Effects of self-management support and family participation enhancing program for delayed progression of diabetic nephropathy in Thai adults with type 2 diabetes

Abstract

Abstract

Background/Purpose: Type 2 diabetes mellitus (DM) is increasingly becoming common in developing countries including Thailand. Uncontrolled hyperglycemia can lead to progression of severe complications for persons with DM which include diabetic nephropathy and can, later on, lead to kidney failure. Self-management support and participation of social groups, specifically the family of the patient, can help people with DM in controlling the complications of their disease from progressing; in this case, the advancement of diabetic nephropathy. The aim of this research is to develop a program and determine if self-management support with the participation of the family members will have an effect in delaying the progress of diabetic nephropathy in adults with type 2 DM.

Theoretical Framework: Self-management based on social cognitive and self-regulation theories were used in this study to set a framework which utilizes social support from the family and self-efficacy of patients in implementing self-management activities.

Methods: This is a quasi-experimental research. The sample consisted of 50 Thai adults with type 2 DM, 25 for the control group and 25 for the experimental group. The participants in the experimental group attended a self-management support and family participation enhancing the program for 8 weeks. The interventions included a video presentation, manual, and health education with a family member in a focus group. Data were collected before attending the program and evaluated on the 8th and 12 weeks after the program. The instruments used for the data collection were (1) Self-Management Activity Questionnaire (SMAQ), (2) Self- Efficacy Questionnaire (SEQ). The data collected for clinical outcome used the automatic physiological measures: Systolic and Diastolic blood pressure, Hemoglobin A1c (HbA1c), serum creatinine (SCr) and estimated glomerular filtration rate (eGFR).  Data were analyzed using descriptive statistics, Independent t-test and Paired t-test and repeated measurement ANOVA.

Results: The mean scores of the self-management activity and self-efficacy of the experimental group were significantly higher, their clinical outcomes for blood pressure, SCr and HbA1C levels were significantly lower, and eGFR results were significantly higher after attending the self-management support and family participation enhancing the program.

Conclusions and Implications: The findings of this study indicate that the self-management and family participation enhancing program promote and support health behavior change and leads to better control of the delayed progression of diabetic nephropathy in Thai adults with type 2 DM. This can be applied by health care professionals in health care centers as a supplement to their usual care in dealing with persons with type 2 DM.