糖尿病患者健康信息行为探析：一项扎根理论研究

发布时间：2018-01-18 01:31

本文关键词：糖尿病患者健康信息行为探析：一项扎根理论研究　出处：《第二军医大学》2017年博士论文　论文类型：学位论文

【摘要】：背景自我管理作为糖尿病行为干预的最佳模式之一已在全球范围达成共识。尽管糖尿病自我管理干预研究一直在进行,但仍未解决我国糖尿病患者自我管理水平低下这一难题。世界卫生组织预言,信息是通往健康的必经之路,也是改变行为的先决因素。当前多数糖尿病自我管理教育仍是以健康照护提供者为主导的权威教育,缺乏患者的声音;鲜有研究深入探究糖尿病患者自发寻求、获取和利用健康信息的行为过程。目的本研究旨在还原糖尿病患者在自我管理过程中寻求和利用健康信息的社会过程,指明影响糖尿病患者健康信息行为发生的因素,剖析在此过程中存在的问题,构建糖尿病患者健康信息行为理论模型。方法本研究采用扎根理论研究方法,通过便利抽样、理论抽样,选取上海市、河南省、浙江省3地包含城市、农村地区在内的糖尿病患者,对其从接收信息到使用信息的经历进行深度访谈。本研究最终共纳入30名糖尿病患者,完成40次深度访谈(部分糖尿病患者接受2次及以上访谈)。所有录音的访谈资料逐字转录,通过电子文档整理保存。资料采用开放性、轴心性、选择性编码,同时进行维度分析,并不断持续比较,逐步形成类属,最终形成糖尿病患者健康信息行为理论模型。文献阅读和撰写备忘录贯穿整个研究过程。结果本研究探析了糖尿病患者的健康信息行为(核心类属),即糖尿病患者从接收初始信息起,经历感知/判断信息、主动寻求信息、被动接收信息、有意回避信息、能动使用信息和暂时搁置信息,以能否转化为自我管理行为为结果的动态循环过程。在本理论模型中,接收初始信息是糖尿病患者健康信息行为的逻辑起点,感知/判断信息是介导糖尿病患者采取不同健康信息寻求和使用行为的中间环节。基于感知/判断信息的结果,糖尿病患者可受到信息和需求不匹配这一矛盾推动,疾病负面性、治疗疾病希望的动力激发,在自我效能感和自我责任感的维持下主动寻求信息;也可因否认疾病,或恐惧、抗拒威胁信息而有意回避信息;还可因动机缺乏采取被动接收信息的策略。基于对获取信息的感知和判断,糖尿病患者或能动使用信息,表现为严格执行信息、自我调节信息和参与医疗决策;或暂时搁置信息,表现为知而不行、忽略信息和储存信息。在不同的情境下,患者可因自我效能感的维持而持续寻求信息,逐渐成长为糖尿病自我管理的“专家”;也可因动力缺乏而弱化寻求信息,出现自我管理行为的退化;还可因动机缺失而暂停寻求信息,呈现出糖尿病自我管理效果的停滞或倒退。结论本研究构建的糖尿病患者健康信息行为理论模型,将为医疗卫生机构、健康照护提供者、政策制定者进一步发展糖尿病健康教育干预项目,提高糖尿病健康教育的针对性和有效性,促成糖尿病患者自我管理行为的有效转变和长期维持提供理论依据和实践指导。
[Abstract]:Background Self-management as one of the best models for behavioral intervention in diabetes has been agreed on a global scale, although research on self-management intervention in diabetes has been ongoing. But there is still no solution to the problem of low self-management of diabetic patients in China. The World Health Organization predicts that information is the only way to health. The majority of diabetes self-management education is still dominated by health care providers as the leading authority education, the lack of patient voice; There are few studies on the behavioral process of self-seeking, obtaining and utilizing health information in diabetic patients. Objective this study aims to reduce the social process of seeking and utilizing health information in self-management of diabetic patients. The factors influencing the health information behavior of diabetic patients were pointed out, the problems existed in the process were analyzed, and the theoretical model of health information behavior of diabetes patients was constructed. Methods the method of taking root theory was adopted in this study. Through convenience sampling, theoretical sampling, selected from Shanghai, Henan Province, Zhejiang Province, including urban, rural areas, including the diabetic patients. We conducted in-depth interviews on their experiences from receiving information to using information. A total of 30 patients with diabetes were included in this study. Completed 40 in-depth interviews (some patients with diabetes received 2 or more interviews. All the recorded interview materials verbatim transcribed, stored through electronic documents. Data are open, axis. Selective coding, dimensionality analysis, and continuous comparison, gradually forming a generic. Finally, a theoretical model of health information behavior of diabetic patients was formed. Literature reading and writing memos ran through the whole research process. Results this study explored the health information behavior of diabetic patients (core category). That is, diabetes patients from receiving initial information, experience perception / judgment information, actively seek information, passively receive information, intentionally avoid information, active use of information and temporary use of information. In this theoretical model, receiving initial information is the logical starting point for diabetes patients' health information behavior. Perception / judgment information is the intermediate link that mediates diabetes patients to adopt different health information seeking and using behavior. Diabetes patients can be driven by the contradiction of mismatch of information and needs, the disease is negative, the motive force of treating disease hope is stimulated, and the information can be actively sought under the maintenance of self-efficacy and self-responsibility. It can also be deliberately avoided by denying disease, or fear, resisting threat information; Based on the perception and judgment of obtaining information, diabetes patients or active use of information can be shown as strictly executing information, self-regulating information and participating in medical decision-making. In different situations, patients can continue to seek information because of the maintenance of self-efficacy. Gradually grow into the diabetes self-management of "experts"; It can also be weakened by lack of motivation to seek information and self-management behavior degradation; Because of the lack of motivation, we can pause to seek information, showing the effect of diabetes self-management stagnation or regression. Conclusion the health information behavior model of diabetes patients constructed in this study will be a medical and health organization. Health care providers and policy makers further develop diabetes health education interventions to improve the relevance and effectiveness of diabetes health education. To promote the effective transformation and long-term maintenance of self-management behavior of diabetic patients provides theoretical basis and practical guidance.
【学位授予单位】：第二军医大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R473.5

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