わが国における自己決定理論ヘルスケアモデルの検証―外来血液透析患者への調査を通して

　本研究の目的は，日本の外来血液透析患者における自己決定理論各概念の認知を測定・検討し，自己決定理論を透析患者の自己管理支援に取り入れることが可能であるかを明らかにすることである．透析導入1年以上の患者323名（平均61.3±10.6歳）を対象に，自己決定理論ヘルスケアモデルを用いて，理論の構成概念と自己管理行動の因果関係を分析した．自律性支援の認知，自律的動機づけ，有能感の測定にはHealth-Care Climate Questionnaire（HCCQ），Treatment Self-Regulation Questionnaire（TSRQ），Perceived Competence Scale（PCS）を使用した．自己決定理論ヘルスケアモデルをもとにこの理論の各概念と自己管理行動の関係を作成したパス図では，各概念間の標準化パス係数は0.26～0.55であり，患者の自律性を支援された認知が自律的動機づけを促進し，自律的動機づけが有能感を介して自己管理行動を変化させるという関係が支持された．以上から，日本の透析患者においても自己決定理論が適応できる可能性と，透析患者の自律性を支援することの重要性が示唆された．

　A purpose of this study is to clarify whether the self-determination theory can apply to Japanese patients, to examine the support that aimed at the promotion of the self-management behavior of the patients with hemodialysis treatment. Effective responses were obtained from 323 patients. There mean age was 61.3 years (SD±10.6). Perception of the autonomy support, autonomous motivation, competence was assessed using the Health-Care Climate Questionnaire (HCCQ), the Treatment Self-Regulation Questionnaire (TSRQ), the Perceived Competence Scale (PCS). A multiple regression analysis was conducted to examine patient's self-management behavior and the relations of each concept of the self-determination theory health care model, and the contribution rate of a predicted variable was the highest. The standardized coefficient between each concepts of the self-determination theory health care model was 0.26～0.55. The perception of the autonomy support promotes autonomous motivation, and autonomous motivation facilitates competence. Furthermore, competence changed the self-management behavior. The above findings suggest that the self-determination theory can apply to Japanese patients with hemodialysis treatment, and importance of supporting the autonomy of the patient.