糖尿病の自己管理における対人関係の困難性―困難な気持ちから肯定的な気持ちへと変化した対処行動

Difficulties for Relationships in Diabetic Self-management Coping Behaviors Enabling Change from Difficult Feelings to Positive Feelings

要旨

　本研究は, 糖尿病の自己管理に関して対人関係に起因する困難な気持ちから肯定的な気持ちへと変化した対処行動を明らかにすることを目的とした. 外来通院中の成人糖尿病患者を対象に, 糖尿病の自己管理を行ううえでの困難な気持ちとその変化について半構成的面接を行い, 質的帰納的に分析した．

　【つき合いにおける食事療法の負担感】という困難な気持ちを抱いていた対象者において, 〈食事療法に対する負担感の減少〉,〈食事自己管理への自信〉,〈自己管理調整への満足感〉といった【自己管理法の確信】へと肯定的な気持ちへの変化が見出された. 気持ちの変化につながる対処行動には,〈糖尿病の告白〉という【視座の転換】や,〈自分なりの食事自己管理基準での実行〉,〈仕事上の責任回避〉という【無理のない管理】が認められた．

　困難な気持ちから肯定的な気持ちへと変化した対処行動は, 糖尿病患者が社会生活において自己管理を継続する際に, 他者との良好な関係構築・維持のための重要な行動であると考える．

Abstract

　The purpose of this study was to clarify coping behaviors helping to change feelings of difficulty caused by relationships into positive feelings during diabetic self-management. Data from adult diabetic outpatients were obtained using semi-structured interviews about difficult feelings and associated changes after patients had practiced diabetic self-management. Data were analyzed inductively.

　Subjects who had felt that their “diet was burdensome in social contacts” displayed changes to positive feelings of “firm belief in the methods of self-management”, which involved “reducing feeling of burden from dietary requirements”, “confidence to undertake dietary self-management” and “satisfaction with adjustment of self-management”, after experiencing “conversion of perspective”, which involved “diabetic confession” and “reasonable management” which involved “fulfilling dietary self-management standards” and “responsibility evasion on work”.

　Coping behaviors changing feelings of difficulty into positive feelings appear crucial for constructing and maintaining good relationships with others in diabetic self-management in social contacts.