13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Lifestyle, life goal and Social network analysis: Tool for
Empowering Chronic Disease Patients.
Dr Chanuantong Tanasugarn1, Pissamai Charuchaovalit2
Background
Number of patients with chronic disease have increased every year due to
differences of physiological status and health status of the people. Chronic
disease referred to diseases which cannot be cured but can be controlled
depending upon each individual self care behavior, these diseases include
diabetes mellitus, hypertension, or heart disease. At Buddachinaraj Hospital,
there were 10, 640; 21937; and 25, 139 patients in 2002, 2003,and 2004. The
hospital provided services to have equal access to care. Moreover, activities
to increase ability to learn about their disease conditions, their self care
responsibility and behavior such as diet, exercise and complication prevention
were also offered. The hospital has also promoted the continuity of care
concepts and services by referring patient’s information to the hospital
network to provide service at patient’s home and community. The
abovementioned activities could not satisfy the needs of patients due to the
larger number of patients and could not successfully promote health of the
patients. Therefore 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 the treatment. They felt hopeless.
The hospital patient care team taken this situation in to account and
brainstorm the countermeasure based on the concept of health promoting
hospital and accreditation guideline used in Thailand. The hospital planed
their discussion with a patient on their goal in life after having a disease, their
daily activities which appears as a pattern of behavior in a day, a month, a
year; and their interaction with the existing social network after having
diagnosed of the disease. These information were recorded in a form.
In addition, the process of learning through active participation in the ladder of
participation for empowerment was applied as underlying empowerment
implementation principle. (adapted from Sherry Arnstein’s ladder of
participation)
The empowerment ladder of participation in this study were divided into 5
levels: (1) comply to the regimen; (2) receiving counseling service in order to
have cognitive participation towards the regimen; (3) after learning about the
disease condition, treatment plan and its consequences, a patient join the
team in making decision what he or she needs to do; (4) assessing outcome
and impact of the decision made by the team and the patients; (5) sharing the
benefit of care which was jointly decided. Participation level one equals to no
1
Assistant professor, Department of Behavioral Sciences and Health Education Mahidol
University, Thailand
2
Chief of Health Education Unit, Buddhachinaraj Hospital, Pitsanulok province Thailand
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
participation. Level 3 to 5, each enhances a person ability to manage his life
and environment which is the key concept of empowerment. To promote the
empowering participation levels (3-5), the team has developed a form to
inquire patient’s goal in life, daily lifestyle, and social network. Information
from these forms was used to determine what to say and what to discuss with
the patients for participation they can offer to other patients in the clinic.
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 ?
Research objectives:
1. To investigate how empowerment tools affect changes in chronic
disease patient?
2. To examine changes made by the study empowerment process and
tools for chronic disease patients.
Research Design: Quasi experimental and comparison group design,
Triangulative research methods include :
Focus group discussion, questionnaire administration and indepth interview.
Population
Chronic disease patient attending diabetic during August
2004 – January 2005
Sampling methods Probability sampling method was applied to all patients
attending diabetic clinic during August 2004 – January
2005
Samples were patients from 210 diabetic patients from diabetic clinic were
randomly assigned to the experimental and comparison
groups.
Results can be summarized as follows:
Total of 210 diabetic patients were included in the study, 105 were in the
experimental group and another 105 were in the comparison group. More
female ( 83 - 79%) than males ( 16-21%) participated in both groups.
Majority of the experimental and comparison groups were in the 41-50 and
51 – 60 age groups. Both groups have had the disease diagnosis for more
than five years, and majority of them ( 46 – 50%) were farmers, followed by
business group.
After participating in the intervention, patients in the experimental group
expressed more positive attitude towards the disease ( 53.3%) such as “even
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
though I have the disease, I can live happily”; “I don’t think about it anymore”.
“What ever will be will be, I deal with it when it comes.”
Patients can adjust their life goal in concordance with disease condition (74.8
%) than before ( 25.7%) Patients in the experimental group changed their
lifestyle more appropriate than those in the comparison group. And the
empowerment level of the experimental group were higher in aspects of
less stress, less lonely, able to make decision for oneself, able to contact
people or health staff without fear, able to contact people or health staff
without fear, solve his/her own problems, know how to help other people,
want to help other people , want to join other people who have the same
disease.
When applying a t-test statistical significance on the difference of changes
level towards empowerment, it shows a statistical significance between
experimental group and comparison group at 0.05 statistical level.
Discussion
After discussing with patients through focus group discussion, data revealed
that the Life goal analysis has helped in reminding patients of what is
important to them and how can the disease obstructs or facilitates their goal.
Activities in their daily activities, or seasonal activities, life style can also
affect their goal, therefore they should take control over their life through what
they do in their daily living. In addition, the social network analysis
information also helped the patients see feasible support which they have and
can utilize. It gives them power to control over their social and physical
environment with a concrete ideas discussed and supported by the health
staff. This area of discussion was not covered in the professional service care
plan before.
The forms used in this study become a tool for soliciting information and for
guiding a discussion 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 increasing 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. The patient becomes
confidence after realizing that the patient care team listens to them and allows
them to make adjustment and sets goal related to their disease condition and
future life.
The patient care team has expressed through focus group discussion with the
researcher that these forms helped them to be systematic and patient focused
in their discussion. It makes them feel relief since they do not have to make
decision alone. They also felt that the patients do comply with their decision
which makes both parties happy.
Reference:
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13th International Conference on Health Promoting Hospitals,
“Empowering for Health: Practicing the Principles”
Dublin, May 18-20, 2005
Virtual Proceedings
Bhudhachinaraj hospital report (2004) Number of Patient’s utilization record
Chanuantong Tanasugarn ( 2000) Behavior change and health promotion in
primary care , Pitsanulok supplies : Pitsanulok: (Thai)
Fetterman, D (2005) Empowerment Evaluation: Collaboration, action research
and a case example available at http:// www.aepro.org/
imprint/conference/fetterman.html.
Richard Leider (1994) Life skills: Taking Charge of Your Personal and
Professional Growth Pfeiffer:London
Pollacheck,J ( 2005) Empowering patients with Chronic Prostatitis http://
prostate-usa.com/empowering.html
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