| Summary: | 碩士 === 國立臺灣師範大學 === 教育心理與輔導學系 === 103 === The treatment of chronic illness involves not only medication, but also proper self-care activities conducted by patients on a daily basis. The aim of this study was to explore what are the key factors that facilitates or impedes adjustment in patients with chronic illness in their illness self-regulation process. The Self-regulation Theory was used as the theoretical foundation for the current study. Representative cases were selected from patients living with hypertension and diabetes. The purposes of this research were: (1) To explore what key factors were involved in the illness self- regulation process from the perspectives of patients with chronic illness, and how these factors identified were interrelated and interacted. (2) From data-driven to explore the types of illness self- regulation by categorizing the varying forms of regulation processes reported by patients . (3) Based on the types identified, to further find what are the key factors that facilitate or impede chronic illness adjustment and in what conditions transformations may occur.
In order to have an in-depth understanding of each patients' unique experiences in their illness, this study conducted semi-structure interviews with sixteen patients living with either hypertension or diabetes. Qualitative data were collected regarding the patients’ perceptions on illness and actions they took for adjustments. Interview transcripts and verbatim were analyzed with the grounded theory method through a procedure of coding, categorization, axial analysis, process analysis and cross-case analysis. In the end of the inductive analysis, the self-regulation processes in patients living with chronic illness were presented.
It was revealed in the results that: (1) Seven elements were indistinguishably seen among all participants with regard to illness self- regulation process; that is illness symptoms, illness interpretation references, illness cognitive representations, emotional representations, goals of regulation, coping actions, and action outcome and appraisals. (2) Illness identity and timeline representations formed different goals for illness regulation, which would further interact with the illness consequence and controllability, which contributed to ten different types of self-regulation process of chronic patients. (3) The adaptive verse maladaptive outcome are influenced by elements in illness self- regulation. These elements could be understood on a hierarchical structure. Without appropriate elements at the higher levels / in the early stages, the patients would have adjustment difficulties in the later stage as the critical characteristics associated with better adjustment to chronic illness were insignificant. Moreover, feedbacks in each level are likely to amend aberrations of higher level. (4) Patient will change their regulation types because of perceiving new illness symptoms or different illness interpretation references. Regulation types might be changed among patients if they perceived new symptoms of illness or new information about illness interpretation references.
This study proposed a hierarchical illness self-regulation model to look at patients’ experiences in illness regulations. This framework could serve as a reference for clinical assessments and evaluations in working with chronic patients regarding the process and factors related to illness regulations. If possible, intervention plans are also expected to be developed on the basis of this framework.
Keywords: chronic illness, self-regulation, qualitative research, illness representation, regulation goals
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