臺灣博碩士論文加值系統

研究背景與目的：研究證據指出青春期為糖尿病疾病管理由好轉壞的重要階段，影響青少年疾病管理的因素，大多研究家庭功能與疾病管理之間的關係，鮮少研究探討父母和青少年間如何分擔疾病控制責任。在父母與青少年分擔疾病控制責任時，父母管教方式會造成親子和諧或衝突，進而影響青少年的疾病管理和血糖控制。因此，本研究欲以疾病控制責任知覺與父母管教方式來看對第一型糖尿病青少年疾病管理和血糖控制的效果。
研究方法：本研究以罹患第一型糖尿病青少年和其主要照顧者（父親或母親）為研究對象。參與本研究的受試者有107名，其主要照顧者100人，符合本研究所需的青少年與其主要照顧者配對共計82組，其中男生36 名，女生46名。研究工具為基本資料表、糖尿病家庭責任分擔量表、父（母）親管教方式量表和糖尿病自我照顧量表。以相關分析、共變數分析與多元迴歸分析，進行假設考驗。
研究結果：本研究發現父母對青少年的要求與反應愈多，青少年的疾病管理愈好。當父母採開明權威的管教方式，青少年自評疾病管理會優於父母採寬鬆放任、忽視冷漠之管教方式；而開明權威或專制權威的管教方式在青少年評估其疾病管理上則沒有差異。但父母管教方式在青少年的血糖控制效果上沒有差異，疾病控制責任知覺之責任公平、責任重疊模式對青少年疾病管理和血糖控制效果亦無差異。進行多元迴歸分析發現，父母管教方式的要求向度可以預測青少年疾病管理，父母管教方式的反應向度、疾病管理則可以預測血糖控制的效果。
結論：本研究於疾病控制責任知覺有責任公平和責任重疊模式兩組，缺少不負責任模式組，建議未來研究應包含三組，以比較其對疾病管理和血糖控制效果的差異。研究結果發現開明權威的管教方式，能使青少年疾病管理最佳，可以提供臨床工作者，予宣導及衛教時參考。

Background and purpose：Adolescence was the turning point of diabetes management. While studies considered that the reasons influenced adolescent diabetes management, most studies were curious about the relationship between family function and diabetes management. Few studies discussed the diabetes management responsibility between parents and adolescents. When parents and adolescents shared the diabetes management responsibility, parenting style could cause family cohesion or conflict and then influenced adolescents’ diabetes management and metabolic control. Consequently, the present study examines the effect of diabetes management responsibility and parenting style on type 1 diabetes adolescents’ diabetes management and metabolic control
Methods：Type 1 diabetes adolescents and their major care taker（father or mother）were subjects of study. The subjects participating in this study were 107 type 1 diabetes adolescents and 100 major care takers. Among subjects and their care takers, 82 parents-child dyads were suitable for this study. The subjects of this study included 36 adolescent boys and 46 adolescent girls. The instruments are the basic information questionnaire, Diabetes Family Responsibility Questionnaire, Parenting Style Scale, and the Chinese version of Self-Care Inventory. The statistical analyses included correlation, analysis of covariance, and multiple regression.
Results：This study discovered while parents provided more demand and response toward their adolescent children, adolescents’ diabetes management were better. Regarding adolescents’ evaluation of their degree of diabetes management, the effect of authoritative parenting style was better than the effect of indulgent or neglecting parenting style, but there was no difference between the effect of authoritative parenting style and authoritarian parenting style. Parenting style made no difference in adolescents’ metabolic control; both the perfect agreement pattern and overlap pattern of diabetes management responsibility made no difference in adolescents’ diabetes management and metabolic control. The multiple regression results were that the demanding dimension of parenting style can predict adolescents’ diabetes management and the responsive dimension of parenting style and adolescents’ diabetes management could predict adolescents’ metabolic control.
Conclusion：This study included perfect agreement pattern and overlap pattern of diabetes management responsibility, but did not include no-one-takes-responsibility- pattern of diabetes management responsibility. There was a need for further research to include three patterns in order to contrast the difference in adolescents’ diabetes management and metabolic control. The research result indicated that authoritative parenting style caused the best adolescents’ diabetes management. Clinicians could provide this kind of information to parents.

