Effects of a self-management support program delivered through telehealth services on self-management behaviors to delay renal impairment in public health volunteers with type 2 diabetes 10.55131/jphd/2025/230313
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Abstract
Diabetes is a major global public health problem, and patients have a high risk of complications and mortality. Changing patient behavior through telehealth monitoring can help reduce the risk of chronic kidney complications. This experimental study aimed to evaluate the effectiveness of a self-management support program delivered through telehealth services in improving self-management behaviors to delay kidney deterioration in healthy volunteers with type 2 diabetes. The sample was selected through multistage random sampling and consisted of 102 participants, who were divided into experimental and control groups with 51 participants each. The experimental group participated in a self-management support program based on Lorig and Holman’s self-management concept, focusing on six key self-management skills. The program included health education delivered through videos, self-management behavior tracking, and communication through the LINE application. A questionnaire was used to assess self-management behaviors related to delaying kidney deterioration, particularly in terms of food consumption and exercise. The study duration was 12 weeks. Data were analyzed using descriptive statistics, independent t-tests, and paired t-tests. After the experiment, the experimental group had significantly higher mean scores for eating and exercise behaviors (M = 71.47, SD = 9.31) than those recorded before the program (M = 47.39, SD = 9.06) (p < .001). These findings suggest that a self-management support program delivered through telehealth can effectively promote behavior modification, particularly in maintaining normal blood sugar levels, which may help prevent kidney failure in individuals with type 2 diabetes. The study recommends further research to compare blood sugar levels (hemoglobin A1C) and their effect on glomerular filtration rates before and after the intervention. It also highlights the importance of closely monitoring the behaviors of health volunteers with type 2 diabetes from its onset.
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References
International Diabetes Federation. Diabetes Atlas 10th ed. 2021. [Cited 2022 July 15]. Available from: https://diabetesatlas.org/ idfawp/resourcefiles/2021/07/IDF_Atlas_10th_Edition_2021.pdf
Division of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand. Guidelines for remission service in people with diabetes Ministry of Public Health. 2023.
Health Data Center. New cases of diabetes 2023. [cited 2023 July 28]. Available from: https://hdcservice. moph.go.th/hdc/reports/report.php?source=pformated/format1.php&cat_id=6a1fdf282fd28180eed7d1cfe0155e11&id=eeeab22e386d32e7f5f5ecefebce0001#
Sthiraphon B. Pathophysiology of diabetic nephropathy. In: Anutrakulchai S, Chancharoenthana W, Kittisakunnam P, Trakarnwanich T, Ditsabunchong S, Opascharoensuk W, editors. Textbook of Chronic Kidney Disease. 3rd ed. Bangkok: Text and Journal Publication; 2023; p. 238-60.
Kawamura T, Yunihiro K, Kouzuki M, Tomino Y. One hundred and fifty kidney disease questions. 1 st ed. Bangkok: Nanmee Books: 2022; p. 44-77.
Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000; Apr;23: 21-9. [Cited 2023 July 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/10860187/
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; Aug 12;321(7258): 405-12. doi: 10.1136/bmj.321.7258. 405. [Cited 2023 July 15]. Available from: https://pubmed.ncbi.nlm.nih. gov/10938048/
American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017; 35 (1): 5-26. Available from: https://doi.org/ 10.2337/cd16-0067
Cooper H, Booth K, Gill G. A trial of empowerment-based education in type 2 diabetes-global rather than glycaemic benefits. Diabetes Res Clin Pract. 2008;82(2):165-71. doi:10.1016/ j.diabres.2008.07.013. [Cited 2023 July 15]. Available from: https://pubmed. ncbi.nlm.nih.gov/18804887/.
Klug C, Toobert DJ, Fogerty M. Healthy Changes for living with diabetes: an evidence-based community diabetes self-management program. Diabetes Educator. 2008; 34(6): 1053-61. Available from: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC4908955/
Krebs JD, Parry A, Gamble E, McBain L, Bingham LJ, Dutton ES, Tapu S, Howells J, Metekingi H, Smith RB, Coppell KJ. A structured, group-based diabetes self-management education (DSME) programme for people, families and whanau with type 2 diabetes (T2DM) in New Zealand: an observational study. Primary Care Diabetes. 2013; 7(2): 151-8. Available from: https://pubmed.ncbi.nlm.nih.gov/23517821/
Boonnak P. Pathophysiology of diabetic nephropathy. In: Anutrakulchai S, Chancharoenthana W, Kittisakunnam P, Trakarnwanich T, Ditsabunchong S, Opascharoensuk W, editors. Textbook of Chronic Kidney Disease. 3rd ed. Bangkok: Text and Journal Publication. 2023; p. 899-914.
