臺灣博碩士論文加值系統

本研究採質性研究深入訪談法，研究目的在於探索糖尿病患個人生病經驗及疾病的意義，並試著從病患內在對糖尿病意義的瞭解及自我病因探究，外顯至當初罹病時的身體徵兆的察覺，以及對於糖尿病治療的意義，且在治療過程中遇到的阻礙及困境所造成的抗拒，在經歷這些過程後，重新建構新的生活傳記。針對南區某區域醫院新陳代謝科十三名糖尿病患進行訪談，個案年齡從22~71歲，糖尿病罹病期3~24年。從受訪者之訪談文本中歸納出六項經驗主題：「說文解字--『糖』、『尿』、『病』」、「疾病的歸因」、「糖尿病的徵兆」、「糖尿病治療的意義」、「治療過程中的抗拒」、「重新改寫的生活傳記」。以「糖尿病」命名的污名為始，並搜尋引發疾病的原因，發現「前世因果」、「種不好」、「不良行為習慣」、「多重生活事件交錯」及「不知及無解」為受訪者罹病的原因。在罹病過程中，身體產生異常的徵兆，會因年齡老少有不同的角色期待，疾病徵兆的解釋在有家族病史的受訪者身上，因為過去經驗不同，產生不同的結果。糖尿病治療的意義包括「西藥有毒，中藥天然」，胰島素的治療的「隱喻」--「病得很嚴重的最後一步治療」、「失去自主性的身體」、「上癮的污名」，「千瘡百孔的針包娃娃」，「控制不良的懲罰」。治療過程中所產生的抗拒包含「甘願呷乎死，喀贏死毋呷」、「身體外觀的改變」、「數字為心情溫度計」。
病患需面對不斷變化的疾病狀況，醫療人員在此方面扮演很重要的角色。在照顧病患方面，醫療人員往往忽略了病患的主觀經驗，而只是就一些客觀的數據，照顧病人身體方面的需要，對病患每天「掙扎」面對疾病及殘疾的問題並沒有加以理會。每個糖尿病患都有其本身的獨特性，因此，不可以一概而論，而需依循病患文化背景、個人脈絡深入探討研究實有必要性。

A qualitative study was conducted by applying in-depth interview and participant observation to collect information from diabetic patients. Thirteen patients were interviewed by a set of semi-structure questions, focusing on patients’ viewpoints of illness experience and disease meaning. This study also explored patients’ understanding of aetiology, symptoms of onset, meaning of treatment process which resulted in patients’ resistance and re-construction biography. After tape-recorded and transcribed literally, interview data were categorized into meaningful codes and were categorized into six major themes. These six themes are: 1) Sugar, urine, and disease, 2) Aetiology of diabetes, 3) The symptoms of diabetes, 4) The meaning of diabetic treatment, 5) The resistances during treatment process, and 6) Re-construction biography. This inner world is often ignored by medical professional when they face diabetic patients. To better understand and serve diabetic patients, medical professionals need to understand patients’ culture and social backgrounds and see from their perspective.

第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與目的 4
第二章 文獻探討 6
第一節 疾病意義 6
第二節 生病經驗 12
第三章 研究方法 23
第一節 研究方法 25
第二節 研究流程 31
第三節 信效度考量 34
第四章 糖尿病患的敘事 35
第一節 說文解字—「糖」、「尿」、「病」 35
第二節 疾病的歸因 42
第三節 糖尿病的徵兆 50
第四節 糖尿病治療的意義 56
第五節 治療過程中的抗拒 62
第六節 重新改寫的生活傳記 76
第五章 結果與討論 89
第一節 生命傳記的瓦解與再建構 89
第二節 疾病意義 93
第三節 糖尿病的治療及抗拒 96
第四節 重新改寫的生病歷程 100
第六章 結論與建議 103
第一節 結論
102
第二節 研究者的反省 107
第三節 研究限制 109
第七章 參考文獻 111
附錄一訪談大綱 116
附件二研究說明書 118

