臺灣博碩士論文加值系統

本研究目的為(1)調查第二型糖尿病個案情緒困擾、賦權感受、自我照顧行為與生活品質情形；(2)探討第二型糖尿病個案個人特性、疾病特性、情緒困擾、賦權感受、自我照顧行為與生活品質之相關性；(3)探討第二型糖尿病個案生活品質之重要解釋因子。
　　採橫斷性、描述性相關性研究設計，以糖尿病十年內之糖尿病個案為研究對象，採結構式問卷調查和方便取樣方式共收案220位。問卷內容包括：個人與疾病特性、情緒困擾、賦權感受、自我照顧行為與生活品質等量表，其中生活品質量表分別測量滿意度、衝擊與糖尿病的擔憂層面之生活品質。量表經信度及效度檢定，包括內在一致性、再測信度、專家效度與表面效度。研究資料以百分比、平均值、標準差、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關與逐步複迴歸分析。
研究結果發現：(1)研究對象生活品質得分指標為79.6，呈中上程度；(2)教育程度、年齡、加入共同照護網與使用胰島素在生活品質上有顯著差異；(3)研究對象情緒困擾得分指標為36，呈現輕度情緒困擾，且情緒困擾越嚴重，各層面生活品質越差；(4)研究對象賦權感受得分指標為76.8，呈中上程度，個案賦權感受程度越好，滿意度生活品質越好；(5)糖尿病個案自我照顧行為得分指標為68.8，呈中上程度，自我照顧行為越好，滿意度生活品質越佳。飲食、運動、高低血糖的預防與處理和足部自我照顧行為越好，滿意度生活品質越佳。而藥物與血糖監測自我照顧行為越好，其糖尿病的擔憂層面生活品質越差。個案足部自我照顧越好，衝擊和與糖尿病的擔憂層面生活品質越差；(6)情緒困擾為總生活品質與其各次量表之重要解釋因子，可分別單獨解釋28.7%-53.8%之總變異量。

The purposes of the research are to (1) explore emotional distress, empowerment perception, self-care behavior and quality of life in patients with type 2 diabetes; (2) investigate the relations of demographic data, disease characteristics, emotional distress, empowerment perception, and self-care behavior to quality of life in patients with type 2 diabetes; and (3) identify the important explanatory factors of quality of life in patients with type 2 diabetes.
This is a cross-sectional, correlated and descriptive research design. The participants of this study are patients who have been suffering from type 2 diabetes within ten years. With purposive sampling, participants were collected from one medical center and two regional teaching hospitals after consent forms were obtained. A total of 220 questionnaires were collected. In this study, a constructed questionnaire was established with relevant scales, including questions on demographic data, disease characteristics, emotional distress, empowerment perception, self-care behavior and quality of life. The quality of life scale measured three domains of the quality of life: satisfaction, impact, and worried about the diabetes. The reliability and validity of the questionnaire were evaluated for internal consistency, test-retest reliability, surface validity and content validity. Data analysis was performed by using percentage, mean, standard deviation, independent t-test, one-way ANOVA, Pearson’s correlation, and stepwise multiple regression analysis.
The results were: (1) the score index of quality of life was 79.6, considered as a moderate to high level; (2) patients with different educational level, age, diabetes share care disease management participation and insulin therapy showed a significant difference in quality of life; (3) the score index of emotional distress was 36, considered as a relatively low level. The more severe emotional distress is, the worse quality of life in every domain is; (4) the score index of empowerment perception was 76.8, considered as a relatively moderate to high level. The better empowerment perception is, the better the satisfaction domain of quality of life is; (5) the score index of self-care behavior was 68.8, considered as a moderate to high level. The better self care behavior is, the better the satisfaction domain of quality of life is; moreover, the better dietary, exercise, management of abnormal blood sugar level and foot care is, the better the satisfaction domain of quality of life is. However, the better self care behavior in medication-taking and blood sugar monitoring is, the worse the anxiety domain of quality of life is; moreover, the better the foot self-care behavior is, the worse the impact and anxiety domains of quality of life is; (6) emotional distress was the most important explanatory factor for the total and each domains of quality of life and accounted for 28.7%-53.8% of the total amount of variance.

