Identification of Potential Leverage Points for Self-Management Support Intervention in Thais with Type 2 Diabetes
Wiroj Jiamjarasrangsi MD, PhD*1,*2, Rungrawee Navicharern RN, PhD*3, Suwapiccha Attavorrarat BPharm, MSc*4, Ananya Manit RN, PhD*5, Wichai Aekplakorn MD, PhD*6, Prasit Keesukphan MD*7
Affiliation : *1 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand *2 Department of Preventive and Social Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand *3 Adult Nursing Program, Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand *4 Technical and Planning Division, Food and Drug Administration, Ministry of Public Health, Nonthaburi, Thailand *5 Department of Medicine, King Narai Hospital, Lop Buri, Thailand *6 Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *7 Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Although social-ecological models and multi-level interventions have been recommended for implementing
the holistic self-management support for patients with type 2 diabetes, they are complex, costly, and need long-term effort.
A more realistic approach would be to identify and implement a single or limited leverage point(s) that is most effective and
feasible to create change.
Objective : To assess the independent relationships of the social-environmental supports with self-management behaviors
in Thai patients with type 2 diabetes.
Material and Method: A cross-sectional survey was conducted among 1,000 type 2 diabetic patients from 64 healthcare
facilities throughout Bangkok. A set of structured questionnaires were used to collect data related to social-environmental
supports, and self-management behaviors. The predictor-outcome relationships were presented by beta (β) coefficients (95%
confidence limits).
Results : Personal support was significantly associated with the overall self-management, dietary, physical activity, and
medication taking behaviors. Neighborhood support was significantly associated with the overall self-management, physical
activity, and medication taking behaviors. Personal support was found to interact negatively with neighborhood support
on the overall self-management and medication taking behaviors.
Conclusion : Personal and neighborhood supports are two potential leverage points for self-management support interventions
for Thai patients with type 2 diabetes. Patients with low and high personal supports may need different strategies for
neighborhood support.
Keywords : Leverage point, Self-management, Social-ecological model, Social support, Type 2 diabetes
