The quest for autonomy: Patient decision-making behaviors in type 2 diabetes.

摘要

The purpose of this study was to examine the phenomenon of decision-making about exercise from the perspective of the patient with type 2 diabetes. Through the use of participant observation, semi-structured interviews, and the analysis of the Stages of Behavior Change Scale, the Diabetes Empowerment Scale, and the Cooper Clinic Physical Activity Questionnaire, this comparative cross-case analysis explored the social, clinical and contextual factors, as well as the barriers that influence patient decision-making. The relationship between autonomous regulation of exercise behavior and perceived competence to follow through with one's decisions to exercise by patients, and the concept of autonomy support on the part of healthcare practitioners were also established as important components to consider in the development of an effective diabetes patient education curriculum.; The analysis of the data is presented in qualitative, narrative form, using the voices of the participants and first-person accounts of the researcher in an effort to portray the challenges and emotion-filled meanings associated with the lived experience of daily decision-making in type 2 diabetes. The major findings of the study suggest that exercise decision-making is a complex process of interplay between a logical, rational, cognitive approach, and a more dynamic, unconscious, affective process of balancing reasons for exercise choices with one's values, beliefs, experiences and meanings about health, diabetes and exercise. There appears to be a relationship between the stage of behavior change and the degree to which one is a cognitive or affective decision-maker in type 2 diabetes. Cognitive factors such as one's perception regarding the threat of diabetes, having and positive exercise schema, and the degree of internal versus external motivation impact exercise decision-making. Social-contextual factors such as exercise group support, family or social support, and having a positive exercise role model or expert leader/teacher influence adoption and adherence to an exercise habit by those with diabetes. Affective factors such as the meaning-making associated with having diabetes, locus of control and coping behavior have an emotional impact on the person with diabetes, and often unconsciously influence decision-making and autonomous behavior. Barriers to following through with exercise decisions include conflicts with time management, patient fatigue that interferes with exercise tolerance, ease of access to exercise equipment or facilities, boredom with the exercise regimen, and interference with leisure-time television viewing. (Abstract shortened by UMI.)