Effectiveness of Program to Slow Progression of Chronic Kidney Disease Among T2DM With HT With CKD 3 in the Community: A Randomized Controlled Trial.

Chronic kidney disease (CKD) is a significant threat to the quality of life of the global population. Thus, slowing kidney disease progression is considered vital in the treatment of CKD patients. The study aimed to evaluate the effectiveness of a program designed to slow the progression of CKD among Type 2 diabetes mellitus patients with HT with stage 3 CKD (CKD 3) in Thailand by adopting the information-motivation-behavioral skills (IMB) model and applying technology. This study was conducted as a cluster randomized controlled trial. The program activities comprised: (i) providing disease information and teaching behaviors to slow the progression of kidney disease to patients and family members via a 2-h session; (ii) teaching practical behavioral skills for appropriate diet and exercise to patients and family members via a 2-h session; (iii) enhancing personal motivation via the Line application and motivational interviewing via telephone calls; (iv) enhancing social motivation with the support of a family member; (v) employing technology to monitor behaviors and increase patient motivation; and (vi) assessing behaviors that were not practical, exploring barriers to behavior modification, and teaching further practical behavioral skills via the Line application. The data were analyzed using percentages, means, standard deviations, chi-square tests, t-tests, and a 2-way repeated-measures analysis of variance. The results showed that after the experiment, the experimental group had significantly higher mean scores in terms of knowledge, perceived benefits, perceived severity, self-efficacy, and behaviors to slow the progression of kidney disease than the control group (P < .05). Further, the experimental group had significantly better clinical outcomes (SBP, DBP, eGFR, BUN, creatinine, albuminuria, FBS, and HbA1c) than the control group (P < .05). In summary, the findings indicate that the program improved clinical outcomes, especially kidney function, effectively slowing the progression of kidney disease.

Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial.

BACKGROUND: The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control. AIM: To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels. METHODS: We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test. RESULTS: One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater. CONCLUSION: The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.

The effectiveness of tobacco cessation programs for university students: A systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to explore the existing tobacco interventions and synthesize whether those interventions affected tobacco use among university students. METHODS: We searched and found 1799 studies in PubMed, ClinicalKey for Nursing, Embase, and SCOPUS between 2009 and 2022. The risk of bias was assessed using similar criteria for RCT and non-randomized studies guided by the Cochrane Handbook for Systematic Reviews. The heterogeneity of studies was evaluated using Cochran's Q and I2 index. The GRADE system was used to distinguish the quality of evidence, and Egger's linear regression test was performed to assess publication bias. RESULTS: Eighteen studies used data extraction and analyses, and only eleven were meta-analyzed, which found that the estimate obtained via the fixed-effects model was statistically significant. Technology-based and motivational interview interventions found pooled ORs of statical significance, while reinforcer interventions showed the smallest effect size. The level of heterogeneity was considered substantial. The assessment for quality of evidence showed low overall certainty of evidence due to imprecision of outcome and suspicion of publication bias. Egger's test showed no publication bias among included studies (p=0.38). CONCLUSIONS: There were numerous tobacco cessation interventions for university students, but the most effective intervention to change tobacco consumption behavior was still inconclusive and uncertain. TRIAL REGISTRATION: This systematic review was registered with PROSPERO. The registration number is CRD42019142491.

A Community Health Volunteer Involvement Program for Glycated Hemoglobin Reduction Among Thai Patients With Uncontrolled Type 2 Diabetes: A Mixed-Method Study.

BACKGROUND: Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors. AIM: The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA1c) levels among Thai patients with uncontrolled type 2 diabetes. METHODS: This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King's General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent t-test, and paired t-test. RESULTS: The intervention group exhibited a lower mean HbA1c (p < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen's d > 1.0, effect size large). CONCLUSION: Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.

Feasibility study of automated interactive voice response telephone calls with community health nurse follow-up to improve glycaemic control in patients with type 2 diabetes.

BACKGROUND: Thailand has a shortage of community health nurses for supporting the self-management of type 2 diabetes, which is prevalent and poorly controlled. AIM: This study examined the feasibility and acceptability of a self-care assistance programme for poorly controlled type 2 diabetes mellitus. The SukapapNet programme consisted of automated interactive voice response calls to patients and automated follow-up email notifications to their nurses. DESIGN: Single-arm pre-post trial. METHODS: Six nurses and 35 type 2 diabetes patients were recruited from primary care settings in suburban provinces in Thailand. The study was conducted from June 2017 to November 2017. We assessed patients before and after 12 weeks of the SukapapNet intervention. RESULTS: Mean glycated haemoglobin decreased by 0.9%. Patients reported reduced carbohydrate consumption, increased physical activity, increased medication adherence, improved sleep quality, and more frequent foot care. Patients and nurses both recommended using the intervention, although nurses expressed concerns regarding increased workload. CONCLUSIONS: The study programme could improve outcomes in Thai type 2 diabetes patients. Further study of the impact of technology upon nurses' workload is warranted.

Effects of a dietary modification on 2 h postprandial blood glucose in Thai population at risk of type 2 diabetes: An application of the Stages of Change Model.

