아동의 만성질환관리에 영향을 미치는 가족요인 = Family Factors Affecting Children`s Chronic Illness Management

국문 초록 (Abstract)

당뇨병의 관리는 식사, 운동, 약물요법과 혈당측정 등의 복잡한 치료지침을 따라야 하는 가족전체의 부담이 되는 경우가 많다. 특히 어린 아동의 경우 질병 초기에 부모에 의해서 주로 질병관리가 이루어지다가 아동의 성장에 따라 점차적으로 질병관리의 책임이 아동에게로 이전되기 때문에 가족요인이 질병관리에 중요한 영향을 미칠 것으로 예상된다. 본 연구는 가족갈등, 가족응집력 등의 일반적인 가족특성 외에도 당뇨병관리와 좀더 밀접하게 관련된 가족변인, 즉 모-아동간 순응도에 대한 인식차이가 아동의 당뇨관리와 밀접한 상관관계가 있을 것으로 보고, 미국의 한 대학병원에서 조사한 2차 자료를 활용하여 당뇨환아 가족 134 가구에 대해서 이러한 가족요인과 아동의 순응도 및 건강상태간의 관계를 살펴보았다. 분석결과, 가족환경, 즉 가족갈등과 가족응집력은 모-아동간 당뇨관리 인식차이 및 순응도와 유의한 관계가 있는 것으로 나타났다. 또한 가족환경과 순응도간의 관계는 모-아동 간 순응도에 대한 인식차이를 통제했을 때 통계적으로 유의하지 않은 것으로 드러났다. 이는 가족환경과 질병관리의 관계를 질병관리자간의 인식차이가 매개할 가능성을 시사하는 것이라 하겠다. 이상의 결과는 가족환경이나 의사소통과 아동의 질병관리간의 관련성에 초점을 둔 기존 연구결과들과 유사하며, 일선 사회사업가들이 아동의 당뇨병 관리 향상을 위해 가족에 대하여 적극적인 사정과 개입을 해야 할 필요성을 보여주는 것이라 하겠다.

다국어 초록 (Multilingual Abstract)

Management of a chronic illness such as diabetes is a challenge for the family as well as the patient. Children of young age present additional challenges in that the primary responsibility of illness management gets transitioned from parents to the ill child as she grows up. Previous research on children`s diabetes has shown that family functioning is associated with the child`s diabetes management behaviors as Well as their metabolic control. This study proposes another family factor that could possibly mediate the relationship between family characteristics and illness management: the discordance between parent and child`s perception of adherence. A sample of 134 mother-child dyads was extracted from a secondary data to explore the extent to which the parent`s perceptions in adherence are discordant from those of the child. and whether this discordance is associated with family environment. adherence level, and metabolic control. The findings suggest that parents` and children`s reports of adherence were not significantly different from each other at the group level comparisons. However. at the dyadic level, parent-child discordance was observed in more than one third of the adherence items measured. Family environment was a significant predictor of the parent-child discordance in perceptions of adherence as well as adherence. The relationship between family environment and adherence was not significant when the effect of discordance in perceptions was controlled. suggesting possible mediating relationship among the variables. These findings are in line with previous studies that documented significant association between family environment. family communication, and the management of childhood chronic illness. Implications for social workers are discussed.

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