第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 5
第二章 文獻查證 6
第一節 糖尿病人生活品質 6
一、生活品質的概念 6
二、生活品質的層面與測量 9
三、糖尿病個案之生活品質 12
第二節 糖尿病個案情緒困擾 16
一、糖尿病個案情緒困擾的定義 16
二、糖尿病個案情緒困擾與生活品質 19
第三節 糖尿病個案賦權感受 21
一、賦權的定義 21
二、糖尿病個案賦權感受與生活品質 24
第四節 糖尿病個案自我照顧行為 27
一、自我照顧之定義 27
二、糖尿病個案之自我照顧行為 28
三、糖尿病個案自我照顧行為與生活品質 31
第五節 影響糖尿病人生活品質之個人特性與疾病特性 33
一、 個人特性 33
二、 疾病特性 35
第三章 研究架構與假設 39
第一節 研究架構 39
第二節 研究假設 40
第三節 名詞界定 40
第四章 研究方法 43
第一節 研究設計與對象 43
第二節 研究工具 45
第三節 研究工具之信效度檢測 52
第四節 資料之收集 56
第五節 研究對象權益之維護 57
第六節 資料之分析 58
第五章 研究結果 60
第一節 研究變項之描述 60
一、糖尿病個案的個人特性 60
二、糖尿病個案的疾病特性 62
三、糖尿病個案的自我照顧行為 64
四、糖尿病個案的情緒困擾 71
五、糖尿病個案的賦權感受 76
六、糖尿病個案的生活品質 78
第二節 各研究變項與生活品質之關係 83
一、糖尿病個案的個人特性在生活品質總量表及各次量表的比較 83
二、糖尿病個案的疾病特性在生活品質總量表及各次量表的比較 89
三、糖尿病個案的自我照顧行為在生活品質總量表及各次量表的相關 94
四、糖尿病個案的情緒困擾與生活品質總量表及各次量表的相關 96
五、糖尿病個案的賦權感受與生活品質總量表及各次量表的相關 97
第三節 生活品質重要解釋因子之分析 99
一、排除「年齡」變項之逐步複迴歸分析 102
(一)總生活品質之重要解釋因子分析 102
(二)滿意度次量表之重要解釋因子分析 103
(三)衝擊次量表之重要解釋因子分析 105
(四)糖尿病的擔憂次量表之重要解釋因子分析 106
二、納入「年齡」變項之逐步複迴歸分析 108
(一)總生活品質之重要解釋因子分析 108
(二)滿意度次量表之重要解釋因子分析 109
(三)衝擊次量表之重要解釋因子分析 111
(四)糖尿病的擔憂次量表之重要解釋因子分析 112
第六章 討論 114
第一節 糖尿病個案的個人特性 114
第二節 糖尿病個案的疾病特性 115
第三節 糖尿病個案的自我照顧行為 117
第四節 糖尿病個案的情緒困擾 121
第五節 糖尿病個案的賦權感受 122
第六節 糖尿病個案的生活品質 123
第七節 糖尿病個案生活品質之相關因素 125
一、個人特性與總生活品質及各次量表之相關 125
二、疾病特性與總生活品質及各次量表之相關 126
三、自我照顧行為與總生活品質及各次量表之相關 128
四、情緒困擾與生活品質之相關 130
五、賦權感受與生活品質之相關 131
第六節 糖尿病個案生活品質之重要解釋因子 133
(一)總生活品質之重要解釋因子 133
(二)滿意度次量表之重要解釋因子 135
(四)糖尿病的擔憂次量表之重要解釋因子 140
第七章 結論與建議 142
第一節 結論 142
第二節 建議 145
第三節 研究限制 149
參考文獻 150
中文文獻 150
英文文獻 153

中文文獻
王秀紅（2000）•自我照顧的概念及其在國內護理研究應用之評析•護理雜誌，47（2），64-70。
王美華（2001）•第一型糖尿病青少年生活品質及其相關因素之探討•載於財團法人糖尿病關懷基金會，糖尿病與生活品質研討會 （頁40-43）•台北：財團法人糖尿病關懷基金會。
王惠玲、江慧玲、莊峻鍠、蔡培癸（2005）•糖尿病中老年患者生活品質及其相關因素之探討•長庚護理，16（4），90-101。
王榮德、游正芬、鍾智文、姚開屏、黃景祥（2001）•健康效用計量觀念與生活品質調整後存活分析•載於財團法人糖尿病關懷基金會，糖尿病與生活品質研討會（頁4-6）•台北：財團法人糖尿病關懷基金會。
