investigate community patients’ cognition, illness experience and self care behaviour, I hope my results will help physicians to develop adequate patient-centered culture-sensitive clinical skills.
Methods ዊHere in this study, I used twenty two in-depth interviews and seven focus groups to collect the perspectives from diabetic patients recruited from a rural Taiwan community. The interview protocol, including three parts of questions: (1) illness experiences since diagnosis, (2) viewpoint on diabetes including cognitive and emotional aspects, (3) the contextual factors related to diabetic and health conditions, was modified from Kleinman’s EM model and Leventhal’s CSM. All interviews were audio-taped and the transcripts were analyzed by editing and immersion/crystallization. Emerging themes were compared with current medical knowledge to determine their clinical significance.
ResultsዊI found that the object-oriented method, characterized by objects, attributes, classification and inheritage, is useful in describing layman illness model, which can also been classified according to EM model. The key points of layman cognitive model can be described as following: “Genetic and dieting factors, which can reduce pancreas secreting function and impair sugar metabolism, are the main etiological factors of type 2 DM. Its illness course progress when the pancreas deteriorate gradually and loss its function totally at the end. The severity, indicating the position of some patient in the illness course do exists as a one-dimensional scale. Dietary restriction and exercise were beneficial. The former, mainly understood as reducing carbohydrate intake, was thought to be most important; Exercise, to the point of sweating, was seen as a way to eliminate pharmaceutical toxins. Taking medicine was regarded with ambivalent attitudes due to concerns about adverse effects (especially renal injury and vicious cycle increasing more and more dosage).”
ConclusionsዊIn conclusion, laymans’ cognitive concepts to diabetes, characterized by reflexive, inprecisive, linked loosely in illness model. Patients regard all treatment strategies as integrative and were intertwined in daily life. Some of their non-adherence behaviours are products of intentional rational decision influenced by misconceptions which needs clarification. The most important misconceptions are: 1. focusing on sugar-control only, 2. benefit of sweating to eliminate toxins, 3. fear of renal toxicity and vicious cycle of hypoglycaemic agents. Renaming diabetes, such as “metabolic syndrome” or a specific kind of “ti-zhi”, may bring new, acceptable insight to Chinese diabetic patients.
Subjects
罹病經驗
自我照顧行為
糖尿病
質性研究
疾病解釋模
illness experience
qualitative research
self-care behavior
diabetes mellitus
explanatory model
SDGs
Type
thesis
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