Main Article Content
Type 2 diabetes (T2D) is a public health challenge globally and in Thailand. Uncontrolled diabetes leads to acute and chronic complications. Diabetes mellitus self-management (DMSM) with social support from family members is considered an effective strategy to control diabetes. This study aims to evaluate the effectiveness of a family support coaching program on diabetes mellitus self-management (FS-DMSM) to improve health outcomes among Thai patients with uncontrolled T2D. A quasi-experimental study employing a pre- and posttest design with a nonequivalent control group was conducted at Bamrasnaradura Infectious Disease Institute (BIDI), Thailand. Sixty-four patients with T2D who met inclusion criteria were selected in experimental and comparison groups for a period of 3 months. The patients and their family members of the experimental group were recruited in the FS-DMSM program receiving 4 sessions of DMSM and family support education while the patients of the comparison group received routine treatment and care at BIDI. The results showed that after completing the intervention program, the experimental group significantly increased perceived diabetes family support, diabetes knowledge, diabetes self-efficacy and diabetes self-management within and between groups before and after intervention (p<0.05). Fasting plasma glucose and HbA1c also decreased significantly within and between groups before and after implementing (p<0.05). In conclusion, the FS-DMSM program could improve health outcomes of Thai patients with uncontrolled T2D. The FS-DMSM program should be merged with routine diabetes self-management education interventions to enhance DMSM practices.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
2. World Health Organization. Diabetes 2018. [Internet]. [ Cited 2019 September 21]. Available from:. https://www.who.int/news-room/fact-sheets/detail/diabetes.
3. The International Diabetes Federation (IDF). [Internet]. [Cited 2020 May 31]. Available from: https://www.diabetesatlas.org/en/.
4. Roglic G. WHO Global report on diabetes: A summary. Int J Non-Commun Dis 2016;1:3-8.
5. The International Diabetes Federation (IDF). Thailand. [Internet]. [Cited 2019 December 21]. Available from: https://www.idf.org/our-network/regions-members/western-pacific/members/115-thailand.html.
6. World Health Organization. Thailand. [Internet]. [Cited 2019 December 21]. Available from: https://www.who.int/nmh/countries/tha_en.pdf.
7. Mahikul W, White LJ, Poovorawan K, Soonthornworasiri N, Sukontamarn P, Chanthavilay P, et al. A Population Dynamic Model to Assess the Diabetes Screening and Reporting Programs and Project the Burden of Undiagnosed Diabetes in Thailand. Int J Environ Res Public Health. 2019 Jun 21;16(12):2207. doi: 10.3390/ijerph16122207.
8. Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of Diabetes and Relationship with Socioeconomic Status in the Thai Population: National Health Examination Survey, 2004-2014. J Diabetes Res. 2018 Mar 1;2018:1654530. doi: 10.1155/2018/1654530.
9. Aekplakorn W, Kessomboon P, Sangthong R, Chariyalertsak S, Putwatana P, Inthawong R, et al. NHES IV study group. Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009. BMC Public Health. 2011 Nov 10;11:854. doi: 10.1186/1471-2458-11-854.
10. Novo Nordisk. The diabetes epidemic and its impact on Thailand. [Internet]. [Cited 2020 March 30]. Available from: https://thailand.um.dk/en/news/newsdisplaypage//~/media/thailand/documents/handel/diabetes_book_thai-eng.pdf.
11. Martha M. Funnell, Tammy L. Brown, Belinda P. Childs, Linda B. Haas, Gwen M. Hosey, Brian Jensen, et al. National standards for diabetes self-management education. Diabetes
12 . American Diabetes Association. Diabetes Care 2020 Jan; 43(Supplement 1): S14-S31.[Internet]. [Cited 2020 May 24]. Available from: https://doi.org/10.2337/dc20-S002.
13. American Diabetes Association. Complications. [Internet]. [Cited 2020 May 24]. Available from: https://www.diabetes.org/diabetes/complications.
Care. 2010; 33(Suppl 1): S89-96. doi:10.2337/dc10-S089.
14. Chrvala C.A, Sherr D, Lipman R.D. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-43.doi: 10.1016/j.pec.2015.11.003.
15. Linda Haas, Melinda Maryniuk, Joni Beck, Carla E. Cox, Paulina Duker, Laura Edwards, et al. National standards for diabetes self-management education and support. Diabetes Care. 2012;35(11):2393–2401. doi:10.2337/dc12-1707.
16. Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care. 2013; 36:2960–2967.doi.org/10.2337/dc13-0108.
17. Duncan I, Ahmed T, Li QE, Stetson B, Ruggiero L, Burton K, et al. Assessing the value of the diabetes educator. Diabetes Educ, 37(5), 638–657. doi.org/10.1177/0145721711416256.
18. Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. 2008;31:655–660. doi.org/10.2337/dc07-1871.
19. Wu SF, Liang SY, Wang TJ, Chen MH, Jian YM, Cheng KC. A self-management intervention to improve quality of life and psychosocial impact for people with type 2 diabetes. J Clin Nurs. 2011 Sep;20(17-18):2655-65. doi: 10.1111/j.1365-2702.2010.03694.x.
20. Sinclair KA, Makahi EK, Shea-Solatorio C, Yoshimura SR, Townsend CK, Kaholokula JK. Outcomes from a diabetes self-management intervention for Native Hawaiians and Pacific People: Partners in Care. Ann Behav Med. 2013;45(1):24-32. doi:10.1007/s12160-012-9422-1.
21. Bukhsh A, Khan TM, Sarfraz Nawaz M, Sajjad Ahmed H, Chan KG, Goh BH. Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2019;12:1409–1417. doi:10.2147/DMSO.S209711.
22. Mohebi S, Azadbakht L, Feizi A, Sharifirad G, Kargar M. Review the key role of self-efficacy in diabetes care. J Educ Health Promot. 2013;2:36. doi:10.4103/2277-9531.11582718.
23. Wen LK, Parchman ML, Shepherd MD. Family support and diet barriers among older Hispanic adults with type 2 diabetes. Fam Med. 2004;36(6):423-30.
24. Vaccaro JA, Exebio JC, Zarini GG, Huffman FG. The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes. World Journal of Nutrition and Health. 2014;2(1):1-9. doi:10.12691/jnh-2-1-1.
25. Choi SE, Lee JJ, Park JJ, Sarkisian CA. Spousal support in diabetes self-management among Korean immigrant older adults. Res Gerontol Nurs. 2015;8(2):94-104. doi: 10.3928/19404921-20141120-01.
26. Ojewale LY, Oluwatosin AO, Fasanmade AA, Odusan O. A survey on patients' characteristics, perception of family support and diabetes self-management among type 2 diabetes patients in South-West Nigeria. Nurs Open. 2019;6(2):208–215. doi:10.1002/nop2.236.
27. Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behav Sci (Basel). 2017;7(3):62. Published 2017 Sep 15. doi:10.3390/bs7030062.
28. Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci. 2015;1353(1):89–112. doi:10.1111/nyas.12844.
29. Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes Care. 2012;35(6):1239–1245. doi:10.2337/dc11-2103.
30. Miller TA, Dimatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes Metab Syndr Obes. 2013;6:421‐426. Published 2013 Nov 6. doi:10.2147/DMSO.S36368.
31. Thojampa S. Effects of self-management support and family participation enhancing program for delayed progression of diabetic nephropathy in Thai adults with type 2 diabetes. Journal of Current Medical Research and Opinion. 2017. doi:10.15520/jcmro.v1i1.5.
32. Wichit N, Mnatzaganian G, Courtney M, Schulz P, Johnson M. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes. Diabetes Res Clin Pract. 2017;123:37-48. doi: 10.1016/j.diabres.2016.11.013.
33. Pamungkas RA, Chamroonsawasdi K. Self-management based coaching program to improve diabetes mellitus self-management practice and metabolic markers among uncontrolled type 2 diabetes mellitus in Indonesia: A quasi-experimental study. Diabetes Metab Syndr. 2020;14(1):53‐61. doi:10.1016/j.dsx.2019.12.002.
34. House, J.S. Social support and social structure. Sociol Forum 2. 1987, 135–146. https://doi.org/10.1007/BF01107897.
35. Belle G.v. Statistical Rules of Thumb, Chapter II; Sample Size 2008. [Internet]. [Cited 2016 October 15]. Available from: http://www.vanbelle.org/-chapters%5Cwebchapter2.pdf.
36. Cohen J. Statistical Power Analysis for the Behavioral Sciences: Hillsdale, N.J. : L. Erlbaum Associates; 1988.
37. Schafer LC, McCaul KD, Glasgow RE. Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes. Diabetes Care. 1986;9(2):179‐185. doi:10.2337/diacare.9.2.179.