王璟璇、王瑞霞、林秋菊（1998）•門診診斷初期非胰島素依賴型糖尿病患者的自我照顧行為及其相關因素之探討•護理雜誌，45（2），60-74。
石孝殊（2004）•牛津高階英漢雙解詞典（6 ed.）•香港：牛津大學出版社。
江鳳葦（2004）•非胰島素依賴型糖尿病患者家庭支持、生活滿意度、自我照顧行為與糖尿病控制之研究•長庚科技學刊，2，27-50。
行政院國民健康局（2002）•糖尿病共同照護工作指引手冊•2007年9月13日，取自http://health91.bhp.doh.gov.tw/opinion.htm。
行政院國民健康局（2004）•糖尿病防治手冊：糖尿病預防、診斷與控制流程指引•台北：遠流。
余文彬（2004）•糖尿病患者的血糖控制、自我效能、自我照顧和生活品質之探討•未發表碩士論文，台北：國立台北護理學院護理研究所。
李玉（2003）•糖尿病共同照護疾病管理對生活品質及醫療利用影響之研究─以某區域教學醫院為例•未發表碩士論文，台中：中國醫藥大學醫務管理研究所。
李璟佩、朱正一、吳篤安、傅振宗、李哲全、王懿萱等（2007）•東台灣糖尿病一般門診照護模式與糖尿病共同照護疾病管理模式之比較•慈濟醫學雜誌，19（2），66-73。
林生傳（2005）•教育社會學•臺北市：巨流。
林冠品（2004）•與公衛護士互動關係感受、疾病知識、疾病態度與糖尿病自我照顧行為的關係•臺灣公共衛生雜誌，23（6），479-486。
姚開屏（2002）•健康相關生活品質概念與測量原理之簡介•臺灣醫學，6（2），183-192。
胡月娟（1994）•慢性病患者所承受的衝擊與因應行爲•護理研究，2（2），140-152。
張峰紫、林秋菊（1997）•以自我效力評估胰島素依賴型糖尿病患者之自我照顧情形•高雄護理科學雜誌，13（6），351-359。
張慈惠、黃秀梨（2000）•生活品質評量之臨床應用•台灣醫學，4（1），86-90。
張麗春、李怡娟（2004）•賦權概念分析•護理雜誌，51（2），84-90。
郭寶蓮、蔡秀鸞、陽琪（2002）•充能訓練對糖尿病患者糖化血色素, 自我效能和照護之成效•台灣醫學，6（6），848-857。
陳滋茨、張媚、林豔君（1998）•自我效能、社會支持與糖尿病病人居家自我照顧行為相關之探討•護理研究，6（1），31-43。
章淑娟、傅振宗（2004）•花蓮縣糖尿病照護品質病患成果評估及其預測因子•慈濟護理雜誌，3（4），38-48。
曾淑津（2006）•探討成年糖尿病人的生活品質及其相關因素•未發表碩士論文，台北：臺灣大學預防醫學研究所。
馮觀富（2005）•情緒心理學•台北：心理。
黃美娟、洪志秀（2007）•第二型中老年糖尿病患生活品質及其預測因素•護理研究，15（3），193-201。
楊淑溫、鍾玉珠、夏德霖、房基璇、林瑞祥（2003）•北部某醫院門診糖尿病患疾病接受度及因應能力與血糖控制之相關性研究•內科學誌，14（5），232-242。
溫世頌（2006）•心理學辭典•臺北市：三民。
雷玉華、丘周萍（2000）•生活品質概念分析•國防醫學，31（2），163-169。
劉惠瑚、陳玉敏（2004）•自我照顧之概念分析•慈濟護理雜誌，3（1），8-13。
樓美玲、李怡娟、葉明珍、張彩秀（2004）•社區非胰島素依賴型糖尿病患者家庭功能與自我照顧行為•長期照護雜誌，8（2），195-212。
蔡世澤（2000）•台灣糖尿病照護現況與省思•臨床醫學，45（5），316-320。
鍾聿琳（2007）•護理實務研究與應用•台北：高立。
魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟（2002）•1996~2000年台灣地區糖尿病盛行率與住院率•台灣公共衛生雜誌，21（3），173-180。
蘇雅玲、張媚、陳月枝（1994）•某醫學中心門診非胰島素依賴型糖尿病患者壓力感受與因應方式之探討•護理研究，2（1），29-40。


英文文獻
Aalto, A. M., Uutela, A., & Aro, A. R. (1997). Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates. Patient Education and Counseling, 30, 215-225.
