Abstract

Objective

The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management ‘schemas’).

Design

A qualitative design was applied.

Methods

Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis.

Results

Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management (‘lulls’). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to ‘lulls’: a ‘problem-solving orientation’ depicted lulls as inevitable and was associated with varied coping strategies; a ‘willpower orientation’ attributed lulls to lack of ‘willpower,’ and described willpower as a main coping strategy.

Conclusion

There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.

中文翻译：

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跨不同健康素养水平的 2 型糖尿病自我管理模式：定性调查

摘要

客观的

本研究的目的是探讨糖尿病患者和不同健康素养水平的人如何将他们的经验和努力概念化为进行自我管理行为（他们的自我管理“模式”）。

设计

应用了定性设计。

方法

澳大利亚悉尼的 26 人参加了半结构化访谈，这些访谈是使用框架分析进行录音和编码的。

结果

一半的参与者 (54%) 的健康素养有限，而 38% 的参与者有足够的健康素养（使用最新生命体征）。无论健康素养如何，人们都描述了监测如何提高自我管理意识并标志着自我管理水平低下（“平静”）的时期。对于具有足够健康素养的参与者来说，维持动力的监测说明更为明显。大多数参与者描述了简单而灵活的规则（例如使用人造甜味剂；适量进食）。与“平静”相关的两种模式：“解决问题的方向”将平静描述为不可避免的，并与各种应对策略相关联；“意志力导向”将平静归因于“意志力”的缺乏，并将意志力描述为主要的应对策略。

结论

人们对糖尿病自我管理和他们使用的策略的看法存在很大差异。健康素养可能会导致这种变化。自我管理干预可以受益于将动机描述为关于意志力和自责的波动和具有挑战性的想法。