The Effects of a Self-Management Program on Knowledge, Self-Management Behaviors, and Kidney Filtration Rate in Diabetic Patients with Stage 3 to Stage 4 Chronic Kidney Disease

Abstract

This study utilized a quasi-experimental design, employing a one-group pretest-posttest approach. The objective was to evaluate the effects of a self-management program on delaying kidney deterioration among patients with chronic kidney disease (CKD) at the CKD Clinic, Tha Mai Hospital, Tha Mai District, Chanthaburi Province. The population comprised patients diagnosed with both diabetes and CKD stages 3 to 4, receiving continuous treatment and registered at the CKD Clinic, which is integrated with the Diabetes Clinic at Tha Mai Hospital. The sample included 60 participants, and the study was conducted between September and December 2024. The research tool was a self-management program for diabetic patients aimed at delaying kidney deterioration. This program consisted of six steps: Setting goals, collecting data, analyzing data to identify root causes of problems, setting self-management action targets, Implementing the action plan, and Reflecting on and monitoring progress. Data collection tools included a general information record, a knowledge assessment questionnaire for diabetic patients with CKD, a behavior assessment questionnaire for self-management to delay kidney deterioration, and a record of the glomerular filtration rate (GFR). Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to analyze general data. The Paired t-test was employed to compare knowledge, self-management behaviors, and GFR before and after participation in the self-management program. The majority of participants were female (68.30%), aged 70–79 years, followed by those aged 60–69 years (43.33% and 26.67%, respectively; M = 73.15, SD = 8.65). Most were married (60.00%) and had completed primary education (91.67%). The largest proportion was unemployed (51.67%), with a monthly income of 5,001–10,000 baht (56.67%; M = 10,755.00, SD = 7,386.10). After participating in the self-management program, the participants demonstrated significantly higher knowledge regarding delaying kidney deterioration and exhibited better self-management behaviors after the program compared to before the program (t = 16.79, p < .001, t = 25.84, p < .001). Although the participants' GFR improved after the program, the difference was not statistically significant (t = .73, p > .05).

The results of the research found that the self-management program for chronic kidney disease patients at Tha Mai Hospital, Chanthaburi Province, helped chronic kidney disease patients manage themselves appropriately for their disease. Therefore, it should be used in chronic kidney disease clinics in the future. The results of self-management should be evaluated periodically and continuously.