38. Apinya S, Somchit H, Gail D’ Eramo M, Thavatchai V, Chatcharit R, Manee A. Factors Contributing to Integrating Lifestyle in Thai Women with Type 2 Diabetes. Thai J Nurs Res 2008; 12 (3) 166 – 178.
39. Michigan Diabetes Research and Training Center. Brief Diabetes Knowledge Test.[Internet].[Cited 2016 October 08]. Available from: http://www.med.umich.edu/borc/profs/documents/svi/dkt5answers.pdf.
40. Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998 May;21(5):706-10. doi: 10.2337/diacare.21.5.706.
41. Self-Management Resource Center. Self-Efficacy for Diabetes.[Internet]. [Cited 2016 October 15]. Available from: https://www.selfmanagementresource.com/docs/pdfs/English_-_self-efficacy_diabetes.pdf.
42. Wattanakul, Boontuan (2012): Factors Influencing Diabetes Self-Management Behaviors among Patients with T2DM in Rural Thailand. University of Illinois at Chicago. Thesis. https://hdl.handle.net/10027/9139
43. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. 2013;11:138. Published 2013 Aug 13. doi:10.1186/1477-7525-11-138.
44. Boonsatean W. Living with type 2 diabetes in a Thai population: experiences and socioeconomic characteristics. [Internet].[Cited 2016 October 12]. Available from: https://mau.divaportal.org/smash/get/diva2:1404267/FULLTEXT01.pdf.
45. Ardeňa GJ, Paz-Pacheco E, Jimeno CA, Lantion-Ang FL, Paterno E, Juban N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes Res Clin Pract. 2010;90(2):160‐166. doi:10.1016/j.diabres.2010.08.003.
46. Ku GM, Kegels G. Knowledge, attitudes and perceptions of people with type 2 diabetes as related to self-management practices: Results of a cross-sectional study conducted in Luzon, Philippines. Chronic Illn. 2015;11(2):93-107.48. doi: 10.1177/1742395314538291.
47. Chawla SPS, Kaur S, Bharti A, Garg R, Kaur M, Soin D, et al. Impact of health education on knowledge, attitude, practices and glycemic control in type 2 diabetes mellitus. J Family Med Prim Care. 2019;8(1):261–268. doi:10.4103/jfmpc.jfmpc_228_18.
48. Jiang X, Wang J, Lu Y, Jiang H, Li M. Self-efficacy-focused education in persons with diabetes: a systematic review and meta-analysis. Psychol Res Behav Manag. 2019;12:67–79. Published 2019 Jan 29. doi:10.2147/PRBM.S192571.
49. World Health Organization 2011. Use of GlycatedHaemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. [Internet]. [Cited 2016 October 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK304267/pdf/Bookshelf_NBK304267.pdf.
50. Hu J, Wallace DC, McCoy TP, Amirehsani KA. A family-based diabetes intervention for Hispanic adults and their family members. Diabetes Educ. 2014;40(1):48‐59. doi:10.1177/0145721713512682.
51. Hu J, Amirehsani KA, Wallace DC, McCoy TP, Silva Z. A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members. Diabetes Educ. 2016;42(3):299‐314. doi:10.1177/0145721716636961
52. Cai C, Hu J. Effectiveness of a Family-based Diabetes Self-management Educational Intervention for Chinese Adults With Type 2 Diabetes in Wuhan, China. Diabetes Educ. 2016;42(6):697‐711. doi:10.1177/0145721716674325.
53. McEwen MM, Pasvogel A, Murdaugh C, Hepworth J. Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults. Diabetes Educ. 2017;43(3):272‐285. doi:10.1177/0145721717706031
54. Mao L, Lu J, Zhang Q, Zhao Y, Chen G, Sun M, Chang F, Li X. Family-based intervention for patients with type 2 diabetes via WeChat in China: protocol for a randomized controlled trial. BMC Public Health. 2019 Apr 5;19(1):381. doi: 10.1186/s12889-019-6702-8.
55. McEwen MM, Pasvogel A, Murdaugh C. Effects of a Family-Based Diabetes Intervention on Family Social Capital Outcomes for Mexican American Adults. Diabetes Educ. 2019;45(3):272‐286. doi:10.1177/0145721719837899.
56. Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behav Sci (Basel). 2017 Sep 15;7(3):62. doi: 10.3390/bs7030062.