Effectiveness of self-management program on glycemic control of uncontrolled type 2 diabetic patients, Non Sang sub-district, Kanthararom district, Sisaket province
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Abstract
This research aimed to (1) evaluate the effectiveness of a conventional self-management program for type 2 diabetes patients with poor glycemic control, (2) develop a new program using Community-Based Participatory Research (CBPR), and (3) test the effectiveness of the new program on glycemic control, knowledge, self-management skills, and quality of life. The research was a quasi-experimental study divided into three phases. Phase 1 tested the conventional program with 30 type 2 diabetes patients with poor glycemic control (HbA1c ≥ 7%) over 12 weeks. Phase 2 developed a new program using Community-Based Participatory Research (CBPR) with a working team of 26 people. The program was then pilot-tested in two rounds with 18 patients to assess its appropriateness and feasibility. Phase 3 tested the effectiveness of the new program with 60 participants (30 in the experimental group, 30 in the control group) over 12 weeks.
Results showed that the conventional program had low effectiveness: HbA1c decreased by 0.62% (from 8.68% to 8.06%, p < 0.001), with 16.67% achieving good control (HbA1c < 7%). Knowledge increased by 9.20% (p<0.001), self-management skills by 5.86% (p<0.05), and quality of life by 6.60% (p<0.05), reflecting the need to develop a new program aligned with the community context. The development of NCS-SManMod (Non Sang Community-Based Self-Management Model) consisted of five core components: (1) Knowledge - 3 sessions, (2) Skills - 4 sessions, (3) Motivation - 2 sessions, (4) Social Support - 2 sessions, and (5) Continuous Follow-up. Comparative results showed that NCS-SManMod was significantly more effective than the conventional program. The experimental group showed an HbA1c reduction of 1.85% (from 8.72% to 6.87%, p<0.001) with a large effect size (Cohen's d = 1.41), and 76.67% achieved good control (HbA1c < 7%), compared to the control group's 0.62% reduction and 16.67% good control rate. The experimental group had significantly better outcomes than the control group (p<0.001) on all variables: (1) Knowledge: the experimental group increased by 48.90% while the control group increased by 9.20%, (2) Self-management skills: the experimental group increased by 38.57% while the control group increased by 5.86%, (3) Self-efficacy: the experimental group increased by 38.17% while the control group increased by 5.17%, (4) Social support: the experimental group increased by 43.77% while the control group increased by 3.43% (12.8-fold increase), and (5) Quality of life: the experimental group increased by 16.41% while the control group increased by 6.60%. Satisfaction with the program was at the highest level (4.83/5.0). Conclusion: Developing a program through CBPR after evaluating the limitations of the conventional program resulted in a significantly more effective intervention (HbA1c reduction: 1.85% vs. 0.62%). The new program is characterized as person-centered, participatory, sustainable, holistic, evidence-based, culturally appropriate, flexible, cost-effective, empowering, and scalable, making it suitable for replication in other areas with similar contexts.
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References
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