자기결정성 이론 기반의 골관절염 의료급여 수급자의 운동중재 경험
Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory
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연구배경: 골관절염은 노인기의 흔한 만성질환으로 자기관리가 매우 중요한 질환이다. 본 연구는 자기결정성 이론(SDT)을 기반으로 운동중재를 제공받은 골관절염이 있는의료급여 수급 노인의 운동 자기관리 행위 변화 과정을 확인하고자 실시되었다. 방법: 지역사회 기반으로 제공된 운동중재에 참여한 의료급여 수급 노인 가운데 골관절염을 진단받은 총 8명을 대상으로, 중재프로그램 종료 직후와 6개월 이후, 12개월 이후총 3회에 걸쳐 운동 자기관리와 관련된 다양한 행위변화에대한 경험을 면담을 통해 자료수집하였다. 수집된 자료(면담 필사본, 현장상황 기록지)는 골관절염 의료급여 수급 노인의 운동 자기관리 동기화 과정 탐색을 위해 SDT에 기반하여 해석현상학적 기법으로 분석하였다. 결과: 골관절염 의료급여 수급 노인의 운동 자기관리 형태는 불이행자, 중단자, 이행자의 세 가지 유형으로 구분되었다. 노인의 운동 자기관리는 SDT에 기반한 자율성, 유능성, 관계성의 충족이 행위 이행에 동기를 부여하는 것으로확인되었다. 행위의 동기화 시작에는 외적 조절이 영향을미쳤고, 행위의 지속적인 이행에는 확인된 조절이 영향을미쳤다. 결론: 골관절염 의료수급 노인의 운동 자기관리 행위 이행에 동기 부여와 점진적 행위 변화를 이해하는 데 SDT는효과적인 이론이며, 노인 대상자의 운동 자기관리 도모를위한 중재프로그램 개발 시 자율성, 유능성, 관계성, 외적 조절 및 확인된 조절을 향상시키는 데에 노력을 기울여야 할것이다.
Abstract
Background: Osteoarthritis is the most common chronic disease among elders, and it crucially requires self-management. This study aimed to qualitatively examine exercise experiences of elderly Medicaid beneficiaries with osteoarthritis receiving exercise intervention based on self-determination theory (SDT). Methods: Eight elders who received a community-based exercise intervention were interviewed three times. Using the interview transcriptions and field notes, researchers conducted an interpretative phenomenological analysis based on SDT to explore the motivational process of exercise compliance. Results: Three meaningful profiles (non-compliant, intermitter, and compliant) were identified along with satisfaction with needs (autonomy, competence, and relatedness) that motivate exercise compliance based on SDT. Compliance of exercise is primarily initiated by external regulation and followed by the internalization process of recognizing and accepting the value of the behavior. Conclusions: The concepts of SDT could be used to explore factors associated with motivation and gradual behavior change among elderly Medicaid beneficiaries with osteoarthritis. Autonomy, competence, relatedness, external regulation, and identified regulation control may be applied to establish a strategy that promotes behavior change by satisfying the psychological needs and internalizing the behavior of these elders
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