Aalto, A. M., Uutela, A., & Aro, A. R. (2000). Disease-related distress among insulin-treated diabetic patients: Associations with health status, psychosocial factors and self-care practices. European Journal Public Health, 10(1), 68-74.
Akinci, F., Yildirim, A., Gozu, H., Sargin, H., Orbay, E., & Sargin, M. (2008). Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey. Diabetes Research and Clinical Practice, 79(1), 117-123.
Albright, T. L., Parchman, M., & Burge, S. K. (2001). Predictors of self-care behavior in adults with type 2 diabetes: an RRNeST study. Family Medicine, 33(5), 354-360.
American Diabetes Association. (2007). Standards of Medical Care in Diabetes--2007. Diabetes Care, 30(suppl 1), S4-41.
American Diabetes Association. (2008). Standards of Medical Care in Diabetes--2008. Diabetes Care, 31(suppl 1), S12-54.
Anderson, R. M., Fitzgerald, J. T., Gruppen, L. D., Funnell, M. M., & Oh, M. S. (2003). The Diabetes Empowerment Scale-Short Form (DES-SF). Diabetes Care, 26(5), 1641-1642.
Anderson, R. M., Fitzgerald, J. T., Wisdom, K., Davis, W. K., & Hiss, R. G. (1997). A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM. Diabetes Care, 20(3), 299-305.
Anderson, R. M., Funnell, M. M., Barr, P. A., Dedrick, R. F., & Davis, W. K. (1991). Learning to empower patients. Results of professional education program for diabetes educators. Diabetes Care, 14(7), 584-590.
Anderson, R. M., Funnell, M. M., Butler, P. M., Arnold, M. S., Fitzgerald, J. T., & Feste, C. C. (1995). Patient empowerment. Results of a randomized controlled trial. Diabetes Care, 18(7), 943-949.
Anderson, R. M., Funnell, M. M., Fitzgerald, J. T., & Marrero, D. G. (2000). The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy. Diabetes Care, 23(6), 739-743.
Aujoulat, I., d’Hoore, W., & Deccache, A. (2007). Patient empowerment in theory and practice: Polysemy or cacophony? Patient Education and Counseling, 66(1), 13-20.
Bradley, C., & Speight, J. (2002). Patient perceptions of diabetes and diabetes therapy: assessing quality of life. Diabetes/Metabolism Research and Reviews, 18(3), S64-69.
Bradley, C., Todd, C., Gorton, T., Symonds, E., Martin, A., & Plowright, R. (1999). The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Quality of Life Research, 8(1-2), 79-91.
Brown, D. W., Balluz, L. S., Giles, W. H., Beckles, G. L., Moriarty, D. G., Ford, E. S., et al. (2004). Diabetes mellitus and health-related quality of life among older adults: Findings from the behavioral risk factor surveillance system (BRFSS). Diabetes Research and Clinical Practice, 65(2), 105-115.
Brown, G. C., Brown, M. M., Sharma, S., Brown, H., Gozum, M., & Denton, P. (2000). Quality of life associated with diabetes mellitus in an adult population. Journal of Diabetes and Its Complications, 14(1), 18-24.
Burroughs, T. E., Desikan, R., Waterman, B. M., Gilin, D., & McGill, J. (2004). Development and Validation of the Diabetes Quality of Life Brief Clinical Inventory. Diabetes Spectrum, 17(1), 41.
Campbell, A., Converse, P. E., & Rodgers, W. L. (1976). The quality of American life: Perceptions, evaluations, and satisfactions. New York: Russell Sage Foundation.
