The Effects of a Complication Control Program on The Behaviors and Clinical Outcomes of Non- Proliferative Diabetic Retinopathy Patients


  • Ampa Jitkui Faculty of Nursing, Thammasat University Rangsit Campus
  • Jeeraporn Kummabutr Faculty of Nursing, Thammasat University Rangsit Campus
  • Natthapat Buaboon Faculty of Nursing, Thammasat University Rangsit Campus


complication control program, behavio, clinical outcomes, non-proliferative diabetic retinopathy patients (NPDR)


Introduction: Diabetic retinopathy is a change in microangiopathy caused by high blood sugar level. If it remains negligently untreated, there would be the chance of ischemic retina complication, vitreous hemorrhage, and retinal traction detachment (RTD) caused of visual loss and blindness.

Research objectives: To investigate the effects of a complication control program on the behaviors and clinical outcomes of non-proliferative diabetic retinopathy (NPDR) patients.

Research methodology: This quasi-experimental study used a two-group pretest and posttest design. Moreover, 26 participants were randomly assigned to an experimental group and 26 to a control group. For a period of 24-weeks, the experimental group received a complication control program guided by a health belief model. Instruments consisted of two parts, including the complication control behavior assessment, and the complication control program. Data were analyzed using descriptive statistics, paired t-test, and MANOVA.

Results: The results of the study showed that at follow-up, mean score of the behavior in the experimental group was significantly higher than at baseline (p<.05). Furthermore, at follow-up, the HbA1c level was significantly lower than at baseline (p<.05). And diabetic retinopathy severity did not increase at follow-up. Regarding between-group difference at follow-up, mean score of behavior in the experimental group was significantly higher than the control group (p<.05). The HbA1c levels of the experimental group were significantly lower than the control group (p<.05). However, the severity of diabetic retinopathy of both groups did not change.  

Conclusion: The findings suggest that a program focusing on perceptions and cues to action can help to appropriately modify behaviors and improve clinical outcomes among NPDR patients.  

Implications: Activities should be implemented to promote correct perceptions and cues to action by healthcare providers of NPDR patients. The study duration should be increased to follow up behavior sustainability and HbA1c levels to monitor long term severity of diabetic retinopathy.


Download data is not yet available.


World Health Organization [WHO]. Global report on diabetes. [Internet]. 2016. [cited 2018, February 9]. Available from:

Office of The Permanent Secretary Ministry of Public Health. Indicators report [internet]. 2019 [cited 2019 August 6]. Available from: (in Thai)

Waruttaporn C. Ocular complications from diabetes mellitus. Journal of Medicine and Health Sciences. 2016; 23(2): 36-45. (in Thai)

International Council of Ophthalmology [IDF] . Guidelines for diabetic eye care. 2014.

Division of non-communicable Diseases, Department of Disease Control. Guidelines diabetic retinopathy. Nonthaburi: Sahakornthai. 2015. (in Thai)

Diabetes Association of Thailand under The Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn. Guidelines for diabetes mellitus 2017. Bangkok: Aroonprinting. 2017. (in Thai)

Petcharat C, Benjamat C, Ladda S, Maneerat H, Umaphon Chatwirote. Perceived health and behavioral health of diabetes patients who received services in hospital health Bueng Bua. Wachirabarami District Pichit Province. The 4th National Conference Kamphaengphet Rajiabhat University 2017: 1082-87. (in Thai).

Arunya J, Chommanard W, Supaporn N. Comparison of diabetes patients health promotion behaviors between patients with no diabetes retinopathy and mild non-proliferative diabetic retinopathy. Journal of Nursing and Health Sciences 2016;10(3): 86-95. (in Thai)

Kingkarn S, Rungrawee N. Factor related to health promoting behaviors of type 2 diabetes patients with insulin and oral agent therapy. Journal of The Police Nurse 2014; 6(1):102-12. (in Thai)

Suwat K. Factors related to blood glucose level among patients with diabetes mellitus type II in responsible area of Tombon health promoting hospital Ban Yang Luang Nuea, Kut Chik subdistrict, Mueang District, Nongbua Lamphu Province. The1st National Conference Ubonrachathani Thailand 2016: 65-75. (in Thai)

Ratchanee P. Factors effecting to prevention of complication diabetic mellitus among diabetic mellitus type 2 at public health center 2, division of public health and environment, Nakhonsawan municipality. Journal of Health Science and Community Public Health 2018; 1(2):86-101. (in Thai)

Chutima S, Jariyawat K. Pornsiri P. A study of health belief model and the risk of type 2 diabetes in working muslim populations. Journal of Royal Thai Army Nurses 2018;19:267-77. (in Thai)

Pornpimol P, Krajaang T, Wanlapa S. Effect of self-monitoring health behavior program to non-insulin dependent diabetes mellitus of the risk group in Tan Neang Sub-District health promotion, Sawang Daen Din District, SakonNakhon. Journal of Sakon Nakhon Hospital 2015; 18(3): 52-62. (in Thai)

Duangduan H, Worraphol W, Warakorn K. The effects of an applied health belief model program on self-care behaviors of diabetic patients in meung-pai sub-district health promotion hospital zone. Phranakhon Rajabhat Research Journal 2016;11(1):36-51 (in Thai)

Kritsana D, Jariyawat K, Napaporn K. Effects of educative supportive nursing system on self-care behaviors fasting plasma glucose and level of diabetic retinopathy in type 2 diabetes mellitus patients. Thammasat Thai Journal of Ophthalmology 2016;34-53. (in Thai)

Tasranporn P, Songsamon Y, Sukunya W. Effects of a case management program on self-care behaviors and diabetic retinopathy clinical signs among elderly with diabetic retinopathy in quality elderly clinic. Journal of The Royal Thai Army Nurses 2018;19: 110-18. (in Thai)

Patcharaporn K, Kwanjai A, Pornthip R. Effect of a case management program for older people with diabetic retinopathy. Journal of Public Health Nursing 2017;31(2)1-10. (in Thai)

Rosenstock M, Strecher J, Becker H. Social learning theory and the health belief model. health education quarterly 1988; 15(2): 175-83.

Somjai J, Teppagone P, Nirachon C. Factor related to self-care behavior for prevention of diabetes mellitus and hypertension among population groups at risk. The Southern College Network Journal of Nursing and Public Health 2016;3(1):110-28. (in Thai)

Wisut N, Suthisa S, Suwattana K, Supsiri S, Budsaya D, Juntima N. Predictive factors of self-health care among patients with type 2 diabetes in sapphaya district, chainat province. Journal of Kanchanaburi Rajabhat University 2019;8(2):200-12. (in Thai)

Panomporn K, Sutham N, Chokchi M, Supachai P, Korravan Y. Health promotion program with family participation among uncontrolled type 2 diabetic elderly. Thai Journal of Health Education 2020;43(2):119-33. (in Thai)

Surakri H, Araya P, Sarodh P. On self-care behavior for preventing diabetes among the group at risk of diabetes in vibhawadi district suratthani province. Journal of graduate research. 2015;7(1):101-14. (in Thai)



How to Cite

Jitkui A, Kummabutr J, Buaboon N. The Effects of a Complication Control Program on The Behaviors and Clinical Outcomes of Non- Proliferative Diabetic Retinopathy Patients. JHNR [Internet]. 2022 Aug. 1 [cited 2023 Jan. 28];38(2):293-305. Available from:



Research articles