慢性病的個人控制觀：自主與依賴之間

Personal Control over Chronic Illness︰ Between Independence and Dependence

本研究以119位慢性病患者為樣本，探討慢性病患者的個人疾病控制信念內涵、相對式覺知控制程度，及控制信念與生活適應的關係。文中首先說明慢性病定義的問題性，而後表明作為一種研究策略的慢性病界定，構成本文立場。研究發現疾病控制信念呈多元結構，以因素分析抽出「解釋與預測」、「自我功效感」、「他者牽制式」、「工具理性式」四種控制信念，研究者認為這四類疾病控制信念，恰分別座落於「內在vs.外在」；「穩定vs.變動」的2X2座標上，其中愈持解釋與預測、自我功效感控制信念者，生活適應狀態傾向愈佳；愈持他者牽制式、工具理性式控制信念者，生活適應狀態傾向欠佳。另外，在九個向度的控制對象，發現與「醫療建制」有關的範疇，患者覺知到醫護人員較可以控制；與「日常生活」有關的面向，患者則自我覺知相對比較可以控制，文中並討論有關疾病「後代觀」的可能意涵。本文同時針對研究結果，指出患者逆處控制困境中，仍會尋求參與式控制以維持個人認同，說明疾病控制觀的動態多元性。最後，嘗試提出研究成果進行臨床實踐之可能徑路。

The study surveyed 119 chronical outpatients, explored the structures of illness-control beliefs, the degrees of relatively perceived control among different domains, and patient’s life adjustment states. After factor analysis, we found there were four-factor structures in illness-control beliefs; namely, interpretation/prediction, sense of self-efficacy, other-directed mastery and instrumental rationality. According to the results, it showed the patients with the illness-control beliefs of interpretation/prediction and sense of self-efficacy tended to have a better life adjustment states, yet the patients with the illness-control beliefs of other-directed mastery and instrumental rationality got the contrary outcomes. In the nine dimensions of control targets, the patients felt they could control better than the medical staff on the domains of “everyday life” from their illness experiences. But on the domains of “medical regime”, they perceived the medical staff got more power to control. Finally, we pointed out the dialectics of control over chronic illness, and discussed the implications in the clinical practice regarding the research results.