Abstract
Introduction: Self-management plays a significant role in improving diabetes-related conditions and minimises the risk of developing diabetes-related complications for people diagnosed with type 2 diabetes. A structured health education programme is recommended to encourage the enhancement of self-management for these patients. However, there is no clearly structured diabetes education programme available for Thais with type 2 diabetes. This current study aimed to explore the development and evaluate the feasibility of a newly structured diabetes education programme for Thai adults diagnosed with type 2 diabete under the Medical Research Council (MRC) framework.Method: There were two main phases in compliance with the MRC framework throughout this current study. In the first stage, two scoping reviews were undertaken to identify key components of potentially structured diabetes education programmes and to chart a course for further development. The second stage focussed on feasibility RCT study designed to examine the feasibility and acceptability of a newly developed intervention programme. Thai adults with type 2 diabetes, who were registered in two purposive primary care settings in Thailand, were randomly allocated to the intervention and control groups equally. The intervention group received a weekly session for four weeks and then followed by a monthly session for three months. Meanwhile, the control group received the usual care provided by the healthcare professionals. The feasibility outcomes were measured by using response rate, adherence rate, and retention rate. Both biomedical and self-care management behaviours were measured at baseline, the end of the session, and three months after the end of the session as a follow-up period to determine the initial direction and magnitude of the intervention programme's effectiveness. In term of measuring the acceptability outcome, participants allocated to the intervention group were invited to attend a focus group interview at the follow-up period.
Results: The two scoping reviews revealed various key components potential to develop a newly structured diabetes education programmes for Thais with type 2 diabetes. A prospective format of programme was a group-based intervention as theorised with reference to the philosophy of empowerment. The key aim of delivering was to encourage and enable participants to identify diabetes-related behaviour problems, essential for goal- iii setting and suitable action planning for self-management. The contents of programme were relevant to diabetes care such as dietary intake, physical activity, self-monitoring blood glucose and self-assessment about diabetes-related complications. At least 1-2 hours per session led by competent facilitators who were either health professionals or trained educators were required. The findings of the feasibility study show that a response rate was 50 % and the retention rate was 97% at the end of the intervention and the follow-up period. The practicality of the PEST-DM programme tended to support participants in the intervention group could more improve self-care behaviours and reduce glycemic level compared to the control group. The qualitative findings suggest the type 2diabetes participants’ interest and willingness to follow the PEST-DM programme. The atmosphere of group discussion, goal setting and performance of the educators were well received by the participants. However, several limitations of the present study should be considered for the additional refinement of the PEST-DM programme in the future. These include the programme training, identification of suitable facilitators and the process of quality assessment for delivering the programme.
Conclusion: The practicality of the PEST-DM programme is feasible and acceptable to enhance self-management for people with type 2diabetes in the context of clinical practice in Thailand. Participation in such a programme was found to benefit the improvements in self-care behaviours and reduction in HbA1c levels. Despite the limited generalisability in the feasibility study, the findings and general lessons learned from this research are empirical prospects and specific ways in which management of type 2diabetes patients in Thailand can be improved.
| Date of Award | 2020 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Roseanne Cetnarskyj (Supervisor) & Sivaramkumar Shanmugam (Supervisor) |