Identification of Potential Leverage Points for Self-Management Support Intervention in Thais with Type 2 Diabetes.

Background: Although social-ecological models and multi-level interventions have been recommended for implementing the holistic self-management support for patients with type 2 diabetes, they are complex, costly, and need long-term effort. A more realistic approach would be to identify and implement a single or limited leverage point(s) that is most effective and feasible to create change. Objective: To assess the independent relationships of the social-environmental supports with self-management behaviors in Thai patients with type 2 diabetes. Material and Method: A cross-sectional survey was conducted among 1,000 type 2 diabetic patients from 64 healthcare facilities throughout Bangkok. A set of structured questionnaires were used to collect data related to social-environmental supports, and self-management behaviors. The predictor-outcome relationships were presented by beta (ß) coefficients (95% confidence limits). Results: Personal support was significantly associated with the overall self-management, dietary, physical activity, and medication taking behaviors. Neighborhood support was significantly associated with the overall self-management, physical activity, and medication taking behaviors. Personal support was found to interact negatively with neighborhood support on the overall self-management and medication taking behaviors. Conclusion: Personal and neighborhood supports are two potential leverage points for self-management support interventions for Thai patients with type 2 diabetes. Patients with low and high personal supports may need different strategies for neighborhood support.

Development of needs and resources for self-management assessment instrument in Thais with type 2 diabetes: cross-cultural adaptation.

OBJECTIVE: (1) To develop the Chronic Illness Resources Survey (CIRS) questionnaire for Thais with type 2 diabetes and (2) to examine validity and reliability of the instrument. MATERIAL AND METHOD: The present study consisted of two phases, phrase I was development of the comprehensive assessment form, for which the qualitative study was utilized and Glasgow's original CIRS was used as the initial input, and phrases II was tested for validity and reliability of the assessment form, for which quantitative study design was utilized. RESULTS: Final version of Thai comprehensive CIRS composed of 60 items in seven subscales, physician and health care team, family and friends, personal, community, neighborhood, media and policy, and community organization. Worksites subscale was deleted if it differed from original version. Its internal consistency was 0.93 (Cronbach's alpha coefficient = 0.93, p < 0.05). CONCLUSION: The present study demonstrates that the Thai CIRS is appropriate for Thai patients with type 2 diabetes. The instrument has acceptable validity and reliability. However, further research is required to evaluate these properties in other areas. Furthermore, the Thais CIRS should examine psychometric properties before it will be used in other chronic illness patients.