Policy Recommendation: Promoting Health Literacy for Delayed Progressive Chronic Kidney Disease of Diabetes Mellitus and Hypertensive Patients in the 4th Public Health Region

Abstract

          This research and development aimed to develop a policy on promoting health literacy to delay progressive chronic kidney disease (CKD) of diabetes mellitus and hypertensive patients under the 4^th public health region. Mixed methods were used to conduct this study. The study was divided into three phases including 1) situation analysis 2) development and testing of the model and 3) policy development. The sample was recruited by purposive sampling of 824 diabetes and/or hypertensive patients with CKD stage 3 and 143 healthcare personnel. The quantitative instruments encompassed 1) health literacy to delay progressive CKD in diabetes and/or hypertensive patient questionnaire, 2) health literate organization promotion to delay progressive CKD questionnaire, and 3) assessment form of self-management to delay progressive CKD in diabetes and/or hypertensive patients. All instruments were developed by researchers and tested for content validity by five experts and CVI were 0.97, 1, and 0.97, respectively. Cronbach's alpha reliability were 0.94, 0.96, and 0.96, respectively. The qualitative instruments included the semi-structured open-ended questions about health literate organizations delay progressive CKD and the semi-structured open-ended questions for stakeholders who develop policy recommendations. The experimental instruments were 1) the model for promoting health literacy to delayed progressive CKD, and 2) the prototype model of the health service system for delayed progressive CKD in the 4^th public health region. The research was conducted between January 2020 - December 2021. Quantitative data were analyzed using descriptive statistics and paired t-tests. Qualitative data were analyzed through content analysis.
            The results of the study revealed as follows:
            1. The average total score of the health literacy to delay progressive CKD of diabetes mellitus and/or hypertensive patients under the 4^th public health region was at a high level (Mean = 3.59, SD = 0.81).
           2. The average score of the health literate organizations to delay progressive CKD under the 4^th public health region was at a moderate level (Mean = 2.77, SD = 1.02).
            3. Based on the health literacy and self-management concept, the model for promoting health literacy to delay progressive CKD among diabetes and/or hypertension under the 4^th public health region had a statistically significant average score for health literacy, self-management behavior, clinical outcome, and kidney function better than the score before participating in the program (p < .01). In addition, 88.46% of the patients highlighted that the model demonstrated delayed progressive CKD.
            4. The prototype model of the health service system to promote health literacy to delay progressive CKD based on the health literate organization was divided into 2 levels; 1) the primary healthcare settings included ten characteristics and 2) the secondary/tertiary healthcare settings included eleven characteristics.
            5. The policy recommendations on promoting health literacy for delayed progressive CKD under the 4^th public health region were 1) health literacy and health literate organization should be carried out along the way 2) enhancing health literacy for delayed progressive CKD requires systematic proactive planning with a clear and continuous pattern and cooperation from all relevant sectors 3) raising awareness for the people to recognize that health belongs to the people. They are responsible for their health with support from healthcare personnel 4) providing adequate healthcare personnel to effectively care for patients and support the concrete implementation of promoting health literacy, and 5) designing a health service systems that provide the value of slowing down kidney degeneration.