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題名：第2型糖尿病人健康行為之策略管理
作者：王銘杰
作者(外文)：Ming-Jye Wang
校院名稱：中華大學
系所名稱：科技管理博士學位學程
指導教授：林淑萍
學位類別：博士
出版日期：2012
主題關鍵詞：第2型糖尿病；重要績效缺口分析(IPGA)；跨理論模式；行為改變；自我效能；社會支持；Type 2 diabetes；Importance-performance gap analysis (IPGA)；Transtheoretical model；Stages of change；Self-efficacy；Social support
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糖尿病人生活型態的改變，才能有效控制血糖及降低相關併發症的風險，然迄今卻僅低於1/2的糖尿病人得到適當的照護與生活品質，故本研究從病人的觀點，第一階段運用重要績效缺口分析(Importance-Performance and Gap Analysis, [IPGA])探討糖尿病人日常健康行為之影響因素和認知與自我績效評估之缺口；第二階段結合行為改變理論-社會認知理論和跨理論模式探討糖尿病人行為改變的關鍵要素，期有助於提升糖尿病人自我管理能力及發展以糖尿病人為中心的健康照護策略管理。
研究結果發現毅力是影響血糖監測及規律運動的關鍵要素且有性別差異，而飲食控制的關鍵在口慾；自覺糖尿病的嚴重度和妨礙日常活動二項因素與規律運動有關，而遵醫囑和自覺健康狀況分別與血糖監測和飲食控制有關。糖尿病人之社會支持，自我效能和遵醫囑在行為改變階段有顯著差異，而日常管理效能是持續行為改變的關鍵因素，並與遵醫囑直接正相關，另受社會支持的影響；遵醫囑和家人或朋友不表達負面批評或行為與糖化血色素直接負相關。
重要績效缺口分析為糖尿病人的自我管理提供了特殊的管理指引，社會心理因素在行為改變階段的差異，提供了加強糖尿病人持續行為改變之道；建立社會支持系統，擬訂客製化的自我管理計畫，運用以"意義為中心”取代”以訊息為中心”的傳播觀念，善用現代化科技協助或提醒健康行為，凡此均致力於提升糖尿病人的日常管理信心為依歸，是為能持續行為改變和促進血糖控制的較佳方法。
Lifestyle behavior change in type 2 diabetic patients may provide effective glycemic control and reduce the risk of related complications. To date, fewer than one-half of all diabetic patients receive appropriate care and enjoy a good quality of life. Therefore, in this study, from the patient perspectives, used the importance-performance gap analysis (IPGA) to investigate the key factors in and gap between perception and performance of daily blood glucose monitoring, regular exercise, and diet control in individuals with type 2 diabetes and applied the transtheoretical model to investigate the key factors that promote behavior change in diabetic subjects.
Results showed that Perseverance was the key factor affecting blood glucose monitoring and regular exercise in men more than in women. The critical factor in diet control was the desire to eat. Patients’ perceived severity and limited daily activities of diabetes correlated with regular exercise; patients’ compliance correlated with glucose monitoring and perceived health status with diet control. The social support, self-efficacy, and compliance demonstrated differences in stages of behavior change in type 2 diabetic patients. Routine management of diabetes was a key factor in behavior change, which correlated indirectly with HbA1C values through compliance and was positively affected by social support. Compliance and undermining from family or friends were directly associated with HbA1C.
This study may provide more specific management guideline by applying IPGA approach for patient's self-management to clinical practice. The differences in psychological factors at stages of change may provide the references to maintain lasting behavior changes. Establishing a social support system, developing a tailored self-management plan, putting into use a "meaning-centered" rather than a "message-centered" philosophy of communication, and applying the current technology to assist or reminder patients health behavior, which all to improve the patients’ perceived confidence in routine management may be the best way to achieve sustainable behavior change and promote better blood glucose control.
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