秘密-自我管理循环：基于 2 型糖尿病和精神健康症状老年拉丁裔患者中提供者不信任的实证理论。

The Secret-Self Management Loop: A grounded theory of provider mistrust among older Latinas with type 2 diabetes and mental health symptoms.

机构信息

University of California, Los Angeles, 1100 Glendon Ave. Suite 900, Los Angeles, CA, USA.

University of California, Los Angeles, 5-659 Factor Building, Los Angeles, CA, USA.

出版信息

Diabetes Res Clin Pract. 2021 May;175:108787. doi: 10.1016/j.diabres.2021.108787. Epub 2021 Apr 9.

DOI:10.1016/j.diabres.2021.108787

PMID:33845050

Abstract

AIMS

The purpose of this study was to examine how older Latina women emotionally experience type 2 diabetes mellitus and interactions with care providers using a grounded theory approach.

METHODS

Sixteen English-speaking, Latina women, 60 years and older, diagnosed with type 2 diabetes mellitus and experiencing symptoms of depression or anxiety participated in 21 phone interviews guided by a semi-structured interview guide. Data was collected and analyzed using Grounded Theory methodology; theoretical sampling was used to achieve data saturation.

RESULTS

Participant data informed the creation of a theory, The Secret Self-Management Loop, with four interconnected phases: 1) having a negative relationship origin story; 2) doubting provider motivation; 3) reacting to doubts about provider; and 4) engaging in secret self-management. These phases reflected participants' lost trust in their providers and the medical system, resulting in undisclosed self-management strategies that complicated clinical management of their type 2 diabetes mellitus diagnosis. Primary sources of loss of trust were interactions that lacked empathy or caused them to question their providers' motivation.

CONCLUSION

The Secret Self-Management Loop negatively influences patient disclosure and distorts providers' ability to adequately render care for this group.

摘要

目的

本研究旨在通过扎根理论方法，探讨老年拉丁裔女性如何在情感上体验 2 型糖尿病以及与护理提供者的互动。

方法

16 名英语流利、60 岁及以上、被诊断患有 2 型糖尿病且出现抑郁或焦虑症状的拉丁裔女性参加了 21 次电话访谈，访谈由半结构化访谈指南指导。使用扎根理论方法收集和分析数据；采用理论抽样实现数据饱和。

结果

参与者的数据为一个名为“秘密自我管理循环”的理论提供了信息，该理论有四个相互关联的阶段：1）负面的关系起源故事；2）怀疑提供者的动机；3）对提供者的怀疑做出反应；4）进行秘密自我管理。这些阶段反映了参与者对提供者和医疗系统失去信任，导致未公开的自我管理策略，使他们的 2 型糖尿病诊断的临床管理复杂化。失去信任的主要原因是缺乏同理心或让他们对提供者的动机产生质疑的互动。