Chanuantong Tanasugarn, DrPH Pissmai Jaruchovalit, MSc. Faculty of Public Health

1. Life Goal, Life Style and Social Network Analysis as a tool to empower chronic disease patients Chanuantong Tanasugarn, DrPH Pissmai Jaruchovalit, MSc. Faculty of Public Health Mahidol University Thailand

2. Number of patients with chronic disease have increased every year. At Buddachinaraj Hospital, there were 2002 10,640 cases 2003 21,937 cases 2004 25,139 cases

3. The hospital provided services • to have equal access to care. • to increase ability to learn about their disease conditions, • To promote self care responsibility and change behavior • such as diet, exercise • to promote the continuity of care through referring system • to provide service at patient’s home and community.

4. patients and hospital staff were helpless in managing their disease conditions. Some of them who are facing threatening diagnosis and treatment decided to drop out from treatment. They felt hopeless

5. Based on the concept of health promoting hospital and accreditation guideline used in Thailand, The patient care team put the emphasis on the patient lifestyle, and social network as way to connect the hospital with the patient’s family and community.

6. Ladder of participation for empowerment. (adapted from Sherry Arnstein’s ladder of participation) • comply to the regimen; • cognitive participation towards the regimen; • Joining in making decision what he or she needs to do; • assessing outcome and impact of the decision made by the team and the patients; • (5) Sharing the benefit of care which was jointly decided. EMPOWERMENT No participation

7. Research questions: How does lifestyle, life goal and social network analysis help in empowering patient process? What are the indicators of effective chronic patient empowerment ?

8. Research objectives: • To investigate how empowerment tools • affect changes in chronic disease patient? • To examine changes made by the study • empowerment process and tools for chronic • disease patients;

9. Research conceptual framework: Independent Variables Dependent variables • Empowering intervention includes • Lifestyle analysis • Life Goal Analysis • Social network analysis Acceptance of disease condition Goal setting in controlling one’s life New lifestyle performed Less anxiety, more confidence Feeling content and wanted to help others Managing and learning about one’s lifestyle Less anxiety or feeling more in control of one’s life Willing to help others. Better disease and health conditions Extraneous Variable Age Sex Occupation Disease condition and period of having the disease

10. Research Design: • Quasi experimental and comparison group design, • Triangulative research methods include : • Focus group discussion, • questionnaire administration and • indepth interview.

11. Research Tool: Life style analysis form • The form includes • Information on daily activities (regular days) • Information on activities a patient does when he/she faces different conditions such as being alone, with family, with closed friends, with someone he/she just has met. • Information on things that he/she does and always gets compliment from the family and friends. • Research Tool: Life goal analysis form • The form includes information on • ‘goals’ which he/she wish to achieve and his/her action plan • to achieve the goal. • his/her opinion towards effect of the action plan on his/her • health or disease condition. • his/her opinion on the order of importance among exercise, diet, stress • management, and let go (healthy coping) (rank from the most the least important)

12. Research Tool: Social network analysis form • The form includes information on • ‘ a person’ whom he/she loves to do things with; to • seek help or support when he or she facing problems ie • financial problem, work problem, family problem, etc. • family and social activities which he/she loves to attend • and how does each activitiesaffect him/her; • Who are the source of stress or non-stress which created symptoms • such as headache, frightened, hopeless, happiness.

13. Population Chronic disease patient attending diabetic and cancer clinic during August 2004 – January 2005 Sampling methods Probability sampling method was applied to all patients attending diabetic clinic or receiving cancer treatment during August 2004 – January 2005 Samples were patients from 105 diabetic patients from diabetic clinic and 14 and 15 cancer patients from cancer ward were randomly assigned to the experimental and comparison groups.

14. Data analysis Descriptive statistics and t-test analysis were applied to the data collected through the questionnaire. Content analysis was applied to the qualitative data.

15. Table 1: Demographic Characteristics: Sex

16. Table 2 : Demographic Characteristics: Age

17. Table 3:Demographic: Period of being diagnosis

18. Table 4:Demographic: Occupation

19. Table 5: Acceptance of disease condition

20. Table 6: Setting Life Goal Setting life goal refers to identifying reason or motivation to go on and managing his or her life and disease

21. Table 7: Changing Life style

22. Table 7: Changing Life style (Cont’d)

23. Table 7: Changing Life style (Cont’d)

24. Table 7: Changing Life style (Cont’d)

25. Table 8: Level of empowerment changed after participating in the life goal, lifestyle and social network analysis process

26. Table 8: Level of empowerment changed after participating in the life goal, lifestyle and social network analysis process Test of significance between experiment and comparison groups of the DM group T-test value = 0.083 at 0.04 p value.

27. Discussion After discussing with patients through focus group discussion, data revealed that the Life goal analysis had helped in reminding patients of what was important to them and how the disease could obstruct or facilitate their goal. What they do in their life, life style, can also affect their goal, therefore they can take control over their lives through what they do in their daily living. Thesocial network analysis information also helps the patients see feasible support which they have and can utilize. It gives them power to control over their social and physical environment with concrete ideas discussed and supported by the health staff. This area of discussion has never been part of the professional practice.

28. Discussion The forms used in this study have become a tool for soliciting information and for sharing information between a patient and a patient care team. Positive information such as patient’s life goal has put the discussion on the patient’s perspective view of life. This helps increase participation level. Moreover when talking about their life goal, the patient care team has given the power back to the patient, it makes the patient feel in control. They become confident after realizing that the patient care team listens to them and allows them to make adjustments and set goals about their disease condition and life.

29. Discussion Patient care team : Point of View The patient care team has expressed through focus group discussions with the team that these forms helps them be systematic and focused in their discussion. It also helps the professionals in getting the patients to participate and it makes these professionals feel relived since they do not have to make decisions alone. They also feel that the patients do comply with their decisions which makes both parties happy.

30. Acknowledgement This study was possible due to supports given by Diabetic and Cancer patients of Buddhachinaraj Hospital Diabetic Patient care team and Cancer Patient care team Health Education Staff of Buddhachinaraj Hospital And Financial support from Planning and Development Division Buddhachinaraj Hospital.