慢性病因應歷程中自我效能感與因應策略的作用與關係：兩種情緒聚焦因應的區辨

Functions of and Relations between Self-Efficacy and Coping Strategies in Adaptation to Chronic Illness: Two Different Emotion-Focused Coping Strategies

研究目的：慢性病患者的自我效能感與因應策略，影響了適應與控制其疾病狀況。然而過去慢性病研究對情緒聚焦因應策略的效果未有定論，也未探討自我效能感與因應策略之間的關係。本研究試圖對情緒聚焦因應進行區分，以及驗證自我效能感與因應策略的中介關係。研究方法：研究於2007~2008年，分為二階段進行。76位（平均年齡55.87歲，46位男性）與151位（平均年齡57.58歲，70位男性）高血壓、糖尿病、高血脂、或痛風患者完成疾病控制行為的自我效能感、因應策略、與慢性病適應結果的問卷。研究結果：情緒聚焦因應可分為：（1）穩定情緒以進行症狀控制的「積極投入情緒聚焦因應」，以及（2）調適衝擊以接受慢性病的「防衛型情緒聚焦因應」。自我效能感與「問題聚焦因應」和「積極投入情緒聚焦因應」兩者有關，後者更中介了自我效能感的效果。「防衛型情緒聚焦因應」對疾病適應有著不利的影響。研究結論：本研究支持慢性病患者在因應的過程中需要同時兼顧實際的問題解決行為和情緒的穩定。慢性病患者需要更關注情緒的起源和因應方式，其所需的介入策略也會不同。

Purpose: Patients’ sense of self-efficacy in disease-management and the coping strategies they adopt play an important role in their ability to control chronic illness. The functions identified for emotion-focused coping strategies were inconsistent in past studies, and researchers did not examine the relationship between the patient’s sense of self-efficacy and the coping strategies they applied to handle their illness The goal of the present study is to discriminate the functions of different emotion-focused coping strategies, and to test the mediation effect of the coping strategy selected on the patient’s sense of self-efficacy. Methods: This study was conducted in two phases during 2007- 2008. In both phases the participants had at least one of the following chronic illnesses: hypertension, diabetes, hyperlipidemia, or gout. In the first phase, 76 participants (mean age 55.87, 46 men) were surveyed and 151 participants (mean age 57.58, 70 men) in the second phase with measurements of self-efficacy, and problem- and emotion-focused coping strategies of disease management. Results: Emotion-focused coping could be divided into two categories: (1) active emotion-focused coping focused on stabilization of emotion for promoting symptom control, and (2) defensive emotion-focused coping focused on protecting the self from the health-threats of chronic illness. Self-efficacy correlated significantly with problem-focused and active emotion-focused coping. The latter also mediated the effect of self-efficacy on illness adaptation. Defensive emotion-focused coping worsened illness adaptation. Conclusions: The results support the assertion that patients can cope with chronic illness in a problem-focused way, but they should differentiate their emotion-focused coping carefully in terms of the origins of their emotions, since different emotion-focused coping strategies requires different intervention strategies.