title: Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes.
abstract: OBJECTIVE
  We evaluated a theoretically-derived family-oriented intervention aimed to improve self-efficacy, self-management, glycemic control and quality of life in individuals living with Type 2 diabetes in Thailand.
  
  
  METHODS
  In a single-blinded randomized controlled trial, 140 volunteer individuals with Type 2 diabetes, recruited from a diabetes clinic in rural Thailand, were randomly allocated to intervention and control arms. Those in the intervention arm received routine care plus a family-oriented program that included education classes, group discussions, a home visit, and a telephone follow-up while the control arm only received routine care. Improvement in outcomes over time (baseline, Week 3, and Week 13 following intervention) was evaluated using Generalized Estimating Equations multivariable analyses.
  
  
  RESULTS
  Except for age, no between-group significant differences were observed in all other baseline characteristics. Diabetes self-efficacy, self-management, and quality of life improved in the intervention arm but no improvement was observed in the controls. In the risk-adjusted multivariable models, compared to the controls, the intervention arm had significantly better self-efficacy, self-management, outcome expectations, and diabetes knowledge (p<0.001, in each). Participation in the intervention increased the diabetes self-management score by 14.3 points (β=14.3, (95% CI 10.7-17.9), p<0.001). Self-management was better in leaner patients and in females. No between-group differences were seen in quality of life or glycemic control, however, in the risk-adjusted multivariable models, higher self-management scores were associated with significantly decreased HbA1c levels (p<0.001) and improved patient quality of life (p<0.05) (irrespective of group membership).
  
  
  CONCLUSIONS
  Our family-oriented program improved patients' self-efficacy and self-management, which in turn could decrease HbA1c levels.
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia; Faculty of Nursing, Suratthani Rajabhat University, Suratthani, Thailand. Electronic address: nutchanath.wichit@myacu.edu.au.
authors.forename: Nutchanath
authors.initials: N
authors.lastname: Wichit
authors.affiliation: College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia; Faculty of Health Sciences, Australian Catholic University, Sydney, Australia. Electronic address: G.Mnatzaganian@latrobe.edu.au.
authors.forename: George
authors.initials: G
authors.lastname: Mnatzaganian
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia. Electronic address: mary@roverville.com.au.
authors.forename: Mary
authors.initials: M
authors.lastname: Courtney
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia. Electronic address: Paula.Schulz@acu.edu.au.
authors.forename: Paula
authors.initials: P
authors.lastname: Schulz
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Sydney, Australia; Ingham Institution of Applied Medical Research Liverpool, Sydney, Australia. Electronic address: Maree.Johnson@acu.edu.au.
authors.forename: Maree
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D017028:Caregivers / Q000193:education; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D013785:Thailand
chemical_list: D001786:Blood Glucose
keywords: Family-oriented; Health outcome; Randomized controlled trial; Self-management; Type 2 diabetes