Chang, H.-Y., Chiou, C.-J., Lin, M.-C., Lin, S.-H., & Tai, T.-Y. (2005). A population study of the self-care behaviors and their associated factors of diabetes in Taiwan: Results from the 2001 National Health Interview Survey in Taiwan. Preventive Medicine, 40(3), 344-348.
Cheng, A. Y., Tsui, E. Y., Hanley, A. J. G., & Zinman, B. (1999). Developing a quality of life measure for Chinese patients with diabetes. Diabetes Research and Clinical Practice, 46, 259-267.
DAFNE Study Group. (2002). Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ, 325(7367), 746-.
Delahanty, L. M., Grant, R. W., Wittenberg, E., Bosch, J. L., Wexler, D. J., Cagliero, E., et al. (2007). Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes. Diabetic Medicine, 24(1), 48-54.
Delamater, A. M., Jacobson, A. M., Anderson, B., Cox, D., Fisher, L., Lustman, P., et al. (2001). Psychosocial therapies in diabetes: Report of the psychosocial therapies working group. Diabetes Care, 24(7), 1286.
Elliott, T. R., Shewchuk, R. M., Miller, D. M., & Richards, J. S. (2001). Profiles in problem solving: Psychological well-being and distress among persons with diabetes mellitus. Journal of Clinical Psychology in Medical Settings, 8(4), 283-291.
Felce, D., & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16, 51-74.
Ferrans, C. E., & Powers, M. J. (1985). Quality of life index: development and psychometric properties. Advances in Nursing Science, 8(1), 15-24.
Feste, C., & Anderson, R. M. (1995). Empowerment: from philosophy to practice. Patient Education and Counseling, 26(1-3), 139-144.
Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Mohr, D., Masharani, U., et al. (2007). Clinical Depression Versus Distress Among Patients With Type 2 Diabetes: Not just a question of semantics. Diabetes Care, 30(3), 542-548.
Funnell, M. M., & Anderson, R. M. (2003). Patient empowerment: A look back, a look ahead. The Diabetes Educator, 29(3), 454-464.
Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B., et al. (2008). National standards for diabetes self-management education. Diabetes Care, 31(suppl 1), 97-104.
Gibson, C. H. (1991). A concept analysis of empowerment. Journal of Advanced Nursing, 16(3), 354-361.
Glasgow, R. E., Ruggiero, L., Eakin, E. G., Dryfoos, J., & Chobanian, L. (1997). Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care, 20(4), 562-567.
Gross, C., Scain, S., Scheffel, R., Gross, J., & Hutz, C. (2007). Brazilian version of the Problem Areas in Diabetes Scale (B-PAID): Validation and identification of individuals at high risk for emotional distress Diabetes Research and Clinical Practice, 76(3), 455 - 459.
Hanninen, J., Takala, J., & Keinanen-Kiukaanniemi, S. (1998). Quality of life in NIDDM patients assessed with the SF-20 questionnaire. Diabetes Research and Clinical Practice, 42, 17-27.
Hassan, K., Loar, R., Anderson, B. J., & Heptulla, R. A. (2006). The role of socioeconomic status, depression, quality of life, and glycemic control in type 1 diabetes mellitus. The Journal of Pediatrics, 149(4), 526-531.
Hermann, B. P., Vickrey, B., Hays, R. D., Cramer, J., Devinsky, O., Meador, K., et al. (1996). A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Research, 25, 113-118.
Hermanns, N., Kulzer, B., Krichbaum, M., Kubiak, T., & Haak, T. (2006). How to screen for depression and emotional problems in patients with diabetes: Comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia, 49(3), 469-477.
Huang, I. C., Hwang, C. C., Wu, M. Y., Lin, W., Leite, W., & Wu, A. W. (2007). Diabetes-specific or generic measures for health-related quality of life? Evidence from psychometric validation of the D-39 and SF-36 [Electronic Version]. Value in Health. Retrieved April 13, 2008, from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-4733.2007.00261.x
Hurley, A. C., & Shea, C. A. (1992). Self-efficacy: Strategy for enhancing diabetes self-care. The Diabetes Educator, 18(2), 146-150.
