Development of a Self-Management Model Based on Health Coaching to Delay Chronic Kidney Disease Progression in Patients with Stages 1–3 CKD in Primary Care Settings Uthai Thani Province

Abstract

This research and development study aimed to develop and evaluate the effectiveness of a self-management model based on the health coaching concept to delay disease progression among patients with chronic kidney disease (CKD) stages 1–3. A mixed-methods approach was employed and conducted in three phases. Phase 1 involved a situational analysis of problems, related factors, and needs among 140 patients with CKD stages 1–3, selected using purposive sampling based on inclusion criteria, including age ≥18 years and a confirmed diagnosis of CKD stages 1–3. Phase 2 focused on the development and synthesis of the self-management model by integrating Self-Management Theory with the health coaching concept. Phase 3 involved the implementation and evaluation of the model using a quasi-experimental pretest–posttest control group design. The sample consisted of 60 patients, divided into an intervention group (n = 30) and a comparison group (n = 30). Stratified random sampling combined with simple randomization was applied to minimize contamination. The intervention was conducted over a 12-week period. Research instruments included health behavior and self-management questionnaires with reliability coefficients (Cronbach’s alpha) ranging from 0.87 to 0.92, as well as clinical data obtained from medical records, including estimated glomerular filtration rate (eGFR), serum creatinine, glycated hemoglobin (HbA1c), and blood pressure. Data were analyzed using descriptive statistics, t-tests (independent and paired), and analysis of covariance (ANCOVA). The results revealed that, after the intervention, the intervention group demonstrated significantly higher self-management and health behavior scores compared to both baseline and the comparison group (p < .001), with an adjusted mean self-management score of 4.01. After controlling for baseline values, the intervention group showed significantly better outcomes than the comparison group. Clinical outcomes also improved significantly in the intervention group, with eGFR increasing from 61.2 ± 18.4 to 63.8 ± 18.1 ml/min/1.73m² (p = 0.003). ANCOVA results further indicated that the intervention group had significantly higher eGFR than the comparison group (F = 6.84, p = 0.011), while no significant changes were observed in the comparison group. In conclusion, the self-management model based on the health coaching concept was effective in enhancing self-management and health behaviors, as well as delaying disease progression among patients with CKD stages 1–3. The model demonstrates strong potential for implementation in primary healthcare and community-based health systems.