論文

内容

要旨

Diabetes knowledge, health beliefs, and healthbehaviour among type 2 diabetes patients in ruralarea Indonesia – Qualitative and quantitativestudies(インドネシアの農村地域における 2 型糖尿病患者の糖尿病知識、健康信念、および保健行動 - 定性的および定量的研究)

主指導教員： 梯正之 教授（医系科学研究科健康情報学）

副指導教員：宮口英樹 教授（医系科学研究科 作業行動探索科学）
副指導教員：國生 拓子 教授（医系科学研究科 精神保健看護開発学）

NICE MAYLANI ASRIL（医歯薬保健学研究科保健学専攻）

The author designed two studies related to diabetes knowledge, health beliefs and healthbehaviour among type 2 diabetes patients in rural areas, Indonesia. The rural areas thatwere targeted in this study were rural areas in Bali because diabetes becomes the second
deadliest disease in Bali. The aims of the first study was to explore diabetes knowledge,
health beliefs, and behaviours among type 2 diabetes patients in rural Indonesia using thetheoretical framework of the Health Belief Model. The first study used qualitative method
involving semi-structured focus group discussion among twenty of type 2 diabetes patients(mean age 49.9 years old, range 33-58). Nine (45%) participants were graduates fromelementary school, 9 (45%) were those from high school, 2 (10%) were those from junior highschool, and all of them were working (45% of them were sellers). Mean age when theparticipants got the diabetes diagnosis was 49.6 ± 6.5 years old. Mean of random blood
glucose level in November 2016 was 184.3 ± 75.7 (mg/dL). About 60% of the participants did
not have a family member suffering from diabetes and 75% participants had no history of
non-communicable disease. There were three themes formulated in this study: the poor
diabetes knowledge, diabetes perceived as a life burden, and the factors affecting self-efficacy
in practicing healthy lifestyle. The results showed that there were poor diabetes knowledge
and health beliefs among type 2 diabetes patients in rural Indonesia. The traditional
indigenous beliefs about diabetes in rural area, i.e., burden, and the lack of internal
intention in patients to practice health behaviours are factors that exacerbate participants'
health beliefs. These findings also showed that the limited knowledge on diabetes and poor
health beliefs are both related to low level of health behaviours of type 2 diabetes patients inrural area. The second study was intended to determine whether demographic
characteristics, clinical and lifestyle factors, diabetes knowledge, and the extended healthbelief model could predict the healthy lifestyle behaviours of type 2 diabetes patients inrural Indonesia. A sample of 203 type 2 diabetes patients representing a cross-section of thepopulation were recruited from community health centres in the rural areas of Bali province.
The sample was taken using convenience sampling method. The data were collected throughquestionnaires. Descriptive statistics and a hierarchical regression test were employed.
Demographic characteristics, clinical and lifestyle factors, diabetes knowledge, and theextended health belief model accounted for 71.9% of the variance in healthy lifestyle
behaviours. The significant demographic factors (p < 0.05) were age, education level,
employment status, and traditional beliefs. The significant clinical and lifestyle factors (p <0.05) were alcohol use, diabetic medicine, and duration of symptoms. From the extended
health belief model, the significant (p < 0.05) factors were perceived severity, susceptibility,barriers, family support, bonding social capital, and chance locus of control. Against
expectations, diabetic medicine and perceived severity had significant negative correlations
with healthy lifestyle behaviours (p < 0.05). This was attributable to low levels of educationand misinformation about diabetes. Based on the results of the two studies, it can besuggested that efforts to promote healthy behaviours in type 2 diabetes patients should not
be limited to educating type 2 diabetes patients about diabetes. Efforts should include theconsideration of their levels of education, health beliefs, the culture that the patients belong
to, and the support of family and people in the environment around them to reduce the riskof diabetes complications.