Rattanasri P. Effects of a Self-Management Support Program on Self-Management Behaviors and Clinical Outcomes to Delay Kidney Failure in Type 2 Diabetic Patients at Samran Subdistrict Health Promotion Hospital. J of Khon Kaen Provincial Health Office. 2022; 4(2): 209-224.
Wongpipit W, Kritpet T, Pongpiboon S. Physical activity and sedentary behavior. J Sports Sci Health. 2021; 21(1):1-21.
Phanwattana P. Food consumption behavior of urban working people in Bangkok. J of 7th Disease Control Office, Khon Kaen. 2019; 26(2): 93-102.Available from: https://he01.tci-thaijo.org/index.php/jdpc7kk/article/view/212982
Ratanophas W. Food consumption behavior of people in Khlong Phikhai Subdistrict, Phran Kratai District, Kamphaeng Phet Province. Rajabhat Rambhai Barni Research J. 2022; 16(1): 58-65.
Health Promotion Division, Health Department, Bangkok Metropolitan. Readiness training for Bangkok Metropolitan public health volunteers. 2021. [cited 2023 November 10]. Available from: www.bankok.go.th/ health.
Nukoonkit S, Sareerattana T. Effects of a health promotion program in combination with group process in the self-care behavior modification of patients with type 2 diabetes at community health centers, Mueang, Sakon Nakhon Province. J Sakon Nakhon Hosp. 2018;21(1):77-86.
Toobert DJ, Strycker LA, King DK, Barrera MJ, Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien!. Transl Behav Med. 2011; Sep;1(3): 416-26. doi: 10.1007/s13142-010-0011-1. [Cited 2023 July 15]. Available from: https://pubmed.ncbi. nlm.nih.gov/22022345/
Jiamjarasrangsi W. Type 2 Diabetes. Bangkok: Chulalongkorn University Printing: 2018.
Allegrante JP, Wells MT, Peterson JC. Interventions to support behavioral self-management of chronic diseases: Annual review of public health. 2019; 40:127-46. [Cited 2023 July 15]. Available from: https://www. annualreviews.org/content/journals/10.1146/annurev-publhealth-040218-044008
Chen L, Chuang LM, Chang CH, Wang CS, Wang IC, Chung Y, et al. Evaluating self-management behaviors of diabetic patients in a telehealth care program: Longitudinal study over 18 months. J Med Internet Res. 2013; 15(12): e266. doi: 10.2196/jmir.2699. [Cited 2023 July 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/24323283/
Chaipan N, Boonkla S, Konhan K, Chaipan N. Handbook on the process of building health literacy in preventing and controlling disease and health hazards. 1st ed. Department of Disease Control, Bureau of Risk Communication and Health Behavior Development; 2021. [cited 2023 July 15]. Available from: https://ddc.moph. go.th/uploads/publish/1188920211018040126.pdf
Silpawittayathorn B, Chitpakdee B. The use of health information technology in nursing for patient safety. J of Nursing and Health Care. 2020; 8(2): 6-14.
Demkhuntod N, Kwancharoen R, Chuantantikamon C, Phaholpak P, Suromrakul S. The effect of telehealth monitoring on blood sugar control and medication adherence in poorly controlled type 2 diabetes patients. Wachirawet J Urban Med. 2021:75-90.
Srisuk P, Methakanjanasuck N. Effects of an internet-based self-management program for dietary carbohydrate control and promotion of exercise in patients with type 2 diabetes. Udonthani Hosp Med J. 2021;30(1):12-20.
Yingyuen K, Methakanjanasuck N. Self-management innovations via a telehealth system for patients with type 2 diabetes and hyperlipidemia. Srinagarind Med J. 2016; 31(6): 365-71.
