Fritz Heather Ann
Institute of Gerontology, Wayne State University, Detroit, Michigan, USA.
Health Soc Care Community. 2017 Jan;25(1):26-34. doi: 10.1111/hsc.12172. Epub 2014 Dec 19.
High rates of diabetes diagnosis and poor diabetes outcomes are particularly significant in low-income, socially disadvantaged populations. Although many social and economic predictors of poor self-management outcomes are known, few studies have examined how these elements impact the ability to develop self-management capacities in low-income populations. This article presents new insights into low-income women's challenges and successes to becoming more adept self-managers. Interview data were collected in 2012 with a sample of low-income, middle-age women with type II diabetes recruited from a non-profit medical clinic serving low-income clients in North Carolina, United States. Data were analysed using a grounded theory approach. Developing self-management skills within disadvantaged life contexts involved negotiating three related, overlapping sub-processes: negotiating access to care systems, negotiating disruptions to diabetes self-management patterns, and negotiating self-care knowledge. Developing diabetes self-management skills is a long and arduous process. Data and analysis presented here help explain how disadvantaged life contexts can impact self-managers' efforts to develop self-management skills and why continued support is important for reducing and preventing future problems. These initial findings suggest that future studies and intervention development on the topic are warranted.
在低收入、社会处境不利的人群中，糖尿病的高诊断率和不佳的糖尿病治疗效果尤为显著。尽管已知许多自我管理效果不佳的社会和经济预测因素，但很少有研究探讨这些因素如何影响低收入人群发展自我管理能力。本文阐述了关于低收入女性在成为更熟练的自我管理者过程中所面临的挑战与取得的成功的新见解。2012年，研究人员从美国北卡罗来纳州一家为低收入客户服务的非营利性医疗诊所招募了患有II型糖尿病的低收入中年女性样本，并收集了访谈数据。数据采用扎根理论方法进行分析。在不利的生活环境中培养自我管理技能涉及三个相关且重叠的子过程：协商获得医疗系统的机会、协商糖尿病自我管理模式的干扰以及协商自我护理知识。培养糖尿病自我管理技能是一个漫长而艰巨的过程。此处呈现的数据和分析有助于解释不利的生活环境如何影响自我管理者培养自我管理技能的努力，以及为何持续的支持对于减少和预防未来问题至关重要。这些初步研究结果表明，有必要对该主题进行未来的研究和干预开发。
