Application of The WHO's Innovative Care for Chronic Conditions Framework According to The Role of Professional Nursesin Primary Health Care Level


  • Nongnut Oba


Professional nurse role, Chronic diseases management, Innovative Care for Chronic Condition


Chronic diseases are a major problem of public health around the world, including Thailand. Prevention and controlling of chronic diseases are effective strategies in reducing risk factors. Professional nurses in primary health care level are important health personnel inmanaging to achieved goals. The WHO's Innovative Care for Chronic Conditions Framework (ICCC) is a model of care that the World Health Organization developed to suit the context of various countries and to achieve better health outcomes for patients of chronic diseases. This model consists of 3 levels of care management, including individuals and families, health service organization and community, and policy level. The implementation of WHO's Innovative Care for Chronic Conditions Framework for making better outcomes on chronic disease management by professional nurses are 1) promoting self-care for patients with family participation, 2) organizing the chronic disease service system in the hospital and community, and 3) being policy driven.


Download data is not yet available.


Australian Institute of Health and Welfare.(2017).

Impact of overweight and obesity as a risk factor

for chronic conditions:Australian burden of

disease study.Canberra: Australian Institute of

Health and Welfare.

Barr, V.J., Robinson, S., Marin-Link, B., Underhill, L.

&Dotts, A.(2003).TheExpanded Chronic Care

Model: An integration of concepts and strategies

from population health promotion and Chronic

Care Model. Healthcare Quarterly,7(1)73-82.


Department of Non-Communicable Disease.(2017).

Annual report 2017.Bangkok: AusornGraphic

Publishing House.[in Thai].

Goffman, E. (1963). Stigma: note on the managementof

spoiled identity. New Jersey: Prentice-Hall.

Jaspers, L., Colpani, V., Chaker, L. Van der Lee, S.J.,

Muka, T., Imo, D., ……Franco, O.H. (2015).

The global impact of non-communicable diseases

on householdsand impoverishment: A systematic

review.European Journal of Epidemiology,30,

-188. DOI 10.1007/s10654-014-9983-3.

Kongprasert. J. (Ed.) (2015).Guideline for NCD quality

clinic (diabetes and hypertension) in sub-district

health promotion hospital. Nonthaburi: Department

of Disease Control, Ministry of Public Health.

[in Thai].

Kunee, N. & Udomchairatana, R. (Ed.). (2014). Literature

review, current situation, and service

model for non-communicable disease. Bangkok:

Art Qualified Company Limited.[in Thai].

Likitlucha, N., Attachaiwat, A., Lappugdee, T.

(Ed.).(2016). Nursing standard in community.

PathumThani: SautawanPublishing Co., Ltd.

[in Thai].

Pan American Health Organization. (2013). Innovative

Care for Chronic Conditions: Organizing

anddeliveringhigh quality care for chronic

noncommunicablediseases in the Americas.

Washington: Pan American Health Organization.

Phanfran, S. (2017).Health care system for patients

with hypertension Chiang Klang District, Nan

Province. [PowerPointslide].Retrieved from http://

treatment-communitydistrict.pdf. [in Thai].

Promthet, S., Saranrittichai, K., Kamsa-ard, S., Senarak,

W., Vatanasapt, P., Wiangnon, S., ..Moore, M.A.

(2015). Situation Analysis of Risk Factors

Related to Non-communicable Diseases in

KhonKaen Province, Thailand. Asian Pacific

Journalof Cancer Prevention,12, 1337-1340.

Sareelae, N., Jooprempree, K. & Munluan, K. (2018).

The stigma of patients with alcohol use disorder

with discrimination and the human rights in the

community way of life. Srinagarind Medical

Journal, 33(6),589-94.[in Thai].

Srisuphan, V & Chan Thai, K. (Ed.).(2013). Manual of

professional nurse practices in sub-district health

promotion hospital. Judtong Publishing Co., Ltd.

[in Thai].

Srivanichakorn, S. (2017).NCDs and SDG : The way

forward Thailand. Present for side event

PMAC,Centara Convention,BKK,Thailand 30

January 2017 [in Thai].

Tritipsombut,J. (2018). A follow-up study of the effects

of health education program by using an

applicationof protection motivation and social

support theories on the blood pressure control

of the hypertension Risk Groups. Srinagarind

Medical Journal,33(6) 543-550.[in Thai].

Wagner, E.H., Austin, B.T., Davis, C.., Hindmarsh, M.,

Schaefer, J. &Bonomi, A.(2001). Improving

chronic illness care: Translating evidenceinto

action. Health affairs,20(6), 64-78.

World Health Organization.(2002).Innovative Care

for Chronic Conditions: Building blocks for

action.Geneva: World Health Organization.

Retrieved Dec, 2 2018 from


World Health Organization.(2018).Noncommunicable

diseases country profiles 2018.Geneva: World

Health Organization.Retrieved Dec, 2 2018 from





How to Cite

Oba, N. . (2019). Application of The WHO’s Innovative Care for Chronic Conditions Framework According to The Role of Professional Nursesin Primary Health Care Level. NU Journal of Nursing and Health Sciences, 13(2), 1–10. Retrieved from