Page-Carruth Althea, Windsor Carol, Clark Michele
Faculty of health, Queensland University of Technology, Brisbane, Australia;
Faculty of health, Queensland University of Technology, Brisbane, Australia.
Int J Qual Stud Health Well-being. 2014 Jun 24;9:24182. doi: 10.3402/qhw.v9.24182. eCollection 2014.
The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable.
The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context.
The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources.
The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where there is good primary care, there develops a number of downstream effects including a sense of empowerment to manage difficult rural environmental circumstances. This has particular bearing on health outcomes for people with fewer resources.
本研究的目的是探讨农村文化是否以及如何影响2型糖尿病的管理，并更好地理解农村居民在应对糖尿病及其并发症时构建的社会过程。特别是，该研究旨在分析2型糖尿病农村患者与澳大利亚医疗保健系统之间的接口和互动，并形成一种理论理解，以反映可能更广泛适用的结构。
本研究在解释性互动主义框架内应用建构主义扎根理论方法。对来自农村和城市2型糖尿病患者以及农村医疗保健提供者的39次半结构化访谈数据进行了分析，以形成对该背景下定义糖尿病管理的社会过程的理论理解。
分析表明，虽然2型糖尿病带来了需要调整和适应的限制，但农村居民在环境背景下积极协商这些过程，以符合自主和自力更生的突出社会理解。因此，人们将自力更生的糖尿病管理行为常态化，因为这与农村文化一致。促成常态化行动的因素包括参与者与医疗保健专业人员之间的关系、支持以及获取个人资源的机会。
研究结果指出了农村自力更生被视为糖尿病管理主要策略的方式。人们面临着与医疗保健系统接触的矛盾，该系统同时最大限度地增加了个人对健康的责任，并最小化了个人管理病情的社会支持。对自力更生的强调为缺乏预防和慢性病护理服务提供了一定的合理性。然而，糖尿病管理行为的成功取决于相对资源。在有良好初级保健的地方，会产生一些下游效应，包括应对困难农村环境情况的赋权感。这对资源较少的人的健康结果有特别影响。
