A Community Health Volunteer Involvement Program for Glycated Hemoglobin Reduction Among Thai Patients With Uncontrolled Type 2 Diabetes: A Mixed-Method Study.

Abstract

Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors. The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA_1c) levels among Thai patients with uncontrolled type 2 diabetes. This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA_1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King's General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent <i>t</i>-test, and paired <i>t</i>-test. The intervention group exhibited a lower mean HbA_1c (<i>p</i> < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen's <i>d</i> > 1.0, effect size large). Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.