Development of Clinical Practice Guidelines to Delay Chronic Kidney Disease Progression among Type 2 Diabetes Patients
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Abstract
This participatory action research was conducted in three phases: 1) exploring the care situation from the perspectives of stakeholders, including health personnel, village health volunteers, patients, and family members, with data analyzed using content analysis; 2) developing a service guideline based on the Expanded Chronic Care Model and implementing it with 40 patients. Data were collected using a self-management behavior questionnaire with a reliability coefficient of .87 and clinical outcome records, and were analyzed using descriptive statistics, paired t-tests, and repeated-measures analysis of variance; and 3) reflecting on the implementation and synthesizing lessons learned with stakeholders. The findings showed that;
1. Patient care was constrained by limited dietary understanding, high-salt consumption, monitoring of kidney function, health communication, and the roles of families and village health volunteers. However, the community possessed cultural capital, including temples, women’s groups, and religious leaders.
2. The developed guideline comprised self-management support, multidisciplinary care, follow-up by families and village health volunteers, use of clinical data, and linkage with community resources.
2. After the intervention, participants demonstrated significant improvements in self-management behaviors, including dietary behaviors, medication adherence, and physical activity (t = 9.29, 6.05, 8.44; p < .001). Glycated hemoglobin (HbA1C) levels significantly decreased (t = 17.51, p < .001), while kidney function significantly improved (t = 10.90, p < .001). In addition, systolic blood pressure showed a significant reduction over time [F(2.06, 80.15) = 620.63, p < .001, partial η² = .94].
Primary care units should integrate this approach with a communication and monitoring system that actively engages family members and village health volunteers. In addition, future studies should evaluate the long-term effectiveness of the intervention with a follow-up period of at least 12 months.
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