International Diabetes Federation. (2006). The UN resolution on diabetes [Electronic Version]. Retrieved January 20, 2008, from http://www.unitefordiabetes.org/campaign/resolution.html
Israel, B. A., Checkoway, B., Schulz, A., & Zimmerman, M. (1994). Health education and community empowerment: Conceptualizing and measuring perceptions of individual, organizational, and community control. Health Education & Behavior, 21(2), 149-170.
Jacobson, A. M., de Groot, M., & Samson, J. A. (1994). The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care, 17(4), 267-274.
Jacobson, A. M., de Groot, M., & Samson, J. A. (1997). The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. Quality of Life Research, 6(1), 11-20.
Karlsen, B., Idsoe, T., Dirdal, I., Rokne Hanestad, B., & Bru, E. (2004). Effects of a group-based counselling programme on diabetes-related stress, coping, psychological well-being and metabolic control in adults with type 1 or type 2 diabetes. Patient Education and Counseling, 53(3), 299-308.
Keers, J. C., Bouma, J., Links, T. P., ter Maaten, J. C., Gans, R. O. B., Wolffenbuttel, B. H. R., et al. (2006). One-year follow-up effects of diabetes rehabilitation for patients with prolonged self-management difficulties. Patient Education and Counseling, 60(1), 16-23.
Lin, C. C. (2005). Development and testing of the diabetes self-management instrument. Published doctoral dissertation. State University of Michigan, Michigan.
Lin, T., Chou, P., Lai, M. S., Tsai, S. T., & Tai, T. Y. (2001). Direct costs-of-illness of patients with diabetes mellitus in Taiwan. Diabetes Research and Clinical Practice, 54, 43-46.
Maddigan, S. L., Majumdar, S. R., & Johnson, J. A. (2005). Understanding the complex associations between patient–provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: A structural equation modeling approach. Quality of Life Research, 14(6), 1489-1500.
Meeberg, G. A. (1993). Quality of life: a concept analysis. Journal of Advanced Nursing, 18(1), 32-38.
Menard, J., Payette, H., Dubuc, N., Baillargeon, J. P., Maheux, P., & Ardilouze, J. L. (2007). Quality of life in type 2 diabetes patients under intensive multitherapy. Diabetes and Metabolism, 33(1), 54-60.
Northrup, D. T. (1993). Self-care myth reconsidered. Advances in Nursing Science, 15(3), 59.
Oleson, M. (1990). Subjectively perceived quality of life. Journal of Nursing Scholarship, 22(3), 187-190.
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed.). USA: Elsevier Mosby.
Park, H. S., Hong, Y. S., Lee, H. J., Ha, E. H., & Sung, Y. A. (2004). Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care. Journal of Clinical Epidemiology, 57(9), 978-984.
Perkins, D. D., & Zimmerman, M. A. (1995). Empowerment theory, research, and application. American Journal of Community Psychology, 23(5), 569-579.
Pibernik-Okanovi, M., Szabo, S., & Melko, Z. (1998). Quality of life following a change in therapy for diabetes mellitus. PharmacoEconomics, 14, 201-207.
Polit, D. F., & Beck, C. T. (2004). Nursing research: Principles and methods (7th ed.). Philadelphia: Lippincott Williams & Wilkins.
Polonsky, W. H. (2000). Understanding and assessing diabetes-specific quality of life. Diabetes Spectrum, 13(1), 36-45.
Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., et al. (1995). Assessment of diabetes-related distress. Diabetes Care, 18(6), 754-760.
Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., et al. (2005). Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scale. Diabetes Care, 28(3), 626-631.
Pouwer, F., Skinner, T. C., Pibernik-Okanovic, M., Beekman, A. T. F., Cradock, S., Szabo, S., et al. (2005). Serious diabetes-specific emotional problems and depression in a Croatian–Dutch–English Survey from the European Depression in Diabetes [EDID] Research Consortium. Diabetes Research and Clinical Practice, 70(2), 166-173.
Redekop, W. K., Koopmanschap, M. A., Stolk, R. P., Rutten, G. E. H. M., Wolffenbuttel, B. H. R., & Niessen, L. W. (2002). Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care, 25(3), 458-463.
Roglic, G., Matthews, D., Rubin, R. R., & Bech, O. M. (2002). The Oxford international diabetes summit: Implications of the DAWN study. Practical Diabetes International, 19(6), 187-192.
