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.

Diabetes self-management, fasting blood sugar and quality of life among type 2 diabetic patients with foot ulcers.

BACKGROUND: Diabetic foot ulcers have a negative impact on quality of life and diabetes self-management of the condition is a key component of diabetes treatment. However no study has yet been conducted to determine the relationship between diabetes self-management, fasting blood sugar and quality of life among type 2 diabetic patients with foot ulcers in Thailand. OBJECTIVE: To examine the relationship between diabetes self-management, fasting blood sugar and quality of life (QOL) among type 2 diabetic patients with foot ulcers who received the diabetes treatment in King Chulalongkorn Memorial Hospital, Thailand. MATERIAL AND METHOD: This was a cross-sectional study of 80 participants with type 2 diabetes who had foot ulcers in King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Participants with diabetic foot ulcers were given a questionnaire regarding demographic data, fasting blood sugar, diabetes self-management and quality of life. Self-management was assessed by evaluating dietary intake, exercise, medication, self-monitoring, hygienic and foot care. WHOQOL-BREF-THAI, comprising of 26 items, was used to investigate quality of life. A purposive sampling technique was used for selecting patients from two outpatient departments, surgical and rehabilitation. Data were collected between September 2009 and October 2010. Simple descriptive statistics were used to provide the basic information and Pearson's product moment was applied. RESULTS: The majority (51.3%) of study participants were males and in the age group of > 60 years (50%). Over half (61.5%) of the participants had a severity of foot ulcer at the first level. The analysis revealed that there was a negative significant association between fasting blood sugar and quality of life (r = -0.30, p < 0.05). Furthermore, diabetes self-management had a significant association with quality of life (r = 0.35, p < 0.05). CONCLUSION: The results in the present study suggest that good quality of life is significantly related to good diabetes self-management and fasting blood sugar control in type 2 diabetes patients with foot ulcers. Therefore, these patients should be encouraged to perform self-management for controlling their blood sugar and improving their quality of life.

Effects of multifaceted nurse-coaching intervention on diabetic complications and satisfaction of persons with type 2 diabetes.

OBJECTIVE: To examine the effects of multifaceted nurse-coaching intervention on diabetic complications which were assessed by HbA1c, blood pressure, LDL-C levels and satisfaction with nursing intervention of persons with type 2 diabetes. MATERIAL AND METHOD: Quasi-experimental design study was conducted from October 2007 to March 2008. Forty participants with type 2 diabetes of two Red Cross Health Stations in Bangkok, Relief and Public Health Bureau of the Thai Red Cross Society, were selected by purposive sampling and matched pair The participants of the 11th Red Cross Health Station were the control group (n=20) who received the usual care while the participants of the 2nd Red Cross Health Station were the experimental group (n=20) who received the multifaceted nurse-coaching intervention over 12 weeks. A multifaceted nurse-coaching intervention was performed on a trail basis on the coaching model of Eaton and Johnson (2001). The coaching process included assessment, goal definition, analysis, exploring, action plan, learning and feedback and consisted of 3 individualized sessions and 2 follow-up phone calls over 12 weeks. The community nurses were trained to be involved in the intervention. Data from each participant were collected by using a questionnaire related to their personal demography and signs or risk factors of diabetic complications including HbA1c, blood pressure and LDL-C testing, and interviewing satisfaction with nursing intervention questionnaire. The data were analyzed using dependent samples t-test, and independent sample t-test. RESULTS: Both groups were similar in age, sex and duration of diabetic history. After 12 weeks, the mean average of HbA1c of the experimental group was significantly lower than that of the control group (x(exp) = 7.10, SD = .67 vs. x(cont) = 7.72, SD = .97; p < or = 0.5). There was no statistically significant difference in blood pressure between the experimental group and the control group (systolic blood pressure: x(exp) = 121.0, SD = 10.28 vs. x(cont) = 127.4, SD = 15.30; p > 0.5, diastolic blood pressure: x(exp) = 81.30, SD = 9.18 vs. x(con) = 79.4, SD = 19.43; p > .05). There was also no difference between the two groups in average mean of LDL-C level (x(exp) = 123.60, SD = .45.53 vs. X(cont) = 110.40, SD = 25.60; p > .05). The participants in the experimental group had significantly higher satisfaction score than the control group (x(exp) = 4.91, SD = 0.91 vs. x(cont) = 2.49, SD = 0.18; p < 0.5). CONCLUSION: The multifaceted nurse-coaching intervention could reduce HbA1c and increase satisfaction but could not decrease blood pressure and LDL-levels in persons with type 2 diabetes who received the intervention for 12 weeks.