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Arissara Sukwatjanee Supported in part by the Thesis Grant from

Enhancing Self-care Ability and Quality of Life among Rural-dwelling Thai Elders with Type 2 Diabetes through a Self-help Group: A Participatory Action Research Approach. Arissara Sukwatjanee Supported in part by the Thesis Grant from Faculty of Graduate Studies, Mahidol University and

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Arissara Sukwatjanee Supported in part by the Thesis Grant from

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  1. Enhancing Self-care Ability and Quality of Life among Rural-dwelling Thai Elders with Type 2 Diabetes through a Self-help Group: A Participatory Action Research Approach Arissara Sukwatjanee Supported in part by the Thesis Grant from Faculty of Graduate Studies, Mahidol University and Thailand Nursing and Midwifery Council

  2. Arissara Sukwatjanee RN, BNS, MNS (Adult), PhD (Nursing) Faculty of Nursing Srinakharinwirot University Thailand

  3. Background and Significance 1. Rapid increasing of type 2 diabetes among elders in communities 2. Self-care barriers of elders with type 2 diabetes in communities: Low education Poverty Lack of family support Limited access to health care services 3. Impact of complications of type 2 diabetes on health and quality of life of elders in communities

  4. Conceptual Framework Critical Social Theory (Jurgen Habermas, 1970): ♥Emancipate people from disadvantaged conditions for better life or positive changes ☻Disadvantaged conditions: Poor health Poor quality of life ♥ Empower people through helping them identify their own strengths and use their own knowledge ♥ Assumption: “Humans have knowledge and capacity to change their life circumstances”

  5. Participatory Action Research ♥ Espouses the value of emancipation as it helps people identify their life constraints that limit their needs and freedom ♥ Enhances collaborative working between the researcher and participants to identify social or health problems through combined knowledge and action for positive changes

  6. The 2nd Plan for Older Persons (2002-2021) Focus on: 1. Promoting health and quality of life among older people 2. Strengthening elders and communities to fully engage in self- care 3. Increasing social participation among elders 4. Developing living environments to support older persons in community

  7. Self-help Group A voluntary group of people in similar situations, formed for affording mutual assistances and experiences to overcome a common problem, and bring about desired social and/or personal changes. Empirical studies reported benefits of self-help groups among elders with type 2 diabetes: Increase self-care ability Improve quality of life Increasestrengthening in community

  8. Purposes of the Study 1. To investigate the impact of self-help group participation on self-care ability among rural-dwelling Thai elders with type 2 diabetes. 2. To investigate the impact of self-help group participation on quality of life among rural-dwelling Thai elders with type 2 diabetes. 3. To explore perceptions of rural-dwelling Thai elders with type 2 diabetes about their experiences of participating in a self- help group in relation to their self-care ability and quality of life.

  9. Participants and Recruitment Method 20 elders with type 2 diabetes at a diabetic clinic of a primary care unit. Inclusion criteria: ♦ Male and female ♦ Live at a rural village in Bang Pa Han District, Ayutthaya Province, Thailand ♦ Be able to hear and speak ♦ Agree to participate in self-help group meetings at least 10 out of 12 sessions Exclusion criteria: ♦ Have severe complications

  10. Research Setting A rural village in Bang Pa Han District, Ayutthaya Province ☻ 89 km. from Bangkok ☻ Most occupation of working adults is an industrial employee. ☻ 5 km. from the community hospital, 20 km. from the provincial hospital ☻ Only one primary care unit provides health service and diabetic clinic ☻ No public transportation within the village

  11. Research Instruments 1. Group discussion guides 2. Observation guide 3. Personal Information Sheet 4. The WHO Quality of Life-BREF-Thai (WHOQOL- BREF-THAI) 5. The Diabetes Self-efficacy Scale-Thai (DSES-THAI)

  12. Data Collection Procedure 6-month period of data collection, July – December, 2008 The researcher and participants collaboratively worked in a 5-step of participatory action research process for building a self-help group 1. Planning (2 months before group establishment): ☻ Built a relationship with participants and stakeholders ☻ Discussed about disadvantaged conditions ☻ Trained a registered nurse of the diabetic clinic to be a research assistant ☻ Provided the personal information sheet, WHOQOL- THAI and DSES-THAI to participants

  13. Data Collection Procedure (cont.) 2. Acting for conduct the self-help group: ☻ Selected group leader and defined date, time, place, and length of meetings ☻ Shared knowledge and experiences: dietary control diabetic medication adherence foot care exercise ☻ Shared experiences and problem-solving strategy related to diabetes management among group members ☻ Gathered information was recorded in a memo, field notes and audiotape-recording.

  14. Data Collection Procedure (cont.) 3. Observing the self-help group process and its consequence: ☻ The researcher acted as a participant and observed occurred events ☻ The observation guide was used to collect themes of disadvantaged conditions and participants’ behaviors changes ☻ Gathered information was recorded in a memo and field notes

  15. Data Collection Procedure (cont.) 4. Reflecting of the self-help group: ☻ At the end of every meeting ♠ The researcher and participants discussed about the self-help group activities and ways of improvement for the next meeting ☻ At the 2nd , 4th and 6th month of meetings ♠ The researcher and participants discussed about important things they learnt and changed in how they managed their diabetes ☻ After 6 months of establishing the self-help group ♠ The WHOQOL- THAI and DSES-THAI were provided to participants again ♠ The way of group sustaining was discussed

  16. Data Collection Procedure (cont.) 5. Revising the plan: ☻ The researcher and participants discussed about whether the self-help group process should be revised. ☻ Occurred problems found in the self-help group process were revised according to the agreement of participants. ☻ The revised plan was used to take action again until satisfaction.

  17. Results Effect of participation in the self-help group: ☻ There was significantly increased diabetes self-efficacy scores after participating in the self-help group among participants ☻ There was significantly increased quality of life scores after participating in the self-help group.

  18. Results (cont.) Perceptions about positive changes in self-care ability and quality of life: 1. Gained culturally-sensitive knowledge ☻ Understanding ☻ Belief ☻ Acceptance 2. Receiving social support ☻ Self-confidence ☻ Willpower

  19. Results (cont.) 3. Perceived a sense of empowerment ☻ Self-control ☻ Power 4. Perceived self-efficacy ☻Motivation ☻ Conformity

  20. Conclusion Establishing a self-help group in a community by using critical social theory through participatory action research approach are very useful and effective in enhancing better health and quality of life among elders with type 2 diabetes and further bring about a community Strengthening.

  21. Thank You

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