自我决定理论视角下中青年1型糖尿病患者限时饮食体验的质性研究

Qualitative Study of Time-Restricted Eating Experience in Young and Middle-Aged Patients with Type 1 Diabetes under the Perspective of Self-Determination Theory

摘要: 目的：在自我决定理论视角下，深入了解中青年1型糖尿病(T1DM)患者限时饮食的真实体验，旨在日后为临床护理人员制定中青年T1DM患者限时饮食相关的支持方案提供思路。方法：采用目的抽样法，选取2022年9月~2024年4月南宁市某社区卫生服务中心建档的12例中青年T1DM患者进行半结构式深入访谈，使用现象学研究中的Colaizzi 7步分析法进行资料分析和主题提炼。结果：共凝练出中青年T1DM患者限时禁食体验3个主题：自主需要——增强长期坚持的内在驱动力；能力需要——胜任感的构建与健康发展的转换；归属需要——社交的困境与迷茫。结论：限时饮食的模式在一定程度上提升了中青年1型糖尿病患者的自我管理动力，变相促进了患者身心健康发展，同时也面临着诸多挑战，患者营养结构不均衡、禁食负面反应、角色冲突、社交孤独现象说明需要限时饮食模式需要进一步的优化。护理人员应重视患者的营养风险筛查，关注其心理健康，给予患者科学、个性化的饮食指导，并构建和强化家庭、社区、社会支持网络，提供有效的支持方式，化解中青年1型糖尿病患者社交的困境与迷茫，引导患者正确地执行限时饮食。

Abstract: Objective: To investigate the real experience of time-restricted diet in young and middle-aged patients with type 1 diabetes mellitus (T1DM) from the perspective of self-determination theory, and to provide ideas for clinical nurses to develop time-restricted diet-related support programs for young and middle-aged patients with T1DM. Methods: Twelve middle-aged and young patients with T1DM recorded in a community health service center in Nanning City from September 2022 to April 2024 were selected by objective sampling method for semi-structured in-depth interviews, and data analysis and theme extraction were conducted by Colaizzi 7-step analysis method in phenomenological research. Results: Three main themes were summarized in T1DM patients: the need for autonomy—improving the ability of diet self-management; ability need—the construction of competence and the transformation of healthy development; belongingness needs—social dilemmas and confusion. Conclusion: The experience of time-restricted diet in young and middle-aged patients with T1DM is complex and varied, which promotes the self-management motivation, sense of competence, and healthy physical and mental development of patients to a certain extent. At the same time, they also face many challenges, such as unbalanced nutritional structure, negative reaction to fasting, role conflict, and social loneliness. Nursing staff should attach importance to patients’ nutritional risk screening, pay attention to their mental health, give patients scientific and personalized dietary guidance, build and strengthen family, community and social support networks, provide effective support methods, resolve social difficulties and confusion of middle-aged and young T1DM patients, and guide patients to correctly implement time-restricted diet.