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研究生:許心瑜
研究生(外文):HSU, HSIN-YU
論文名稱:第 2 型糖尿病患者之心理困擾、家庭支持 與血糖控制管理之關係探討
論文名稱(外文):The relationship between psychological distress, family support and blood sugar control in patients with type 2 diabetes
指導教授:李易蓁李易蓁引用關係
指導教授(外文):LEE, I-CHEN
口試委員:高浩雲陳榮福
口試委員(外文):KAO, HAO-YUNCHEN, JUNG-FU
口試日期:2021-05-28
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士在職專班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:81
中文關鍵詞:第 2 型糖尿病家庭支持心理困擾血糖控制
外文關鍵詞:type 2 diabetesfamily supportpsychological distressglycemic control
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研究目的
糖尿病日常生活管理涉及到不同的自我照護行為,也需要改變生活方式,會與既定的家庭習????相衝突和影響家庭常規。然而會因為自 我照護管理不當,導致急性住院或持續性的醫療、照護費用負擔增加、 社交困難的狀況,而引起相當大的情緒困擾。故本研究瞭解第2型糖尿病患者其心理困擾、家庭支持與血糖控 制管理的關聯性,並探究相關影響因素,希冀能提供疾病照護計畫與 衛生政策管理規劃研擬之參考。
研究方法
本研究之對象為南部某醫學中心參與糖尿病共同照護網之第2型糖尿病患者,在2020年9月1日至12月31日以方便抽樣選取200位樣本。 使用自行設計的問卷與中文版糖尿病問題量表收集人口學資料、家庭 支持度、糖尿病管理、與糖尿病困擾(PAID總分)等資料。血糖控制管 理狀況則為樣本近一年內糖化血色素(HbA1c)之平均值。使用SPSS 25.0統計軟體進行描述統計、獨立樣本T檢定、皮爾森相關檢定、多 元線性迴歸分析。
研究結果
有無主要健康支持者在血糖控制管理程度(HbA1c)上無顯著差異(t=0.51, p=0.960);但是,主要健康支持者會欣賞及肯定我做好糖尿病 照護(t=3.99, p<0.001);與會鼓勵並支持我持續進行糖尿病管理工作 (t=2.18, p=0.030),血糖控制管理(HbA1c)會比較好。控制其他變項之 後,PAID總分愈高,血糖控制管理(HbA1c)數值愈高(B=0.02, p=<0.001)。
結論與建議
總體而言,若病患對罹病感到困擾(糖尿病困擾),血糖控制狀況會較差。雖然家庭支持與血糖控制管(HbA1c)並無關聯,然而家庭 參與可以支持患者積極面對疾病。建議將家庭支持納入糖尿病自主管 理教育計畫,與糖尿病困擾評估納入糖尿病品質支付服務必要常規檢 查項目,得以提高糖尿病全面性照護。
關鍵詞:第 2 型糖尿病、家庭支持、心理困擾、血糖控制
Purposes
Daily life management of diabetes involves different self-care behaviors, and also requires changes in lifestyle, which will conflict with established family habits and affect family routines. However, due to improper self-care management, acute hospitalization or continuous medical care, increased burden of care costs, and social difficulties can cause considerable emotional distress.
Therefore, the study prescribes the relationship between psychological distress, family support, and blood sugar management in patients with type 2 diabetes. Associated influencing factors were explored, and we hope to provide a reference for disease care planning and healthcare policy planning.
Method
The object of this study is patients with type 2 diabetes participating in the diabetes joint care network of a medical center in the south Taiwan. The 200 cases were selected from September 1 to December 31, 2020. The self-designed questionnaire and the Chinese version of the Diabetes Problem Scale were used to collect demographic data, datas of family support, diabetes management, and diabetes distress (PAID total score). The blood glucose control management status is the average value of glycated hemoglobin (HbA1c) of the cases in the past year. SPSS 25.0 statistical software was used to perform descriptive statistics, independent sample T test, Pearson correlation test, and multiple linear regression analysis.
Result
There is no significant difference in the degree of blood sugar control (HbA1c) between whether there are major health supporters (t=0.51, p=0.960); however, the major health supporters appreciate and affirm the patient’s effort on taking care of diabetes (t=3.99, p<0.001) ); participants with major health supporters are also encouraged and supported to continue diabetes management work (t=2.18, p=0.030). Better blood sugar control management (HbA1c) in this group is also noted. After correcting other variables, the higher total PAID score indicated is associated with the higher HbA1c level (B=0.02, p=<0.001).
Conclusion and suggestion
If the patient is troubled by the disease (diabetes distress), the blood sugar control status will be poor. Although family support is not related to blood sugar control management (HbA1c), family involvement can support patients to actively face the disease. It is recommended to incorporate family support into the diabetes self- management education plan. Adding diabetes distress assessment into the routine of Pay for performance, to achieve comprehensive diabetes care.
Keywords: type 2 diabetes, family support, psychological distress, glycemic control
