Kahn Linda S, Vest Bonnie M, Karl Renée, Tumiel-Berhalter Laurene, Taylor Robert, Schuster Roseanne C, Glaser Kathryn, Danakas Alexandra, Fox Chester H
Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA.
Chronic Illn. 2013 Mar;9(1):43-56. doi: 10.1177/1742395312450895. Epub 2012 Jun 7.
This study explores the perceptions, attitudes, and beliefs that inform how people live with diabetes in a high poverty, ethnically diverse neighborhood with a growing population of refugees. The specific research objective was to examine participants' explanations of how their diabetes began, understandings about the illness, description of symptoms, as well as physical and emotional reactions to the diagnosis.
Qualitative design using semi-structured interviews. The transcripts were analyzed using an immersion-crystallization approach.
Thirty four individuals diagnosed with diabetes for at least 1 year participated. The sample included 14 refugees (from Somalia, Sudan, Burma, or Cuba), eight Puerto Ricans, six non-Hispanic Caucasians, six African-Americans, and two Native Americans. Three broad themes were identified across ethnic groups: (a) the diagnosis of diabetes was unexpected; (b) emotional responses to diabetes were similar to Kubler-Ross's stages of grief; (c) patients' understanding of diabetes focused on symptoms and diet.
Patients were frequently stunned by the diagnosis of diabetes, and expressed emotions associated with the stages of grief including denial, anger, bargaining, depression, and acceptance. Our findings suggest that clinicians might consider addressing the patients' emotions or grief reaction as an early priority to promote acceptance as a first step to self-management.
本研究探讨了在一个贫困率高、种族多样且难民人口不断增加的社区中，人们如何应对糖尿病的认知、态度和信念。具体研究目标是考察参与者对其糖尿病发病原因的解释、对该疾病的理解、症状描述以及对诊断的身体和情绪反应。
采用半结构式访谈的定性设计。使用沉浸 - 结晶法对访谈记录进行分析。
34名被诊断患有糖尿病至少1年的个体参与了研究。样本包括14名难民（来自索马里、苏丹、缅甸或古巴）、8名波多黎各人、6名非西班牙裔白人、6名非裔美国人以及2名美洲原住民。在不同种族群体中确定了三个广泛的主题：（a）糖尿病的诊断出乎意料；（b）对糖尿病的情绪反应与库伯勒 - 罗斯的悲伤阶段相似；（c）患者对糖尿病的理解集中在症状和饮食上。
患者经常因糖尿病的诊断而感到震惊，并表达出与悲伤阶段相关的情绪，包括否认、愤怒、讨价还价、抑郁和接受。我们的研究结果表明，临床医生可能应将处理患者的情绪或悲伤反应作为早期优先事项，以促进接受，这是自我管理的第一步。
