有職２型糖尿病患者の経験するスティグマとその対処

Coping with Stigma among Working Patients with Type 2 Diabetes

　本研究の目的は，有職２型糖尿病患者のスティグマとその対処について明らかにし，糖尿病看護の示唆を得ることである．研究参加者は12名であり，質的記述的手法で分析した．

　糖尿病患者のスティグマには，【欠陥身体という感覚】【怠惰な性格への過剰な反省】【社会生活で不利とみなされる集団】という３カテゴリーが抽出された．対処では５つのカテゴリーが抽出された．以下にストーリーラインを述べる．病状が軽い間は【糖尿病を隠す】【療養行動をとらない自分に目をつぶる】対処をするが，自覚症状の出現，インスリン注射の実施を余儀なくされると，【糖尿病の現実を周囲に小出しにする】【糖尿病を隠せる範囲に社会関係を狭める】対処をとった．また，病気の進行とともに療養行動をとらざるを得なくなり，【健康を装いながら療養行動をとる】対処をとりながら，血糖コントロールへの努力を行っていた．発症早期からスティグマの観点を含むアセスメントや支援の必要性が示唆された．

　The purpose of this study was to clarify the ways in which patients with type 2 diabetes experience and cope with stigma. We interviewed 12 patients with type 2 diabetes and then qualitatively analyzed the content of their responses.

　We identified the following three types of stigmata experienced by type 2 diabetes-patients : “a sense of having an imperfect body” ; “excessive reflection leading to a lazy personality” ; and “group considered as the handicapped in social life”. Five strategies that patients use to cope with these stigmata emerged. When their medical condition was relatively mild, these patients coped with stigma by “hiding their diabetes” and “neglecting their self-care behavior”. When their diabetes symptoms were overt and insulin injections became necessary, they coped by “gradually speaking out to those around them about their illness” and by “withdrawing from social life to hide their diabetes”. Moreover, as their diabetes progressed, to control their blood glucose levels, they had no choice but to improve their self-care behavior, which they coped with by “pretending to be healthy while managing self-care behavior”.

　These findings suggest that support, including that for coping with diabetes-related stigmata, is needed for patients with type 2 diabetes from the early stage of onset.