慢性病患者的意義建構及其行動策略：以糖尿病為例

本研究透過田野觀察法、臨床訪談法與社會建構式紮根法，以糖尿病為案例，探討慢性病患者的疾病意義建構及其行動策略。本研究共訪談44名個案，發現糖尿病的疾病意義建構包含既分立又相關的四個層次。首先，「懵懂期」是患者從症狀符號到疾病認定的意義層次，疾病是作為一種他者的介入。其次，「歸因期」是患者將疾病他者與生病自我進行關係串連的意義層次。復次，「比較期」是患者將疾病經驗與他者受苦性相互關聯，進而從他者的回應或召喚，重構新自我的意義層次。末次，「轉化期」是患者將生病經驗轉化為一種生活成長的必要成分，進而從生活崩解的創傷裡重生，建構生活新秩序的轉變樣態。總之，本研究透過患者的敍說，得已顯現糖尿病患者的受苦經驗涵納從疾病作為一種他者、將疾病他者與生病自我相關連、將自身生病經驗與他者受苦經驗相互比較、編織，到將生病經驗涵變為一種生活態度，如此具現了慢性病患者的疾病敍說、生病經驗、意義建構與行動策略的相互關係，也顯現患者學習重新建立自我領域與他者邊界的社會關係，這是患者編織一種新生活故事的動態開展歷程。

The study was based upon the field participation, clinical interview and social construction grounded methodology, for the purpose of exploring the life experience, meaning construction and coping strategy for the diabetics. The author interviewed 44 cases, and found that the connotation of meaning construction about chronic illness contained four related levels. First, it is 'preconception', in which the patients regard illness as the intrusive other disrupting their life worlds. Second, it is ''attribution'', in which the patients connect the relationship between illness itself and patienthood. Third, it is ''comparison'', in which the patients compared their encounters with the others' suffering experiences, and they reconstruct their new selves through the callings of the others' voices. Last, it is ''transformation'', in which the patients learn to live with the illness, and reorganize their biography. As the research implicated, the patients as human agency empower themselves by taking active steps towards their dilemma, and redefining the boundary between the self and the other during their posttraumatic illness experiences. Therefore, the dynamic and rich life stories that the chronically ill patients narrated denote the illness events are not only disruptive experience one, but provide new psycho-social growth tasks to accomplish.