| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 91 === Abstract
Diabetes is one of the most important chronic diseases associated with lifestyle, because of the high incidence rate and high consumption of medical resources due to diabetes-related complications and co-morbidity. Previous study indicated that the occurrence of diabetes-related complications and co-morbidity could be prevented or delayed by appropriate early intervention. Therefore, the Bureau of National Health Insurance has lunched a diabetic disease management program in 2001, based on the shared care model.
Self-care education played a critical role in disease management model of diabetes. It taught patients how to perform exercise, control diet, monitor glucose level and take medication regularly. Previous researches consistently showed that the compliance of exercise was poor; although few study providing information on why it happened. The aims of this study were to explore how diabetic patients understood, interpreted and performed exercise. Simultaneously, we examined the strategies they employed to manage exercise when confronting with other competing interests in daily lives.
We conducted a qualitative study by applying in-depth interview and focus group discussion to collect information on diabetic patients. Patients were interviewed by a set of semi-structured questions, focused on patients’ viewpoint on exercise, actual exercise experience, perceived barriers in performing exercise, and strategies to cope with barriers. There are fourteen patients participated in in-depth interviews, eight patients participated in focus group discussion. The interviews lasted about 30-45 minutes each and were tape-recorded and transcribed literally. Regarding the analysis, we conducted first and second level of coding procedure, categorized meaningful codes, and summarized associated categories to themes, then we cross-checked results from interviews, focus group discussion, personal experience from participatory observations on the health education class and any other records or files related to the patients. By the method of triangulation we tried to assure the credibility and dependability of the results.
The results of research were summarizes as follows: 1.Culture and personal experience shaped an individual’s concept of body care. 2. A person’s unique ecosystem affected his or her types of exercise. 3. Type of exercise was chosen to fit into a person’s daily activities and to meet an individual’s need 4.Psycho-social factors may or may not predict a person’s exercise behavior.
Factors facilitated a person to perform exercise regularly including 1. Fixed time schedule for exercise. 2. Re-schedule daily living. 3. Regular daily activity. 4.Combine physical activity with daily activity. 5. Convenient place to perform exercise. 6. Being elderly (had time available). 7. Being youth (had energy and were more flexible for choosing type of exercises. 8. Had emotional support from exercise partners. 9. Health education especially from media press. 10.Learning the successful experiences from others. 11.Recommendations from medical professional. 12.Personal perception from the change on body image due to illness.
Inhibited factors to perform exercise regularly including: 1.The change on regular daily living, which interrupted exercise habit. 2.Routine housework or job out of family competed time for exercise. 3. Caring burdens of the Younger people. 4. Poor physical capacity of the elderly. 5. Exercise cause more physical burden. 6. Negative support from exercise partners. 7. Difficulty in limbs mobility and poor bodily fitness. 8. Grouping exercise conducted in early morning competed time to sleep.
Strategies in coping with barriers to exercise were: 1.Physical activity must combine with daily activity. 2. Try nothing but increasing volume of physical activity in the regular daily living. 3. Performed simple exercises to overcome the barriers of time and space. 4.Changed the space of daily living into the space suited for exercise.
Recommends for exercise policy were as follows: 1.Exercise models must be individualized and linked to daily living. 2.The advice on exercise and it’s promoting strategies must be able to fulfill personal needs. 3.Exercise promotion should combine education and media press, and selecting witness with successful exercise experience as the agency. 4.Knowledge of physical care should integrate western and eastern theories. Recommendation for the future studies:1.To apply ecological perspectives to study diabetic patients’ exercise behaviors. 2. Try to find different patterns of ecosystems by quantitative studies. 3. To design exercise closely link to daily living. 4. Verify the physiological efficacy of daily physical activity when comparing the existing exercise.
Key words: diabetes, self-care, health promotion, health behavior, exercise, compliance, qualitative study, illness, lay experience.
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