生活世界的失序——台灣糖尿病婦女疾病經驗之探討應用改善模型規劃護理人力媒合資訊平台

Disorder in Life and the World: The Illness Experiences of Women with Diabetes in Taiwan

背景：女性角色與其健康行為有密切關係，了解女性糖尿病患者的疾病經驗，有助於專業人員提供婦女需求的糖尿病照護。目的：瞭解台灣糖尿病婦女疾病經驗。方法　以詮釋民族誌方法透過深度訪談與田野觀察，從主位觀點（emic point of view）切入，並以Agar（1986）的詮釋循環進行分析。以最大變異（maximum variation）為原則，於台灣南部某糖尿病診所收案18名罹患糖尿病至少一年以上、能以國台語溝通者且有意願接受訪談與錄音之婦女。參與女性年齡分佈在24～79歲。結果　台灣女性糖尿病患者疾病經驗的故事主軸是「生活世界失序」，建構此失序經驗的四個主題是：一、身體失序：仰賴醫療他者來理解自己身體；二、生活失序：從控制食物到被食物控制；三、家庭失序：生病者即為無能者；四、自我失序：為他（家）人控制身體。結論／實務應用　醫護人員應將女性文化角色涵納為女性糖尿病自我管理中重要的動力。此外，將家庭整體做為對象來照顧，也許會使台灣女性糖尿病患者有更正向的疾病經驗。

Background: The role of women is strongly associated with health behavior. Understanding the illness experiences of women with diabetes helps health professionals to provide appropriate health care to women with diabetes. Purpose: The purpose of this study was to explore the illness experiences of women with diabetes. Methods: This study used interpretive ethnographic methods with in-depth interviews and field observations to obtain emic points of view from women who were diagnosed with diabetes. Agar's hermeneutic cycle was used to analyze the collected data. The participants were recruited under the principle of maximum variation. The inclusion criteria targeted women who: (1) had been diagnosed with diabetes for at least one year, (2) were able to speak Mandarin or Taiwanese, and (3) were willing to participate and have their sessions tape-recorded in a diabetes clinic in southern Taiwan. A total of 18 women with diabetes between 24 and 79 years of age were enrolled as participants. Results: ＂Disorder in life and the world＂ was the main storyline elicited from participants. The four themes constructed from this disorder were: (1) disorder of the body: reliance on medical care to understand the body, (2) disorder of life: shift from being in control of food to being controlled by food, (3) disorder of the family: sick person is perceived as incompetent, and (4) disorder of the self: controlling the body for the family. Conclusions / Implications for Practice: Healthcare providers should recognize and make positive use of the potential of the cultural role of women to improve the ability of women to self-manage their diabetes. Additionally, perceiving the entire family as the client may improve the illness experience for Asian women with diabetes.