The purpose of this study was to investigate the effect of a dietary modification intervention programme by applying the Stages of Change Model in 2 h postprandial capillary glucose reduction among Thai population. A randomized control trial was conducted for people at risk of type 2 diabetes for a period of 8 weeks. The intervention programme consisted of evaluating an individual's stage of change after being provided dietary information regarding kind of food and portions, discussion with a role model, and keeping a food diary record. By the end of the intervention programme, most participants in the experimental group were in the action stage (n = 36), whereas those in the control group were in the preparation stage (n = 32). Body mass index, blood pressure, food consumption behaviour and the 2 h postprandial blood glucose (PPG) in the experimental group had improved (P < 0.05). When performing regression analysis, intervention participation and the 2 h PPG at the baseline accounted for approximately 54% of total variance in predicting the 2 h PPG. This study yielded evidence for the benefits of using the Stages of Change Model as a framework in a dietary modification programme among people at risk of type 2 diabetes.

Self-management improvement program combined with community involvement in Thai hypertensive population: an action research.

OBJECTIVE: To investigate the effectiveness of a program that utilizes community involvement to improve the self-management strategies among people living with hypertension. MATERIAL AND METHOD: Forty-four subjects, aged 35 to 59-year-old, with hypertension in Nakhon Pathom Province, Thailand, were randomly allocated to either an experimental group (n = 22) or a control group (n = 20). The experimental group attended a program to improve self-management methods based on social cognitive theory (SCT). The program lasted 12 weeks, consisted of 1 1/2 hours meeting once a week, including group meetings and home visit monitoring. Mann-Whitney U test and Friedman test were employed to analyze the program's effectiveness. RESULTS: After the program, the mean rank of the perceived self-efficacy for the self-management strategies was statistically different between the two groups (p = 0.023). In the experimental group, after the twelve week, the mean rank of perceived self-efficacy and outcome expectancy increased and diastolic blood pressure decreased after the eight week. CONCLUSION: The program applied social cognitive theory (SCT) to promote self-management techniques, increased the health promoting behavior among hypertensive people.

An effect of walking exercise applying the theory of planned behavior in people at risk of hypertension.

OBJECTIVE: To investigate an effectiveness of walking exercise program applying the Theory of Planned Behavior in people at risk of hypertension in Samut Sakorn province. MATERIAL AND METHOD: The present study is a quasi-experimental research. The inclusion criteria were people aged 35-59 years old, systolic blood pressure 120-139 mmHg, and diastolic blood pressure 80-89 mmHg. Participants were randomly selected into the experimental group (n = 34) and the comparison group (n = 34). The experimental group received activities including health information, benefits of walking exercise, group discussion in exercise barriers, modeling and experience exchange, walking exercise practice, and practice on using walking monitoring booklet at the baseline and the 2nd week, whereas the comparison group received only health information and the booklet practice at the beginning of the intervention. Data were collected by self-administered questionnaires at the baseline, 2nd week, and 6th week. Statistical analysis was performed using Chi-square, Independent t-test, and repeated measures ANOVA. RESULTS: The experimental group made significant improvements in attitude towards walking exercise, perceived behavior control, subjective norm, walking exercise intention, and walking exercise over time (p < 0.05). However, no statistically significant differences between the experimental and the comparison groups were found in subjective norm, systolic and diastolic blood pressure from baseline to the 6th week. The experimental group had a significant higher mean difference score of attitude towards walking exercise, perceived behavior control, walking exercise intention, walking exercise, weight, and BMI compared to those in the comparison group (p < 0.05). Subjective norm scores in the experimental group were more likely to increase from baseline to the 6th week, but not a significant difference. CONCLUSION: Walking exercise programs applying the Theory of Planned Behavior should be recommended in people at risk of hypertension. Health professionals should also be motivated to practice with this program.

Effect of personal health record booklet (PHRB) to knowledge, self-efficacy and healthy behaviors among Thai population at risk of cardiovascular disease (CVD).

OBJECTIVE: To investigate an effect of a personal health record booklet (PHRB) to knowledge, self-efficacy and healthy behaviors among Thai population at risk of CVD. MATERIAL AND METHOD: The present study was a quasi-experimental study conducted in a primary care unit during November 2008 and January 2009. A random sample of 204 CVD risk population were recruited as a comparison group (n = 102), who received a regular follow-up and recorded routine blood pressure using booklet and an experimental group (n = 102), who received the regular follow-up and the intervention consisting of health education for CVD information and self-monitoring practice. Data were collected by using self-administered questionnaires at the baseline, the 4th week and the 8th week. These data were analyzed by descriptive statistics, Chi-square test and GLM repeated measures. RESULTS: Knowledge score was significantly decreased although self-efficacy was increased over a time in the experimental group. However except the figure of sweet/cookies consumption, the mean score of healthy behaviors were not improved in the experimental group when compared to the comparison group. CONCLUSION: CVD information, activity illustrations with caption, health record section and daily self-monitoring tables in desired behaviors should be considered for inclusion in the booklet.