中文文獻
1.皮國立（2002）•醫療史話－唐代以前糖尿病病人的生活史與治療•歷史月刊，174，74-78。
2.行政院衛生署（1999）•中華民國生命統計。台北：衛生署。
3.行政院衛生署（2003）•中華民國生命統計。台北：衛生署。
4.吳青眉(2004)•第二型糖尿病男性患者性滿意度及其相關因素之探討」•未發表碩士論文，高雄：樹德科技大學。
5.杜明勳、蔡世滋(1987) •疾病的意涵與求醫行為•臨床醫學20(5)，453-459。
6.林宏達(2000)•千禧話糖尿病－向糖尿病病友報佳音•臺北榮總新陳代謝科網站。http://www.vghtpe.gov.tw/~meta/quest-y2k.htm
7.林耀盛(1998)•疾病意義、身體意象與認同形式：糖尿病患者社會心理因應歷程•國立台灣大學心理學研究所博士論文。
8.林耀盛、吳英璋（2000）•進退維谷：糖尿病患的認同建構•中華心理衛生學刊，13（3），1-34。
9.胡月娟(2002) •慢性病患者的健康概念，醫護科技雜誌，4(1)，31-48。
10.胡幼慧(1996) •質性研究理論方法及本土女性研究實例•台北：巨流。
11.許木柱（1992）•民俗醫療與醫護因應•榮總護理，9(2)，117-119。
12.陳國東、陳建仁（1997）•非胰島素依賴型糖尿病盛行率與危險因子•中華衛誌，16(4)，291-307。
13.陳新綠譯(1994) •談病說痛：人類的受苦經驗與痊癒之道，初版•台北：桂冠。譯自Kleinman (1988)。
14.陳向明(2002) •社會科學質的研究•台北：五南。
15.陳郁夫 (1994) •人類的終極關懷：宗教世界的概說•台北：幼獅。
16.曾凡慈(2001) •看見/看不見—視障學生的生活實體建構•未發表碩士論文，台北：台灣大學。
17.張苙雲(1998) •醫療與社會：醫療社會學的探索•台北：巨流。
18.楊寬弘（1998）•糖尿病的心理建設，我為何奮鬥~寫給所有正在參加長跑或協助別人長跑的人•長庚醫訊，7。
19.劉仲冬(1998) •疾病的社會學觀•醫望，23，123-125。
20.蔣欣欣、盧孳豔(1996) •健康與疾病的文化觀及現象分析•護理雜誌，43(4)，42-48。
21.潘淑滿(2003)•質性研究理論與應用•台北：心理。
22.賴美淑（2002）•糖尿病共同照護•台灣醫學，6(4)，559。
23.蔡世澤（1998）•糖尿病控制與合併症試驗的啟示及省思•臨床醫學，42，25-30。
24.蔡世澤(2000)•台灣糖尿病照護現況與省思•臨床醫學，45(5)，316-320。
25.蔡淑娟(2006) •參觀日本老人性失智症專門醫院：國家衛生研究院電子報 第 125 期 2005-11-16 http://sars.nhri.org.tw/enews/enews_list_new2.php?volume_indx=125&showx=showarticle&article_indx=2993&enews_dt=2005-11-16
26.謝博生(2000) •醫療與社會•台北：國立臺灣大學醫學院出版。
27.簡美玲(1993) •疾病的文化詮釋：阿美族的醫療體系與家庭健康文化•未發表碩士論文，新竹：國立清華大學。
28.龔卓軍(2003) •生病詮釋現象學：從生病經驗的詮釋到醫病關係的倫理基礎•生死學研究創刊號；57-75。

