研究目的：本研究使用共通信念模式，以瞭解第二型糖尿病患者持有的疾病表徵對自我照護行為的預測關係。過去的研究顯示，糖尿病患者的「控制」表徵能夠有效預測患者的自我照護行為和糖化血色素值；也就是，患者相信疾病能被控制的程度愈高，在自我照護行為的表現愈好，糖化血色素值愈低。但是，「結果」表徵與「情緒」表徵無法顯著一致的預測患者的自我照護行為。透過回顧與健康行為相關的理論發展與文獻，考量慢性疾病的自我調節歷程中，除了疾病表徵以外，還需要納入與自我意識有關的人格特質。為此，本研究目的有四:(1)先檢驗在台灣糖尿病患者的疾病表徵建構，是否與國外使用疾病共通信念模式的研究結果一致，有相同的因素結構。(2)檢定台灣第二型糖尿病患者，其持有的疾病表徵對自我照護行為與血糖控制的預測，是否與Harvey和Lawson(2009)的研究結果一致。(3)評估糖尿病患者的人格特質對自我照護行為與糖化血色素值的影響。(4)探索第二型糖尿病患者反芻反思特質，在疾病表徵影響自我照護行為上的調節效果。 研究方法：本研究以立意取樣的方式，邀請新竹某教學醫院門診的第二型糖尿病患者為受試。排除漏答與亂填者，共有142位符合資格的受試者；每位受試者皆需完成受試者同意書、背景資料、糖尿病自我照護量表、疾病表徵問卷與中文版反芻反思量表。根據研究目的，以階層回歸和羅吉斯回歸分析等統計方法進行假設考驗。 研究結果：(1)臺灣第二型糖尿病患者的疾病表徵結構與國外患者相似，共包含：「認同」、「病因」、「時間感急慢性」、「時間感循環性」、「結果」、「情緒」和「控制」表徵。(2)研究結果與Harvey和Lawson(2009)的研究結果一致，「控制」表徵可以顯著預測整體自我照護行為和糖化血色素值。(3)第二型糖尿病患者的反芻反思特質，無法單獨預測自我照護行為與糖化血色素值。(4) 第二型糖尿病患者的反芻反思特質會與病表徵產生交互作用，共同調節各種自我照護行為的表現。 結論：本研究資料與其他使用共通信念模式的研究資料一致，亦即控制表徵能預測自我照護行為和糖化血色素值。此外，本研究發現，不同自我照護行為會受到疾病表徵與反芻或反思特質的交互作用而影響。由於，增加自我照護行為的執行度，是目前糖尿病治療與衛教的首要目標。建議未來從事糖尿病照護的實務工作者，能提供疾病表徵與反芻反思特質的專業心理評估；以協助建立個別評估與個別介入的個別化治療方案，進而提高患者在自我照護行為的執行度、增加臨床治療的效果。 / Background and Aims. It is increasingly being used to understand and predict individuals' coping with and subsequent self-care of chronic illness is Leventhal and colleagues' the common sense model. This model postulates that it is the individual's illness representation is the proximal determinant of coping behavior. The role of personality in determining self-care behavior has been relatively ignored, possibly because of the lack of convergence in concepts and measures. Due to the lack of research in the area of interest, the present study attempt to resolve this issue. We investigated, (a) using subjects of Type-II diabetes in Taiwan, are the results of present study similar as others studies directed by common sense model to identify the factors of illness representation, (b) discussing the influences of illness representation to self-care behavior and glycemic control (HbA1c); like as Harvey and Lawson(2009)’s study, (c) assessing whether traits of normal personality are associated with variations in self-care behavior and glycemic control in patients with type 2 diabetes, (d) examining whether personality moderate the relationships between illness representations and self-care behavior. Methods. Patients were eligible if they had Type 2 diabetes, were aged 20 years or more at diagnosis. Before we collect data, a physician will invite patient to enter the study. Patient want to join this study, they be giving an informed consent and be asked to complete four questionnaires. A total 142 patients completed the demographic survey ( age, educational level, diabetes duration et al.), Diabetes Self-Care Scale, the Revised Illness Perception Questionnaire(IPQ-R), the Chinese version of Rumination- Reflection Questionnaire. Analysis were concluded using multiple regression analysis, logistic regression and so on. Results. The results revealed that: (1) as our hypothesis, the structures of the IPQ-R in type 2 diabetes in Taiwan were similar as other foreign studies directed by common sense model. (2) Control representation can induce main effect on self care behavior. Higher control representation was significantly positive associated with self care behavior, and it was significantly negative associated with HbA1c. (3) Self reflection and self rumination were inconsistently associated with self care behavior and HbA1c. (4) Personality moderated the relationships between illness representations and self-care behavior. Conclusions. This study supports the Common Sense Model (CSM) of illness representation when considering type 2 diabetes in Taiwan. Based on our results, we found personality traits may offer new insights in to variations in self-care in patients with type 2 diabetes undergoing standard management. Personality refers as self-reflection and self-rumination which moderated the relationships between illness representations and self-care behavior. Therefore, CSM could become the theoretical framework for psychological interventions in type 2 diabetes. Furthermore, according to the study result, we suggested the practitioners paying attention to the different interaction when representation and personality are together in diabetes’ each self-care behavior.