中文摘要........................................................................................................................I
英文摘要.......................................................................................................................II
目錄..............................................................................................................................IV
圖目錄...........................................................................................................................V
表目錄...........................................................................................................................V

第一章 緒論..................................................................................................................1
第一節 研究動機..................................................................................................1
第二節 研究問題與目的......................................................................................4
第二章 文獻探討..........................................................................................................6
第一節 第一型糖尿病及其治療方式..................................................................6
第二節 第一型糖尿病的疾病管理與血糖控制..................................................7
第三節 疾病控制責任知覺對疾病管理和血糖控制的重要性........................10
第四節 父母管教方式對疾病管理和血糖控制的重要性................................13
第五節 研究假設................................................................................................23
第三章 研究方法........................................................................................................27
第一節 研究對象................................................................................................27
第二節 研究步驟................................................................................................28
第三節 研究工具................................................................................................29
第四章 研究結果........................................................................................................45
第一節 研究對象的背景資料............................................................................45
第二節 疾病控制責任知覺、父母管教方式與疾病管理的關係....................58
第三節 疾病控制責任知覺、父母管教方式與血糖控制的關係....................59
第四節 疾病控制責任知覺、父母管教方式對疾病管理和血糖控制的預測力............................................................................................................61
第五章 討論與建議....................................................................................................64
第一節 疾病控制責任知覺對疾病管理和血糖控制的效果............................64
第二節 父母管教方式對疾病管理和血糖控制的效果....................................66
第三節 疾病管理和血糖控制的關聯性............................................................67
第四節 研究限制與建議....................................................................................68
參考文獻......................................................................................................................70
一、 中文部份..............................................................................................................70
二、 英文部分..............................................................................................................73

附錄一 青少年的問卷................................................................................................81
附錄二 青少年之主要照顧者的問卷........................................................................85
附錄三 英文版糖尿病家庭責任分擔量表................................................................87
附錄四 英文版糖尿病自我照顧量表修訂版...........................................................88



圖目錄
圖2.5-1 研究架構圖...................................................................................................23
表目錄
表2.1-1 兒童及青少年的HbA1c目標......................................................................7
表2.2-1 不同年齡糖尿病所參與之醫療處置內容...................................................8
表2.4-1 單向度的父母管教方式..............................................................................16
表2.4-2 雙向度的父母管教方式..............................................................................17
表2.4-3 多向度的父母管教方式..............................................................................18
表2.4-4 Maccoby與Martin以雙向度區分的父母管教類型.................................19
表2.4-5 不同管教類型中，父母行為表現的特徵..................................................20
表3.3-1 責任公平、責任重疊和不負責任分數得分標準......................................30
表3.3-2 責任公平、責任重疊和不負責任分數的描述統計數值..........................31
表3.3-3 責任公平、責任重疊和不負責任分數的差異檢定..................................31
表3.3-4 責任公平、責任重疊和不負責任分數的事後比較..................................33
表3.3-5 中文版糖尿病家庭責任分擔量表之項目分析摘要表..............................34
表3.3-6 中文版糖尿病家庭責任分擔量表之因素分析摘要表..............................35
表3.3-7 對照組樣本之各年級與性別人數分布表..................................................38
表3.3-8 父（母）親管教方式量表之臨床組和對照組樣本的描述統計數值......38
表3.3-9 父（母）親管教方式量表之臨床組和對照組樣本的差異檢定..............38
表3.3-10 糖尿病自我照顧量表修訂版之項目分析摘要表....................................42
表3.3-11 糖尿病自我照顧量表修訂版之因素分析摘要表....................................43
表4.1-1 基本資料分析表..........................................................................................46
表4.1-2 青少年和父（母）親的各分量表得分情形..............................................48
表4.1-3 性別對各分量表的平均數差異檢定..........................................................49
表4.1-4 罹病年數、年齡、各分量表之間的相關分析..........................................57
表4.2-1 疾病控制責任知覺、父母管教方式在青少年疾病管理上的描述統計值................................................................................................................59
表4.2-2 疾病控制責任知覺、父母管教方式對青少年疾病管理共變數分析摘要表................................................................................................................59
表4.3-1 疾病控制責任知覺、父母管教方式在血糖控制上的描述統計值...........60
表4.3-2疾病控制責任知覺、父母管教方式對血糖控制之共變數分析摘要表................................................................................................................60
表4.4-1 青少年之疾病控制責任知覺、父母之疾病控制責任知覺、要求、反應預測青少年疾病管理之階層分析摘要表....................................................61
表4.4-2 青少年之疾病控制責任知覺、父母之疾病控制責任知覺、要求、反應、疾病管理預測血糖控制之階層分析摘要表............................................62
表5.3-1 HbA1c值、每天打針與測血糖次數、青少年疾病管理、父母評估青少年疾病管理的相關分析...............................................................................68

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