Cotter AP, Durant N, Agne AA, Cherrington AL. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complications. 2014; 28(2): 243-51. [Cited 2023 July 15]. Available from: https://pubmed.ncbi. nlm.nih.gov/24332469/
Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, Gu D. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med. 2011; 28(4): 455-63. [Cited 2023 July 15]. Available from: https://pubmed. ncbi.nlm.nih.gov/21392066/
Lorig K, Ritter PL, Laurent DD, Plant K, Green M, Jernigan VB, Case S. Online diabetes self-management program: a randomized study. Diabetes Care. 2010; Jun; 33(6): 1275-81. doi: 10.2337/dc09-2153. [Cited 2023 July 15]. Available from: https://pubmed. ncbi.nlm.nih.gov/20299481/
Elgaphar SM, El Gafar SI. Effect of tele-nursing (phone-based follow-ups) on self-efficacy, healthy lifestyle, and glycemic control in diabetic patients. IOSR-JNHS. 2017; 6(3): 67-76. [Cited 2023 July 15]. Available from: https:// www.iosrjournals.org/iosr-jnhs/papers/vol6-issue3/Version-5/J0603056776.pdf
Hadjiconstantinou M, Byrne J, Bodicoat DH, Robertson N, Eborall H, Khunti K, Davies MJ. Do web-based interventions improve well-being in type 2 diabetes? a systematic review and meta-analysis. J Med Internet Res. 2016; 8(10): 270. doi: 10.2196/ jmir.5991. [Cited 2023 July 15]. Available from: https://pubmed.ncbi. nlm.nih.gov/27769955/
Gulavani SS, Kulkarni M. Role of Social Media in Marketing in 21st Century. J of the Maharaja Sayajirao University of Baroda. 2022; 56(1): 75-84.
Boonchan S, Phongpattanawut S. The effect of providing knowledge on carbohydrate counting with telephone follow-up on blood sugar level in type 2 diabetic patients at Phaholyothin Pholpayuhasena Hospital, Kanchanaburi Province. J of Nutrition. 2018; 53(2): 71-83. Available from: http://www.Nutritionthailand.org
Lorig KR, Holman H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1):1-7. doi: 10.1207/S15324796ABM2601_01. [Cited 2023 July 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/12867348/
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. NJ: Lawrence Erlbaum Associates, Publishers; 1988.
Sonketsarin A, Chantra R, Kwanchum R, Rueangduang L. The effect of a health behavior modification program according to the 3A.2S. approach of public health volunteers (PHVs) in Khlong Chanak Subdistrict, Mueang District, Surat Thani Province. J South Nurs Coll Public Health Network. 2017;4(1):253-64.
Aranyasan D, Seesuree Y, Chumnanborirak P. Effects of health behavior changing program on slowly progressive chronic kidney disease in patients with diabetes mellitus and hypertension at Koeng health promotion hospital, Mueang Mahasarakham District, Mahasarakham Province. Academic J Mahasarakham Prov Public Health Off. 2020;1-12.
Yoomuang P. Application-based model supporting self-management for patients with stage 3 chronic kidney disease. Phitsanulok: Narasuan University; 2022.
Boonthanapisan N, Naewbood S, Tipwareerom W. Effect of self-management promotion program using LINE application on health behaviors and A1C levels among uncontrolled diabetic patients. J Nurs Health Sci. 2022;16(3):47-59.
Sritong W, Methakanchanasak N. The effect of a self-management program with LINE reminders to prevent fluid overload in hemodialysis patients. J Nurs Sci Health. 2021;44(4):1-16.
Sabai Suk N, Suphametaporn P, Songthai N. Effects of a self-management support program on health behavior and glomerular filtration rate in patients with type 2 diabetes mellitus with chronic kidney disease stage 3. J Boromarajonani Coll Nurs Uttaradit. 2018;(Special Issue):137-50. [cited 2023 July 15]. Available from: https:// he01.tci-thaijo.org/index.php/unc/ article/view/152763
Dankasai C, Limtrakul P. Delaying renal degeneration in patients with diabetes and renal complications in communities: Phra Klang Thung That Phanom, Nakhon Phanom. J Nurs Health Care. 2016;34(2):6-12.
Sitkunanan P, Kamthip P. Impact of a self-management programme monitored through the application LINE on eating behaviour, arm-swing exercise behaviour, and blood glucose levels in women with gestational diabetes mellitus. J Thailand Nurs Midwifery Counc. 2020;35(2):52-69.
Thailand Nusring and Midwifery Council. Tele-Nursing Guidelines. 2021. [Cited 2023 July 15]. Available from: https://ratchakitcha.soc.go.th/ documents/17157975.pdf
Koshakri, R. Rerkluenrit J. Effectiveness of the Thai traditional health tourism activities empowerment program on the active aging of Thai older adults. J Public Hlth Dev. 2024; 22(2):286-296. [Cited 2024 Oct 15]. Available from: https://doi.org/ 10.55131/jphd/2024/220217
Yingyuen K, Methakanjanasuck N. Self-management innovations via a telehealth system for patients with type 2 diabetes and hyperlipidemia. Srinagarind Med J. 2016; 31(6): 365-71.
Trisirichoke P, Utharasat L, Kaenkan W. The effect of self-management support by a multidisciplinary team to delay chronic kidney disease in primary care units of Khon Kaen Hospital. Srinagarind Med J. 2019; 34(6): 552-8.