Development of a Program to Enhance the Motivation for Self-management in Delaying the Diabetic Nephropathy Progression of Type 2 Diabetic Patients with Hypertension

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Nisakorn Vibulchai
Rungtiwa Sridech


            This research and development aimed to develop a program to motivate type 2 diabetic patients with hypertension to self-manage in delaying the progression of diabetic nephropathy. The study was conducted in Nong Ruea Subdistrict, Na Chueak District, Maha Sarakham Province. Four steps of the program were: 1) situational analysis; 2) program development, validation, and pilot study; 3) implementation to determine the program’s effectiveness; and 4) program evaluation, improvement, and confirmation. Using 26 purposively sampled type 2 diabetic patients with hypertension and using one group pretest-posttest design, the program was carried out from October 2017 to March 2019. The data were analyzed using descriptive statistics, t-test, and content analysis. The results revealed as follows:
            1. The program consisted of four parts conducted over 12 months: 1) participate to care by patients and families, 2) motivation for health behavior change, 3) enable patients to self-manage their diabetes and hypertension, 4) facilitate ongoing support for patients’ self-management. Group activities were carried out through community meeting, group discussion, and role modeling. Individual activities were performed by health education, motivational interviewing, self-management skill training, and promoting empowerment during home visits. Prior to program implementation, experts reviewed and validated the program’s content and found that the program was feasible for implementation.
            2. The results for program implementation revealed that 1) The overall scores and each aspect of self-management after implementing the program were higher than at the baseline (p < .05), 2) The average HbA1C was lower than the baseline (p < .05), 3) After program implementation, all subjects were in the same stage of chronic kidney disease, when compared with baseline, and 4) A representative sample of the patients, caregivers, healthcare providers, village health volunteers, and community leaders expressed that the program was valuable and feasible. The results indicated that the program was efficient and effective in motivating patients with type 2 diabetes mellitus and hypertension to delay diabetic nephropathy.


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