“我别无选择，只能也抓住它”：家族病史和糖尿病经历在疾病表象中的作用。
"I had no other choice but to catch it too": the roles of family history and experiences with diabetes in illness representations.
机构信息
Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 401, USA.
Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite, Philadelphia, PA, 300, USA.
出版信息
BMC Endocr Disord. 2020 Jun 26;20(1):95. doi: 10.1186/s12902-020-00580-x.
BACKGROUND
A family history of diabetes and family members' experiences with diabetes may influence individuals' beliefs and expectations about their own diabetes. No qualitative studies have explored the relationship between family history and experiences and individuals' diabetes illness representations.
METHODS
Secondary data analysis of 89 exploratory, semi-structured interviews with adults with type 1 or type 2 diabetes seeking care in an urban health system. Participants had a recent diabetes-related ED visit/hospitalization or hemoglobin A1c > 7.5%. Interviews were conducted until thematic saturation was achieved. Demographic data were collected via self-report and electronic medical record review. Interviews were audio-recorded, transcribed, and coded using a conventional content analysis approach. References to family history and family members' experiences with diabetes were analyzed using selected domains of Leventhal's Common Sense Model of Self-Regulation.
RESULTS
Participants cited both genetic and behavioral family history as a major cause of their diabetes. Stories of relatives' diabetes complications and death figured prominently in their discussion of consequences; however, participants felt controllability over diabetes through diet, physical activity, and other self-care behaviors.
CONCLUSIONS
Findings supported an important role of family diabetes history and experience in development of diabetes illness representations. Further research is needed to expand our understanding of the relationships between these perceptions, self-management behaviors, and outcomes. Family practice providers, diabetes educators and other team members should consider expanding assessment of current family structure and support to also include an exploration of family history with diabetes, including which family members had diabetes, their self-care behaviors, and their outcomes, and how this history fits into the patient's illness representations.
背景
糖尿病家族史和家庭成员的糖尿病经历可能会影响个体对自身糖尿病的信念和预期。目前还没有定性研究探讨家族史和经历与个体糖尿病疾病观念之间的关系。
方法
对在城市卫生系统中寻求治疗的 1 型或 2 型糖尿病成人的 89 次探索性、半结构式访谈进行二次数据分析。参与者最近有与糖尿病相关的 ED 就诊/住院或糖化血红蛋白（HbA1c）>7.5%。访谈在达到主题饱和时进行。通过自我报告和电子病历回顾收集人口统计学数据。使用传统的内容分析方法对访谈进行录音、转录和编码。使用 Leventhal 的自我调节的常识模型的选定领域分析提及家族史和家庭成员的糖尿病经历的内容。
结果
参与者将遗传和行为家族史都作为其糖尿病的主要病因。亲属的糖尿病并发症和死亡的故事在他们对后果的讨论中占据重要地位；然而，参与者认为通过饮食、体育活动和其他自我保健行为可以控制糖尿病。
结论
研究结果支持家族糖尿病史和经验在糖尿病疾病观念发展中的重要作用。需要进一步研究以扩大我们对这些观念、自我管理行为和结果之间关系的理解。家庭实践提供者、糖尿病教育者和其他团队成员应考虑扩大对当前家庭结构和支持的评估，还包括对家族糖尿病史的探索，包括哪些家庭成员患有糖尿病、他们的自我保健行为以及他们的结果，以及这段历史如何符合患者的疾病观念。
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