Community Participatory Care System for Bedridden and End-of-life Patients in Community

Abstract

This participatory action research aimed to establish and assess the effectiveness of a community participatory care system for bedridden and end-of-life patients. The study, conducted in the community under the purview of Nong Phalan Sub-district Health Promoting Hospital’s responsibility, Mueang Nakhon Ratchasima District, Nakhon Ratchasima Province, Thailand, engaged 55 key informants, including health providers, community leaders, municipality officers, patient’s caregivers and relatives, village health volunteers, and Buddhist monks, along with 216 community members. The research instruments consisted of 1) three discussion interview guides; 2) an evaluation form of medical device management; 3) an evaluation form of patients care; 4) a focus-group interview guide; 5) a questionnaire assessing knowledge with a reliability of .73; 6) a questionnaire assessing competency perception with a reliability of .95; 7) an evaluation form of the benefits perception with a reliability of .96; and 8) an evaluation form of satisfaction with a reliability of .91. The research unfolded across four phases from March to September 2023: analysis of the current situation, development of the care system, implementation, and system evaluation. The statistical analysis used in this study encompassed mean, standard deviation, and Wilcoxon signed-rank test. Additionally, a content analysis was conducted to scrutinize and interpret the qualitative data.

The research results revealed that the existing care system for bedridden and end-of-life patients in community had inadequate management. The development of a community participatory care system centered around six critical aspects, consisting of 1) the establishment of a collaborative network; 2) securing financial support from governmental and private sectors; 3) preparing essential medical supplies; 4) creating a dedicated office for bedridden and palliative care; 5) enhancing caregiver competencies; and 6) implementing home visits by health providers, village health volunteers, and community leaders. Following a three-month implementation of the developed care system involving six bedridden patients and two end-of-life patients, noteworthy improvements in health conditions were observed for two bedridden patients, while the conditions of the remaining patients remained stable. Furthermore, two end-of-life patients experienced peaceful passings at home. Participants’ perceptions of the system’s benefits and satisfaction were very high (M = 46.32, SD = 3.87 and M = 32.14, SD = 2.46, respectively). Moreover, community members expressed a high perception of the system’s benefits (M = 43.22, SD = 5.88) and a strong perceived need for its continuation (M = 4.50, SD = .46).

This research strongly recommends the adoption and adaptation of the developed community participatory care system in other communities and primary care units, emphasizing the importance of tailoring the care system to specific community contexts.