Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial.

Objective: To examine the effectiveness of a family-based program for post-stroke patients and their families. Methods: A cluster randomized controlled trial design was used. Participants were randomly selected in the experimental group (3 districts) and the comparison group (3 districts), with 62 families recruited. Sixty-two persons with new stroke and families (family caregivers and family members) who met the inclusion criteria were assigned to two groups, 31 in each group. Using the Neuman System Model as a framework, we implemented the stressors assessment and family-based intervention into the program. Participants in the comparison group received usual care, and those in the experimental group underwent a stressors assessment and received the family-based program. Measurement of functional status, depression, and complications in post-stroke patients and family function in family caregivers and family members, as well as caregiver burden and caregiver stress in family caregivers, were assessed at baseline, 4 weeks, and 12 weeks after enrollment. Data analysis included descriptive statistics, the chi-square test, Bonferroni test, and repeated measures analysis of variance. Results: After participating in a 12-week family-based program, post-stroke patients in the experimental group showed statistically significant improvements in their functional status and decreased depression compared to the comparison group (P < 0.05). The family function of the experimental group was significantly improved, and caregivers' burden and stress were decreased compared to the comparison group (P < 0.05). Three patients in the experimental group and seven in the comparison group experienced complications. Conclusions: The study findings suggest that the present family-based program improved family function in family caregivers and family members and decreased caregiver burden and stress in family caregivers. The program also improved functional status and reduced depression in post-stroke patients. It is suggested the duration of the program be extended to assess its sustainable effectiveness.

Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial.

BACKGROUND: The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control. AIM: To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels. METHODS: We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test. RESULTS: One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater. CONCLUSION: The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.

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

BACKGROUND: 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. AIM: The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA1c) levels among Thai patients with uncontrolled type 2 diabetes. METHODS: This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA1c 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 t-test, and paired t-test. RESULTS: The intervention group exhibited a lower mean HbA1c (p < .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 d > 1.0, effect size large). CONCLUSION: 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.

The effects of community participation program on smoke-free homes in a suburban community of Thailand.

INTRODUCTION: Smoking inside the home affects the health of both the smoker and family members via secondhand exposure. This research examined the impact of a community participation program on creating smoke-free homes in a suburban community in Thanyaburi district, Pathumthani province in Thailand. METHODS: The study involved families, with a smoker in the home, that were randomly assigned to intervention and control groups each containing 27 families. The intervention group was administered with the community participation program for smoke-free homes for 5 sessions during the 6-month period of study. The program included providing information on secondhand smoking and harms, knowledge about quitting smoking and healthcare support, practice skills, campaigns in the community, visiting and encouraging, and reflecting and evaluation. The control group was normally treated by the community committee and health volunteers. Data collection was undertaken at baseline and at 6 months after implementation by an interview with questionnaires. RESULTS: Our results show that after the implementation, the intervention group reported significantly higher mean score on skills in negotiating with smokers for a smoking-ban inside home and mean score on emotional support for non-smoking inside the home than those at baseline and those of the control group. The proportion having smoking ban home rules in the intervention group was significantly higher than at baseline and that of the control group (92.6% vs 18.5%). The proportion of smoke-free homes was higher in the intervention than in the control group (75% vs 0%). CONCLUSIONS: These findings suggest that community participation programs for smoke-free home may be effective in raising awareness on the impact of secondhand smoke among family members and in working together to manage smoke-free home environments. The program may be applicable for further development within communities to achieve smoke-free homes.

Factors Predicting the Provision of Smoking Cessation Services Among Occupational Health Nurses in Thailand.

The purpose of this study was to identify factors predicting occupational health nurses' provision of smoking cessation services. Data were collected via a self-administered questionnaire distributed to 254 occupational health nurses in Thailand. Analysis by structural equation modeling revealed that self-efficacy directly and positively influenced smoking cessation services, and mediated the relationship between workplace factors, nurse factors, and smoking cessation services. The final model had good fit to the data, accounting for 20.4% and 38.0% of the variance in self-efficacy and smoking cessation services, respectively. The findings show that self-efficacy is a mediator that influences provision of smoking cessation services by occupational health nurses. Interventions to enhance nurses' self-efficacy in providing smoking cessation services are expected to promote provision of smoking cessation services to workers.

Effects of a dietary modification on 2 h postprandial blood glucose in Thai population at risk of type 2 diabetes: An application of the Stages of Change Model.

The purpose of this study was to investigate the effect of a dietary modification intervention programme by applying the Stages of Change Model in 2 h postprandial capillary glucose reduction among Thai population. A randomized control trial was conducted for people at risk of type 2 diabetes for a period of 8 weeks. The intervention programme consisted of evaluating an individual's stage of change after being provided dietary information regarding kind of food and portions, discussion with a role model, and keeping a food diary record. By the end of the intervention programme, most participants in the experimental group were in the action stage (n = 36), whereas those in the control group were in the preparation stage (n = 32). Body mass index, blood pressure, food consumption behaviour and the 2 h postprandial blood glucose (PPG) in the experimental group had improved (P < 0.05). When performing regression analysis, intervention participation and the 2 h PPG at the baseline accounted for approximately 54% of total variance in predicting the 2 h PPG. This study yielded evidence for the benefits of using the Stages of Change Model as a framework in a dietary modification programme among people at risk of type 2 diabetes.

Helping teachers conduct sex education in secondary schools in Thailand: overcoming culturally sensitive barriers to sex education.

