The Effectiveness of Self - and Family Management of Patients with Type II Diabetes and Hypertension in Community Health Center

  • nattaya wisarapun faculty of nursing Ubonratchathani Rajabhat university
  • Jit Mongkolmafai (Senior speciallist). Community Health Center, Kut Chum, Yasothon Province.
  • Nipporn Santo (Senior speciallist). Community Health Center, Kut Chum, Yasothon Province
  • Waratip Kankarn Faculty of Nursing Ubon Ratchathani Rajabhat University
Keywords: self- and family management, type II diabetes and hypertension


Diabetes and hypertension are considered the top risk factors for death in the world. Therefore, prevention
of complications, especially behavior modification is important. The Individual and Family Self-management
Theory (IFSMT) promotes continuous behavior and corrects the wrong behaviors helping patients to control
themselves to be able to live with the illnesses happily. This research was randomized controlled trial with the purpose to study the effectiveness of self-and family management of patients with diabetes and hypertension in Community Health Center, Yasothon Province. The samples consisted of patients with diabetes and hypertension. They were randomly divided into experimental group and control group: 56 people per each group. The experimental group received knowledge about nutrition and were determined with the food that should be eaten on a daily basis, rational drug use, especially the use of herbal medicines and exercised at least 4 times a week. Home visits based on self-tailoring individual need were also provided. The caregivers and families were empowered. The control group received standard care from Community Health Center. Data were collected from October 2018 to September 2019. Clinical outcomes, including blood pressure levels. Cumulative mean sugar, BMI and waist circumference self-management behaviors and quality of life assessment were assessed. Data were analyzed using descriptive statistics and independent t-test. The experimental group and control group had no significant differences in personal characteristics (p <.05). Most of the samples were female. Graduated from elementary school Agriculture career is poor and other non-communicable diseases. At the end of the study, the mean score of self-management behaviors and the quality of life the experimental group were higher than those of the control group with statistical significance (p <.05). The mean levels of blood pressure were 128.41 / 78.52 and 134.93 / 83.70 millimeters of mercury. The mean levels of Hemoglobin A1c were 7.36 and 8. The mean body mass index of the experimental group was lower than that of the control group with statistical significance (p <.05). However, the waist circumferences of the experimental group and the control group were not different. Self-and family management of patients with diabetes and hypertension led to better self-management behaviors, clinical outcomes and quality of life.


Download data is not yet available.


1. ด้านระบบบริการ เนื่องจากในศูนย์สุขภาพชุมชน ขาดนักโภชนาการ และนักกายภาพบำบัด ควรมีเครือข่ายในการดูแลผู้ป่วยโรคเรื้อรังร่วมกับโรงพยาบาลชุมชน
2. การวิจัยครั้งนี้ ผู้วิจัยทำการทดลองโดยใช้ระยะเวลา 12 เดือน และประเมินผลหลังการทดลองเสร็จสิ้นทันที ในการวิจัยครั้งต่อไป ควรเพิ่มระยะติดตามผล เพื่อประเมินความคงอยู่ของพฤติกรรมการจัดการตนเอง ผลลัพธ์ทางคลินิก และคุณภาพชีวิต
งานวิจัยครั้งนี้สำเร็จลุล่วงได้ ด้วยความอนุเคราะห์จากทุกฝ่ายที่เกี่ยวข้อง ผู้วิจัยขอขอบพระคุณโครงการป้องกันและชะลอโรคไตเรื้อรังในภาคตะวันออกเฉียงเหนือ(CKDNET) คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น ที่สนับสนุนสื่อการสอน ทีมสหสาขาวิชาชีพ และกลุ่มตัวอย่างที่ช่วยให้งานวิจัยสำเร็จลุล่วงตามวัตถุประสงค์
1. World Health Organization. Global Health Observatory (GHO) data. [internet]. WHO; [cited 2019 August 9.].
2. Gong B, Yu W, Wang H, YI R. Epidemiology of chronic noncommunicable diseases and evaluation of
life quality in elderly. Aging Medicine 2018; 1:64-6.
3. 5-Year National NCDs Prevention and Control Strategic and Action Plan (2017- 2021). Bureau of noncommunicable diseases, Department of Disease Control. Ministry of Public Health; 2017.
4. Srivanichakorn S. Morbidity and mortality situation of non-communicable diseases (diabetes type 2 and
cardiovascular diseases) in Thailand during 2010-2014. Disease Control Journal 2017;43(3):379-90
5. de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation 2014; 130:1110–30.
6. Singh SK, Srivastava S. Behavioral risk factors and non-communicable diseases among adult men in demographically developed states of India: evidence from District Level Household and Facility Survey-4. Journal of Public Health 2018;26(2):195-204.
7. Nethan S, Sinha D, Mehrotra R. Non-communicable disease risk factors and their trends in India. Asian Pac J Cancer Prev. 2017; 18(7): 2005–10.
8. 5-Year National NCDs prevention and control plan (2017-2021). The Policy and Strategy Section, Bureau of Non- Communicable Disease, Ministry of Public Health; 2017.
9. Srivanichakorn S. Data review for establishing service strategy in primary care units under the structure of the Ministry of Public Health. Health Systems Research Institute (HSRI); 2008.
10. Kut Chum Community Health Center, Kut Chum Hospital, Yasothon province; 2018.
11. Schottenfeld L, Petersen D, Peikes D, Ricciardi R, Burak H, McNellis R, Creating patient-centered team-based primary care. AHRQ Pub. No. 16-0002-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2016.
12. Kankarn W, Thachai S. The effects of integrated care by multidisciplinary team with individual and family self- management to prevent chronic kidney disease in patients with diabetes and hypertension Research and Development Health System Journal 2019;12(2):594-603.
13. Komoltr C. Sample size calculation. Journal of Mental Health of Thailand 2012; 20(3): 192-8.
14. Mahatnirunkul S, Tuntipivatanakul W, Pumpisanchai W. Comparison of the WHOQOL-100 and the WHOQOL- BREF (26 items). J Ment Health Thai 1998; 5: 4-15.
15. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Licence:
16. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. Global prevalence of
chronic kidney disease - a systematic review and
17. Seesawang J, Thongtaen P, Yodthong D. Effectiveness of self-management supportive program among hypertensive older people. Rama Nurs J 2014;20(2)179-92.
18. Kankarn W, Tongkrajai P, Kumphon B, Anutrakulchai S. The impact of self-management and case management on progression of chronic kidney disease in urban communities of Khon Kaen. J Med Assoc Thai 2019;102( 8):30.
19. Bumrungpun. The effect of self-management promotion program on the quality of life among Type II diabetes mellitus patients with acute complications in Prapokklao Hospital. Journal of Nursing Division 2011;38(1): 42-51.