Development Model for Driving Quality of Life District Level of Patient Care among Non-communicable Diseases in Phetchaburi Province

Abstract

This research and development study aimed to: 1) study the current situation of the quality of life care system for patients with non-communicable diseases (NCDs) at the district level in Phetchaburi Province; 2) develop a district-level quality of life driving model for NCD patient care in Phetchaburi Province; 3) implement the developed model; and 4) evaluate the effectiveness of the model. The sample consisted of three groups: 1) sixty-nine key informants, 2) two hundred and fifty-six members of the District Quality of Life Development Board (DHB) network, and 3) two hundred and seventy-two NCD patients. The study areas included Mueang Phetchaburi, Cha-am, Tha Yang, and Ban Lat districts, while the control areas included Khao Yoi, Nong Ya Plong, Ban Laem, and Kaeng Krachan districts. The study was conducted between July and December 2025. The research instruments included a self-health-management program for at-risk groups, a focus group discussion recording form, questionnaires on NCD patient care practices and DHB network participation, and a quality-of-life assessment form. Quantitative data were analyzed using descriptive statistics and paired t-tests, while qualitative data were analyzed using content analysis.

The results revealed that a situational analysis of the quality of life of NCD patients, based on focus group discussions with 69 target individuals, identified obstacles in three main areas. First, regarding the patient care management system, the District Quality of Life Development Committee lacked clear direction and inter-agency integration. Second, regarding the operational support system, there were insufficient resources, personnel, budget, and community participation. Third, regarding the monitoring and evaluation system, there was a lack of standardized data collection and reporting. This information was utilized as the foundation for developing the “4QM Phetchaburi Model”, consists of three main components: 1) five community-based capacity-building activities for personnel responsible for NCDs; 2) seven measures for driving DHB operations (encompassing leadership development, strategic management, citizen focus, professional management development, human resource development, network participation building, and the development of an integrated health management system) and 3) a five-issue self-health management program for patients. The model's content validity was verified by three experts.

The implementation results demonstrated that, after the intervention, the personnel had a significantly higher overall level of NCD patient care practice than before the intervention (p <0.001). The DHB network showed a statistically significant increase in overall patient care participation across all aspects (pre, =107.24, post, =110.28,  =3.04, 95% CI = 1.93–4.15, p <0.001). Furthermore, the proportion of NCD patients in the experimental group with a "fair" quality of life increased from 67.6% to 81.6%, a significant increase compared with the control group. Additionally, the incidence rates of new diabetes and hypertension cases decreased from 22.97% and 8.25% to 20.69% and 7.89%, respectively.