PURPOSE: The purpose of this quasi experimental study was to evaluate the effects of Culturally Sensitive Sex Education Skill Development, a teacher-led sex education program in secondary schools in Thailand. METHODS: Two public secondary schools in the suburban areas of Bangkok were randomly selected. One was designated as the experimental school and the other as the comparison school. Ninety grade seven and eight teachers, 45 from each school, were selected to participate in the study. Self efficacy theory and culturally appropriate basis were applied to develop the program which included 4 weeks of intervention and 2 weeks of follow up. Primary outcomes were attitudes toward sex education, perceived self efficacy, and sex education skills. Statistical analysis included independent and paired t test, and repeated one-way analysis of variance. RESULTS: At the end of the intervention and during the follow-up period, the intervention group had significantly higher mean scores of attitudes toward sex education, perceived self efficacy, and sex education skills than their scores before (p < .001), and than those of the comparison group (p < .001). CONCLUSION: The results showed that Culturally Sensitive Sex Education Skill Development could enhance attitudes and sex education self efficacy to promote the implementation of sex education among teachers.

The diamond level health promoting schools (DLHPS) program for reduced child obesity in Thailand: lessons learned from interviews and focus groups.

Overweight and obesity prevalence among children is increasing globally. Health promoting school policy has been initiated in Thailand to tackle this problem. The schools that best conduct obesity management programs are rated as diamond level health promoting schools (DLHPS). However, the methods used by these schools and their efficacies have not been well-documented. This qualitative study aims to analyze the processes and activities used by four DLHPSs in obesity management programs. In-depth interviews were used to obtain information from school directors, teachers, and cooks, whereas focus group discussions were used for students. School-based obesity management programs have resulted from health promoting school policy and the increasing prevalence of overweight students. Teamwork has been a key strategy in program implementation. Policy diffusion and division of labor have been effected by school directors. A monitoring process is put in place to ensure program delivery. The most evident success factor in the present study has been intersectoral cooperation. Challenges have included confusion about the criteria in obtaining the DLHPS status, parental involvement, and students' resistance to consume vegetables and other healthy foods. From the student focus groups discussions, three activities were most valued: class health and nutrition learning; provision of healthy foods and drinks, together with removal of soft drinks and seasoning from the cafeteria; and exercise for health. Intersectoral cooperation is the key success factor for the operationality of DLHPS, especially in making healthy foods available and physical activity the norm, at school and home.

Family caregiving for dependent older adults in Thai families.

PURPOSE: The aim of this study was to understand how Thai families care for dependent older adults. DESIGN AND METHODS: The methodology used for the study was grounded dimensional analysis. Participants were 30 adult family members from 15 families who were involved in caregiving. A total of 46 interviews were conducted. Data were collected and analyzed in three phases: (a) calling up dimensions, (b) assigning relative value to each of the dimension considers, and (c) inferring. FINDINGS: In Thai families, "natural caregiving" precedes care of dependent older persons (dependent caregiving). Dependent caregiving begins when dependency is first noticed and care needs are identified. Dependent caregiving is a dynamic process integrating three major processes: (a) mobilizing family members, (b) performing dependent care, and (c) maintaining continuity of care. The consequences of performing dependent care and unpredictable changes lead to care remobilizing. CONCLUSIONS: Dependent care for older adults varies across and is influenced by many conditions. Health personnel need to assess and monitor these varying conditions in order to support Thai families caring for dependent older adults. CLINICAL RELEVANCE: The conceptual model developed from the findings of this study provide a starting place for increasing our understanding of how to help Thai families care effectively and continuously for their older family members.

The Thai version of Effort-Reward Imbalance Questionnaire (Thai ERIQ): a study of psychometric properties in garment workers.

This study aimed to test the psychometric properties of the Thai version of the Effort-Reward Imbalance Questionnaire (T-ERIQ). The English version of the 23-item ERIQ was translated and back-translated. Content validity was examined by five experts and face validity was examined by twelve key informants before being tested for construct validity with 828 workers from six garment factories. Predictive validity was assessed through the relationship between the ERI constructs and psychological health outcomes including psychosomatic symptoms, state of anxiety, depression, and job satisfaction. The internal consistency of the Thai ERIQ was tested using the first survey (n=828), and test-retest stability was examined 2 to 4 wk later with a subsample (n=408). The results show that 2% of workers reported effort-reward imbalance (ERI ratio>/=1). The Thai ERIQ has good content validity with a Content Validity Index of 0.95. Cronbach's alpha coefficients for the effort, reward, and overcommitment scales were 0.77, 0.81, and 0.66, respectively. The 2-4 wk stability of these three constructs was moderate (r=0.496-0.576, p<0.001). Overall, the factorial validity was demonstrated as the best model fit, with high values of the goodness-of-fit indices, using confirmatory factor analysis, indicating accordance with the theoretical constructs of the ERI model. Logistic regression analyses supported significant associations of reward with all psychological health outcomes (p<0.05). The findings suggest that the Thai ERIQ has adequate reliability and validity to investigate the psychosocial work environment. The Thai ERIQ can be applied to the Thai working population, particularly industrial manufacturing workers.

Application of the occupational health services model in Thai primary care units.

This study explored the elements of the occupational health services model in Thai primary care units. Seven focus groups with nurses and public health professionals working in primary care units, employees, employers, and occupational health service-related authorities were conducted. Content analysis of the focus groups revealed 15 practical elements in five domains: system inputs, throughputs, services, outputs, and feedback. Examples of existing elements in the five domains were occupational health staff competencies (inputs), collaborative network building (throughputs), on-site occupational health services (services), number of activities performed as on-site occupational health services (outputs), and evaluation (feedback) of occupational health services delivery. The findings have implications for further development of the occupational health services model in Thai primary care units, such as training the staff of primary care units to become competent in delivering effective occupational health services.