英文文獻
1.Ackerman, M.D., J.P.D’attilio, M.H.Antoni, & B.M. Campbell(1991) Assessment of erectile dysfunction in diabetic men. The clinical relevance of self-report sexual functioning. Journal of Sex & Marital Therapy, 17(3), 191-202.
2.Babbie, Earl, 2002, The Basics of Social Research (2nd ed). USA: Wadsworth/Thomson Learing.
3.Broom D, Whittaker A （2004）.Controlling diabetes, controlling diabetics: moral language in the management of diabetes type 2 .Social Science & Medicine, 58(11), 2371-2382.Bissel P, May C.R, Noyce P.R (2004). From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions. Soc. Sci. Med., 58, 851-862.
5.Bury M. (2001) Illness narrative: fact of fiction? Sociology of Health and Illness, 23, 263-85.
6.Cohen, Reimer, ＆Smith (1994). Explanatory model of diabetes: patient practitioner variation. Soc. Sci. Med., 38(1), 59-66.
7.Campbella, Pounda, ＆Popea (2003). Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc. Sci. Med, 56, 671-684.
8.Charmaz, K. (1995). “Identity Dilemmas of Chronically Ill Men.” in Men''s Health and Illness: Gender, Power, and the Body edited by Donald Sabo & David Frederick Gordon. (pp.266-291)
9.DCCT (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications is insulin-dependent diabetes mellitus. N Engl J Med., 329(19), 977-86.
10.DeVault (1996). Talking Back to Sociology: Distinctive Contributions of Feminist Methodology, Annual Review of Sociology, 22, 29-50.
11.Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly M, Johnson PD, Taylor-Moon D, White NH (1991). Empowerment: an idea whose time has come in diabetes education. Diabetes Educ., 37-41.
12.Funnell MM, Anderson RM. (2004). Empowerment and self- management of diabetes. Clinical Diabetes, 22(3), 123-27.
13.Goffman E. (1997) The Disability Studies Reader. In Lennard J. Davis (eds.) Stigma (pp216-231). New York and London Published.
14.Greenhalgh T, Helman C, ＆Chowdhury AM (1998). Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study. BMJ, 316(7136), 978–983.
15.Greenhalgh, ,Chowdhury, ＆Wood(2005) Big is beautiful? A survey of body image perception and its relation to health in British Bangladeshis with diabetes. Psychology, Health & Medicine, 10 (2), 126-138.
16.Gijsbers, V. W., Kolk A. L. (1997). Sex differences in physical symptoms: The contribution of symptom perception theory. Social Science and Medicine, 45, 231-246.
17.Hampson, S. E. (1997) Illness representation and self-management of diabetes. In K. J. Petre &J. A. Weinman. (EDS.), Perception of health and illness: current research and application. Australia: Harwood academic publisher.
18.Hunt L.M, Valenzuela M.A, ＆Pugh J.A (1998). PORQUE ME TOCO A MI? Mexican American diabetes patients’causal stories and their relationship to treatment behaviors. Soc.Sci.Med., 46(8), 959-969.
19.Hunt, L. M., Valenzuela, M. A., & Pugh, J. A. (1997). NIDDM patients’ fears and hopes about insulin therapy. Diabetes Care, 20(3), 292－298.
20.Kelly M., Field D. (1996) Medical sociology, chronic illness and the body, Sociology of Health & Illness, 18(2) ,241-57.
21.Kelleher D., (1988). Living with chronic illness : the experience of patients and their families / edited by Robert Anderson and Michael Bury. London ; Boston : Unwin Hyman.
22.Lai.W.A., Lew-Ting C.Y., ＆Chiet W.-C (2004). How diabetic patient think about and manage their illness in Taiwan, Diabetes UK. Diabetes Medicine, 22, 286-292.
23.Liburd L C., Anderson LA., Edgar T, & JR L J. (1999). Body size and body shape: perceptions of blavk women with diabetes. The diabetes educator. 25(3), 382-388.
24.Lawton J. (2003)Lay experience of health and illness: past research and future agendas. Sociology of Health and Illness,1 (25),23-40.
25.Moch, S. D. (1998). Health-within-illness: Concept development through research and practice. Journal of Advanced Nursing, 28(2), 305-310.
26.Meetoo D., Gopaul H. (2004). Empowerment: Giving power to people with diabetes. Diabetes and Primary Care, 6(4), 164-170.
27.Neuman W. Lawrence, (1997). Social Research method: Qualitative and quantitative approaches (3rd edition). Boston: Allyn and Bacon.
28.Platt FW, Gaspar DL, Coulehan JL, Fox L, Adler AJ, Westen WW. (2001). Tell me about yourself:the patient-centered interview. Ann Intern Med, 134, 1079-1085.
29.Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R. , (2005).Resistance to Insulin Therapy Among Patients and Providers, Diabetes Care , 28, 2673–2679.
30.Parse, R. R. (1992). Human becoming: Parse’s theory of nursing. Nursing Science Quarterly, 5(1), 35-42.
31.Pound, P., Gompertz, P.＆ Ebrahim, S.(1998).Illness in the context of older age: the case of stroke, Sociology of Health and Illness, 20, 489-506.
32.Sander, C., Donovan, J. ＆ Dieppe, P. (2002). The significance and consequences of having painful and disable joints in older age: co-existing account of normal and disrupted biographies, Sociology of Health and Illness, 2, 227-53.
33.Sontag S. (1997) The Disability Studies Reader. In Lennard J. Davis (eds.) AIDS and Its Metaphors (pp232-238). New York and London Published.
34.Selby J V., Karter A J.,Ackerson L M., Ferrara A, Liu J.（2001） Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes. Diabetes Care, 24(8), 1547-1555.
35.Turner, B. (1984) The Body and Society: Disease and Disorder. N.Y.: Basil Blackwell.
36.Toombs S. K (1993) The Meaning of Illness: A Phenomenological Account of different Perspectives of Physician and Patient, Dordrecht: Kluwer Academic Publishers, 55-56.
37.Thompson, S.J., ＆Gifford, S.M.(2000).Trying to Keep a Balanve: the meaning of health and diabetes in an urban Aboriginal community. Social Science and Medline, 51, 1457-1472.
38.UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2diabetes (UKPDS 33). Lancet. , 352, 837 -853.
39.Williams G. (1984). The genesis of chronic illness: narrative re-construction. Sociology of Health & Illness, 6(2), 175-200.
40.Williams S. (1996). Medical sociology, chronic illness and the body: a rejoinder to Michael Kelly andd David Field, Sociology of Health & Illness, 18(5), 699-709.