The effects of a self-management promotion program based on the 5A framework on health behaviors and clinical outcomes in patients with uncontrolled type 2 diabetes mellitus

Abstract

Purposes: To compare the mean scores of knowledge, health behaviors, and clinical outcomes among patients with uncontrolled type 2 diabetes mellitus in the catchment area of Bang Kahai Subdistrict Health Promoting Hospital, Chachoengsao Province.

Study design : Quasi-experimental research was conducted.

Materials and Methods: This quasi-experimental study employed a comparison between an experimental group and a control group. The participants were 60 patients with T2DM who met the inclusion criteria, divided equally into an experimental group (n = 30) and a control group (n = 30). The experimental group received a 12 week self-management enhancement program based on the 5A model (Assess, Advise, Agree, Assist, Arrange), consisting of five activities, while the control group received routine care. Research instruments included a diabetes knowledge questionnaire and a health behavior questionnaire, both validated for content validity by experts and having a reliability coefficient of 0.87. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (Independent t-test and Paired t-test) at a significance level of p < .05.

Main finding: After the intervention, participants in the experimental group showed a significant increase in mean knowledge scores from 14.83 (SD. = 1.97) to 17.13 (SD. = 1.47), with a mean difference of 2.30 (95% CI: 1.36–3.24, p < .05). Health behavior scores also increased from 44.50 (SD. = 5.89) to 61.81 (SD. = 9.63), with a mean difference of 17.31 (95% CI: 13.93–20.74, p < .05), indicating improved knowledge and health behavior after participating in the program. For clinical outcomes, fasting blood sugar (FBS) decreased from 165.57 mg/dL (SD. = 45.65) to 138.80 mg/dL (SD. = 21.65), a reduction of 26.77 mg/dL (95% CI: 8.69–44.85, p < .001). HbA1c decreased from 8.07% (SD. = 0.96) to 7.37% (SD. = 0.42), a reduction of 0.70% (95% CI: 0.48–0.92, p < .001). Body mass index (BMI) also decreased from 26.45 (SD. = 4.08) to 25.82 (SD. = 3.93), a mean reduction of 0.63 (95% CI: -0.83 to -0.42, p = .001). Comparing between groups, the experimental group had significantly higher mean knowledge scores (M = 17.13, SD. = 1.47) than the control group (M = 15.40, SD. = 2.12) (95% CI: 0.67–2.67, p = .002), and significantly higher health behavior scores (95%CI: 14.39–23.68, p < .001). In terms of clinical outcomes, the experimental group had lower mean FBS (95%CI: -40.08 to -16.98, p < .001) and HbA1c (95%CI: -1.48 to -0.77, p = .001) than the control group, while BMI differences were not statistically significant (p = .233).

Conclusion and Recommendations: The self-management promotion program based on the 5A model effectively improved health behaviors and clinical outcomes among patients with type 2 diabetes mellitus. Therefore, this program should be adapted and implemented in community settings to enhance diabetes self-management.