糖尿病で外来通院中の患者の健康行動に対する自己効力感とその影響要因

A Study of Factors Related to Self-efficacy of Health Behavior in Diabetic Outpatients

　健康行動の自己効力感と属性，糖尿病の状態およびソーシャルサポートとの関連を明らかにすることを目的に調査研究を行った．延べ333名の外来通院患者を対象に，健康行動の自己効力感尺度（SE-HB）および慢性疾患患者用ソーシャルサポート尺度を用い，質問紙調査を実施した．健康行動の自己効力感は年齢が高いほど得点が高く，HbA1c値とは負の相関を認めた．また自覚症状のある群は，ない群に比較し，有意に得点が低かった．SE-HBの下位尺度である疾患に関する対処行動の積極性因子において，主婦が有職者よりも有意に高い値を示した．糖尿病性腎症により外来血液透析を行っている群とそれ以外の外来患者群では，透析群のSE-HBが有意に低かった．SE-HBとソーシャルサポートとの間に正の有意な相関を認め，重回帰分析では疾患に対する行動的サポート因子と強く関連しており（β= 0.688），ソーシャルサポートはSE-HBに対して23.9％の説明力をもっていた．したがって健康行動の自己効力感を高める優先度が高い傾向にあるのは，青・壮年期にあること，有職者，あるいは血液透析導入中であることが明らかになった．また具体的な疾患の管理に対するソーシャルサポートの強化や，自覚症状の軽減が，効力感を高める可能性があるとの示唆を得た．

　An attempt was made to characterize relationships between self-efficacy of health behavior and demographic variables, diabetic characteristics and social support in outpatients with diabetes. Investigations were conducted and a total of 333 diabetic outpatients completed questionnaires that included scales of self-efficacy of health behavior (SE-HB) and the social support scale for chronic disease. Self-efficacy of health behavior was significantly related to age, HbA1clevel and self-awareness of symptoms. In the SE-HB sub-scale, housewives scored significantly higher than workers for“active coping with disease”. There was a significant difference between the group of diabetic outpatients and a group of hemodialysis outpatients suffering from diabetic nephropathy: The hemodialysis group showed lower SE-HB scores. Moreover, a significantly high correlation was found between SE-HB score and social support. In particular, the sub-scale“behavior support for disease”influenced the SE-HB score (β= 0.688) and social support predicted 23.9％of the SE-HB in multiple regression analysis. These results suggest that the priority for self-efficacy of health behavior should be placed on young working adults, and those undergoing hemodialysis. Concrete social support for diabetic self-management and treatment to relieve symptoms noticed by patients may be effective for enhancing self-efficacy of health behavior.