思春期の糖尿病患児と親の療養生活に対する認識の相違が血糖コントロールに及ぼす影響

Differences of Perception on Self-care Behavior between Diabetic Adolescents and Their Parents, and Their Influence on Metabolic Control

　本研究は，思春期の糖尿病患児とその親の療養生活に対する認識の特徴を明らかにすること，糖尿病患児の疾患管理行動に対する認識とその行動との関係を明らかにすること，親子の療養生活に対する認識の相違，患児の独立意識，親の養育態度が及ぼす血糖コントロールへの影響を明らかにすることを目的とした．12～18歳の糖尿病患児とその親30組を対象に，療養生活に関する認識を測定する二次元イメージ拡散法，患児の独立意識と親の養育態度に関する質問紙を用いた調査，および療養生活に関する面接調査を行った．データの分析には，相関係数の検定，対応のあるt検定，一元配置分散分析，重回帰分析を使用した．その結果，1）自分の疾患管理行動を厳しく評価する傾向がある患児は，過大評価する傾向がある患児に比べ，有意に血糖コントロールが良好であった．2）患児の独立性の意識が高いこと，親子の疾患管理行動の大切さ・実施の認識の相違と親の受容的子ども中心的かかわりが少ないことがよい血糖コントロールと関連があり，これらの4変数でHbA1c値の分散の45％を説明していた．

　The purposes of this study were to clarify the perceptions of diabetic adolescents and their parents as regards self-care behavior, to examine the relationship between illness-management behaviors and the perception of their“practice”and to examine the relationship among the differences of perceptions on self-care behaviors between adolescents and their parents, the adolescents' own awareness of independence, the child-rearing attitudes of their parents, and to determine their influence on metabolic control, as indicated by such parameters as hemoglobin A1c(HbA1c). The subjects were 30 pairs of adolescents, aged from 12 to 18 years and their parents. The 2-dimensional image diffusion method was used to measure the perceptions of adolescents and their parents. The adolescents' awareness of independence scale and the child-rearing attitude scale were administered, and semi-structured interview were conducted to obtain information on adolescents' self-care behaviors. Results were as follows: Adolescents who estimated their illness-management behaviors strictly had significantly better metabolic control than those who overestimated their behaviors. By using multiple regression, 4 factors (adolescents' self-reliance, the differences of perceptions of“practice”and“importance”on illness-management behaviors between adolescents and their parents, and parental accepted child-centered attitude) accounted for 45％of the variance in metabolic control.