胰島素自我注射是第二型糖尿病的重要治療方法。然而，許多病患的心因性胰島素抗拒（PIR）使他們拒絕胰島素治療，因而導致血糖控制不良。本研究目的即嘗試找出影響第二型糖尿病患者接受胰島素治療與否之可能因素。我們採用計畫行為理論（TPB）為基本架構，此理論主張「態度」、「主觀規範」、「覺知行為控制」三個變項可決定對某行為之意圖，而意圖可預測此行為之發生。此外，我們將情緒變項整合進TPB架構中以提昇預測力，包括「同時情緒」（對行為本身當下之心理或生理反應）與「預期情緒」（預期未來行為之後果成真時的情緒反應）。我們採自陳式問卷，橫斷研究設計，總計457位目前未使用胰島素之第二型糖尿病患者參與研究。階層迴歸分析結果，三個TPB變項（態度、主觀規範、覺知行為控制）均顯著預測胰島素治療之意圖，可解釋39.1%變異量；加入情緒變項後，整體模式解釋力提昇，可解釋43.2%意圖之變異量，「負向同時情緒」及「負向預期情緒」均為顯著預測因子。比較血糖控制較佳（HbA1C < 9%）與血糖控制較差（HbA1C ≧ 9%）兩組受試者，「負向同時情緒」是研究模型中唯一有顯著差異之變項。本研究結果顯示TPB可成功應用於解釋PIR，而情緒變項之影響亦不容小覷。 / Insulin injection is an important treatment in the care of type 2 diabetes mellitus. However, psychological insulin resistance (PIR) has long been an obstacle for many patients to achieve optimal glycemic control. The purpose of this research is to identify the influencing factors in decision-making process of type 2 diabetic patients whether or not to undergo insulin therapy. We adopted the theory of planned behavior (TPB) as our theoretical basis, which argues attitude, subjective norm and perceived behavior control (PBC) are determinants of behavioral intention, and intention is the precursor of behavior. Besides, we integrated extra emotion variables into TPB, which were anticipatory emotion (immediate psychological and physical responses toward the behavior itself) and anticipated emotion (affective responses expected to be experienced in the future when behavioral outcomes occur), to expanded the predictive power of research model. A cross-sectional questionnaire study design was employed, and a total of 457 currently not using insulin type 2 diabetic patients participated in this research. The hierarchical regression analysis revealed that all three TPB variables (attitude, subjective norm, PBC) significantly predict intention to use insulin, which account for 39.1% variance of intention. After the addition of emotional variables, the research model explains intention variance up to 43.2%, with negative anticipatory emotion and negative anticipated emotion being significant determinants. In the comparison of better glycemic-control (HbA1C < 9%) and worse glycemic-control (HbA1C ≧ 9%) participants, negative anticipatory emotion is the only variable in our research model significantly differs between both groups. The results of this research indicate not only TPB is a useful framework in realizing PIR, but also the impact of anticipatory and anticipated emotions cannot be overlooked.