致謝.........................................................................i
中文摘要.....................................................................ii
Abstract...................................................................iii
目錄.........................................................................iv
表目錄.......................................................................vi
圖目錄......................................................................vii
第一章 緒論....................................................................1
第一節 研究背景與動機............................................................2
第二節 研究目的.................................................................3
第三節 名詞解釋.................................................................4
第二章 文獻探討.................................................................5
第一節 第2型糖尿病的成因、診斷與治療...............................................5
第二節 心理困擾與家庭支持之測量與工具...............................................9
第三節 心理困擾、家庭支持與血糖控制之研究...........................................17
第三章 研究方法與材料............................................................20
第一節 研究架構.................................................................20
第二節 研究假說.................................................................22
第三節 研究對象與資料收集.........................................................22
第四節 研究工具.................................................................23
第五節 研究變項與操作型定義.......................................................25
第六節 統計分析.................................................................31
第四章 研究結果.................................................................33
第一節 問卷信效度...............................................................33
第二節 人口學、家庭支持、糖尿病管理之特徵...........................................34
第三節 人口學變項、糖尿病管理和血糖控制管理之關係....................................41
第四節 家庭支持度、糖尿病困擾與血糖控制管理程度之相關性...............................44
第五節 糖尿病困擾、家庭支持與血糖控制關聯性之迴歸模式.................................47
第五章 討論....................................................................49
第一節 第2型糖尿病患的心理困擾、家庭支持與血糖控制之現況..............................49
第二節 第2型糖尿病患的心理困擾、家庭支持與血糖控制之關係..............................53
第三節 第2型糖尿病患的心理困擾、家庭支持與血糖控制之相關影響因素.......................54
第六章 結論...................................................................56
第一節 研究限制................................................................56
第二節 建議...................................................................57
參考文獻
中文參考文獻..................................................................59
英文參考文獻..................................................................60
附錄
附錄一 受訪者同意書............................................................66
附錄二 人體試驗委員會審查通過證明書...............................................67
附錄三 研究工具問卷-第2型糖尿病患家庭支持與糖尿病管理問卷............................68
附錄四 問卷專家內容效度審查名單..................................................71
附錄五 研究工具問卷-中文版糖尿病問題量表(Chinese version of the. Problem
Areas In Diabetes , PAID-C) ..........................................72
附錄六 「中文版糖尿病問題量表(Chinese version of the Problem Areas In Diabetes
, PAID-C)」授權使用同意書...............................................73

表目錄
表 2-1-1 一般(未懷孕及無貧血)成年人糖尿病的診斷標準.................................7
表 2-1-2 糖尿病前期的診斷標準....................................................7
表 2-1-3 糖尿病分類............................................................7
表 2-2-1 臨床上常見的糖尿病心理困擾評估測量工具....................................10
表 2-2-2 臨床上常見的家庭支持評估測量工具.........................................16
表 3-5-1 研究變項與操作型定義...................................................25
表 4-1-1 各量表與信度.........................................................33
表 4-2-1 本研究樣本資料分佈(N=200).............................................36
表 4-3-1 樣人口學資料、糖尿病管理與 HbA1c 的關係(N=200) .........................41
表 4-4-1 樣本家庭支持度、心理困擾與 HbA1c 的關係(N=200) .........................45
表 4-5-1 家庭支持度、心理困擾與血糖控制程度(HbA1c)之迴歸模式 ......................48

圖目錄
圖 3-1 研究架構..............................................................21


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