Weller Susan C, Baer Roberta D, de Alba Garcia Javier Garcia, Salcedo Rocha Ana L
J Health Care Poor Underserved. 2013 Nov;24(4):1498-510. doi: 10.1353/hpu.2013.0166.
In this study we test whether differences between patient and provider explanatory models of diabetes affect self-management and glucose control in type 2 diabetes patients. Diabetic patients (n=60) and family practice physicians (n=39) in Guadalajara, Mexico, responded to a structured explanatory model interview (130 questions on causes, symptoms, and treatments). A cultural consensus analysis indicated a widely shared model among physicians and provided a single shared set of answers to the questions. Patient-provider congruence in beliefs was assessed by comparing each patient's responses with the physician answer set. Congruence in beliefs predicted self-management behaviors (r=0.27, p=.03), more than educational level (r=0.16, p=.23), but was not predictive of A1C (r=0.12, p=.40). Differences between patient and physician explanatory models can adversely affect patient-directed activities and may indirectly affect glycemic control by affecting self-management. These differences may be due to low patient educational level and resulting problems in understanding biomedical approaches to diabetes.
在本研究中，我们测试了2型糖尿病患者与医疗服务提供者对糖尿病的解释模型之间的差异是否会影响自我管理及血糖控制。墨西哥瓜达拉哈拉的糖尿病患者（n = 60）和家庭医生（n = 39）对一份结构化解释模型访谈（关于病因、症状及治疗的130个问题）做出了回应。文化共识分析表明医生之间存在广泛共享的模型，并为这些问题提供了一套单一的共享答案。通过将每位患者的回答与医生的答案集进行比较，评估信念上的医患一致性。信念一致性对自我管理行为具有预测作用（r = 0.27，p = 0.03），其预测作用超过教育水平（r = 0.16，p = 0.23），但对糖化血红蛋白（A1C）无预测作用（r = 0.12，p = 0.40）。患者与医生解释模型之间的差异可能会对以患者为导向的活动产生不利影响，并可能通过影响自我管理间接影响血糖控制。这些差异可能是由于患者教育水平较低以及由此导致的理解糖尿病生物医学方法方面的问题。