Safford, M. M., Russell, L., Suh, D. C., Roman, S., & Pogach, L. (2005). How much time do patients with diabetes spend on self-care? Journal of the American Board of Family, 18(4), 262-270.
Shiu, A. T. Y., Thompson, D. R., & Wong, R. Y. M. (2008). Quality of life and its predictors among Hong Kong Chinese patients with diabetes. Journal of Clinical Nursing, 17(5a), 125-132.
Skinner, T. C., Carey, M. E., Cradock, S., Daly, H., Davies, M. J., Doherty, Y., et al. (2006). Diabetes education and self-management for ongoing and newly diagnosed (DESMOND): Process modelling of pilot study. Patient Education and Counseling, 64(1-3), 369-377.
Skovlund, S. E., Peyrot, M., & on behalf of the Dawn International Advisory Panel. (2005). The Diabetes Attitudes, Wishes, and Needs (DAWN) Program: A New Approach to Improving Outcomes of Diabetes Care. Diabetes Spectrum, 18(3), 136-142.
Snoek, F. J., Pouwer, F., Welch, G. W., & Polonsky, W. H. (2000). Diabetes-related emotional distress in Dutch and U.S. diabetic patients: Cross-cultural validity of the problem areas in diabetes scale. Diabetes Care, 23(9), 1305-1309.
Sousa, V. D., & Zauszniewski, J. A. (2005). Toward a theory of diabetes self-care management. Journal of Theory Construction and Testing, 9(2), 61-67.
Sridhar, G. R., & Madhu, K. (1994). Prevalence of sleep disturbances in diabetes mellitus. Diabetes Research and Clinical Practice, 23(3), 183-186.
Suris, J. C., Parera, N., & Puig, C. (1996). Chronic Illness and Emotional Distress in Adolescence. Journal of Adolescent Health, 19, 153-156.
Tengland, P. A. (2007). Empowerment: A goal or a means for health promotion? Medicine, Health Care and Philosophy, 10(2), 197-207.
Testa, M. A., & Simonson, D. C. (1996). Assessment of Quality-of-Life Outcomes. The New England Journal of Medicine, 334(13), 835-840.
The DCCT Research Group. (1988). Reliability and validity of a diabetes quality-of-life measure for the diabetes control and complications trial (DCCT). Diabetes Care, 11(9), 725-732.
The Diabetes Control Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine 329(14), 977-986.
The WHOQOL Group. (1995). The World Health Organization Quality Of Life Assessment (WHOQOL): position paper from the World Health Organization. Social Science and Medicine, 41, 1403-1409.
The WHOQOL Group. (1998a). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558.
The WHOQOL Group. (1998b). The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. Social Science and Medicine, 46, 1569-1585.
Tomey, A. M., & Alligood, M. R. (2006). Nursing Theorists and Their Work (6 ed.). USA: Elsevier Mosby.
Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950.
Trento, M., Passera, P., Borgo, E., Tomalino, M., Bajardi, M., Cavallo, F., et al. (2004). A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care, 27(3), 670-675.
Trief, P. M., Wade, M. J., Pine, D., & Weinstock, R. S. (2003). A comparison of health-related quality of life of elderly and younger insulin-treated adults with diabetes. Age Ageing, 32(6), 613-618.
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 2 diabetes (UKPDS 33). Lancet, 352(9131), 837-853.
Wandell, P. E., & Tovi, J. (2000). The quality of life of elderly diabetic patients. Journal of Diabetes and Its Complications, 14(1), 25-30.
Ware, J. E., Jr., , & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30(6), 473-483.
Watkins, K., & Connell, C. M. (2004). Measurement of Health-Related QOL in Diabetes Mellitus. PharmacoEconomics, 22(17), 1109-1126.
Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care, 20(5), 760-766.
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care, 27(5), 1047-1053.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA, 273(1), 59-65.
Zhan, L. (1992). Quality of life: conceptual and measurement issues. Journal of Advanced Nursing, 17(7), 795-800.
Zimmerman, M. A. (1995). Psychological empowerment: Issues and illustrations. American Journal of Community Psychology, 23(5), 581-599.