目的：本研究以糖尿病與高血壓為案例，一方面探究慢性病因應的因素結構，以瞭解因應的多樣性。另一方面探索因應方式與生活適應的關係，以探討因應的效用性。方法：研究者修訂「因應方式量表」與「生活適應量表」，搭配疾病預測度、控制度及其他心理變項，對門診病人施測。結果與討論：共有119位樣本參與，男性64人，女性55人。平均年齡53.96歲（標準差10.35）。持續門診時間約為 43.59個月。研究發現⑴經因素分析法，因應方式量表，共抽取十五個因素，因應結構呈現多樣性。其中有七個因素與高生活適應有關聯，愈是傾向採取「積極性」因應，愈少採取「消極性」因應，對生活適應愈有正面效果。因此，因應「多樣性」與「效用性」呈現互補功能。⑵患者對治療的「期待」是「完全戒藥」與「徹底根治」，並能因疾病經驗納入運動與飲食控制。但仍有患者產生悲觀消極的人生態度，或轉移疾病焦點於後代子孫的關懷。結論：本研究顯示慢性病患者的疾病因應，未來需 (1)擴大積極性因應，削弱消極性因應，以提升「因應效率」(2)因應多樣性與效用性的互補作用，促進生活適應，以避免「二度宿命」。本文最後提出理論層次與臨床貢獻的建議。 Purpose: This paper with diabetes and hypertension patients as the participants, on the one hand is to explore the structure of coping, and understand the coping diversity. On the other hand, it is to link the relationship between the coping effectiveness and life adaptation of the outpatients. Method: Two scales are developed, included ‘coping method scale’and ‘illness adjustment scale’. The constructs of predictability and controllability of the chronic illness course combined with other psychological variables are also measured. Results and discussion: There are 119 outpatients to participate totally, men are 64 and women are 55. The average age is 53.96 ± 10.35 years. Duration of the illness is last for 43.59 months in average. Two main findings are shown. The first is the patients who less adopted ‘the passive coping method’, and got the more ‘positive coping way’ about the illness are adapted better in the daily life. The functions of diversity and effectiveness of coping are complementary. The second is there is gap between the remedy expectation and behavior execution of the patients, sometimes, they know more, but do less. They also felt pessimistic about the future, and may shift the attention from the illness to give caring about the next generations. Conclusion: The result is implied that the chronic illness patients should transform their ‘passive’ coping ways into the more active coping strategies to improve the coping utility. Otherwise, they will face the second destiny of fatal life impacts. Finally, the suggestions are proposed from two perspectives of the conceptual level and clinical practice.
