Chanuantong Tanasugarn, DrPH Pissmai Jaruchovalit, MSc. Faculty of Public Health Mahidol University Thailand Life Goal, Life Style and Social Network Analysis as a tool to empower chronic disease patients Copyright 2005 by Dr. Chanuantong Tanasugarn Number of patients with chronic disease have increased every year. At Buddachinaraj Hospital, there were ,640cases ,937cases ,139cases Copyright 2005 by Dr. Chanuantong Tanasugarn The hospital provided services to have equal access to care. to increase ability to learn about their disease conditions, To promote self care responsibility and change behavior such as diet, exercise to promote the continuity of care through referring system to provide service at patients home and community. Copyright 2005 by Dr. Chanuantong Tanasugarn 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 treatment. They felt hopeless Copyright 2005 by Dr. Chanuantong Tanasugarn Based on the concept of health promoting hospital and accreditation guideline used in Thailand, The patient care team put the emphasis on the patient lifestyle, and social network as way to connect the hospital with the patients family and community. Copyright 2005 by Dr. Chanuantong Tanasugarn Ladder of participation for empowerment. (adapted from Sherry Arnsteins ladder of participation) (1)comply to the regimen; (2) cognitive participation towards the regimen; (3)Joining 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. EMPOWERMENT No participation Copyright 2005 by Dr. Chanuantong Tanasugarn 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 ? Copyright 2005 by Dr. Chanuantong Tanasugarn 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; Copyright 2005 by Dr. Chanuantong Tanasugarn Empowering intervention includes Lifestyle analysis Life Goal Analysis Social network analysis Acceptance of disease condition Goal setting in controlling ones life New lifestyle performed Less anxiety, more confidence Feeling content and wanted to help others Managing and learning about ones lifestyle Less anxiety or feeling more in control of ones life Willing to help others. Better disease and health conditions Age Sex Occupation Disease condition and period of having the disease Extraneous Variable Dependent variablesIndependent Variables Research conceptual framework: Copyright 2005 by Dr. Chanuantong Tanasugarn Research Design: Quasi experimental and comparison group design, Triangulative research methods include : Focus group discussion, questionnaire administration and indepth interview. Copyright 2005 by Dr. Chanuantong Tanasugarn Research Tool: Life style analysis form The form includes 1)Information on daily activities (regular days) 2)Information on activities a patient does when he/she faces different conditions such as being alone, with family, with closed friends, with someone he/she just has met. 3)Information on things that he/she does and always gets compliment from the family and friends. Research Tool: Life goal analysis form The form includes information on 1.goals which he/she wish to achieve and his/her action plan to achieve the goal. 2.his/her opinion towards effect of the action plan on his/her health or disease condition. 3.his/her opinion on the order of importance among exercise, diet, stress management, and let go (healthy coping) (rank from the most the least important) Copyright 2005 by Dr. Chanuantong Tanasugarn Research Tool: Social network analysis form The form includes information on 1. a person whom he/she loves to do things with; to seek help or support when he or she facing problems ie financial problem, work problem, family problem, etc. 2.family and social activities which he/she loves to attend and how does each activities affect him/her; 3.Who are the source of stress or non-stress which created symptoms such as headache, frightened, hopeless, happiness. Copyright 2005 by Dr. Chanuantong Tanasugarn PopulationChronic disease patient attending diabetic and cancer clinic during August 2004 January 2005 Sampling methods Probability sampling method was applied to all patients attending diabetic clinic or receiving cancer treatment during August 2004 January 2005 Samples were patients from 105 diabetic patients from diabetic clinic and 14 and 15 cancer patients from cancer ward were randomly assigned to the experimental and comparison groups. Copyright 2005 by Dr. Chanuantong Tanasugarn Data analysis Descriptive statistics and t-test analysis were applied to the data collected through the questionnaire. Content analysis was applied to the qualitative data. Copyright 2005 by Dr. Chanuantong Tanasugarn Table 1: Demographic Characteristics: Sex SexDiabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Male Female Copyright 2005 by Dr. Chanuantong Tanasugarn Table 2 : Demographic Characteristics: Age Age Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Over Copyright 2005 by Dr. Chanuantong Tanasugarn Table 3:Demographic: Period of being diagnosis period Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage < 1 month 5 month month 1 year year year 10 year Copyright 2005 by Dr. Chanuantong Tanasugarn Table 4:Demographic: Occupation Occupation Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage student housewives Buddist monk Private agency worker Farmers Government workers Business Copyright 2005 by Dr. Chanuantong Tanasugarn Table 5: Acceptance of disease condition Verbal expression as disease condition acceptance Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Before experiment Cannot accept the condition of the disease such as When will I die? I am tired of having this disease! I want to die! I cry all night long! After experiment Can accept the condition of the disease Such as even though I have the disease, I can live happily ; I dont think about it anymore. What ever will be wlll be! Deal with it when it comes ( 1 passed away) Copyright 2005 by Dr. Chanuantong Tanasugarn Table 6: Setting Life Goal Setting life goal Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Life goal was set concordance with disease condition Life goal was set inconcordan ce with disease condition Setting life goal refers to identifying reason or motivation to go on and managing his or her life and disease Copyright 2005 by Dr. Chanuantong Tanasugarn Table 7: Changing Life style Changing life style Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Setting Life goal on setting blood sugar level for DM and for CA Larlynx the goal was for a speech rehersal Before experiment After experiment Monitor diet during seasonal holiday for DM patient Smoking and alcohol cessation for CA Larynx patients Before experiment After experiment Copyright 2005 by Dr. Chanuantong Tanasugarn Table 7: Changing Life style (Contd) Changing life style Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Increase Communication with relatives regarding food For DM patients And drinking water before speaking for CA Larynx patients Before experiment After experiment Exercise properly and regularly Before experiment After experiment Copyright 2005 by Dr. Chanuantong Tanasugarn Changing life style Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Foot care for DM patient and Endotrachial tube care for CA Larlynx patient Before experiment After experiment Stress management Before experiment After experiment Table 7: Changing Life style (Contd) Copyright 2005 by Dr. Chanuantong Tanasugarn Changing life style Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage Becoming a community club members for DM patient And living happily with family members for CA larynx patients Before experiment After experiment Table 7: Changing Life style (Contd) Copyright 2005 by Dr. Chanuantong Tanasugarn Table 8: Level of empowerment changed after participating in the life goal, lifestyle and social network analysis process Changes due to Empowerment levels Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage 1)Less stress Before experiment After experiment ) Less lonely Before experiment After experiment ) Able to make decision Before experiment After experiment ) Able to contact people or health staff without fear Before experiment After experiment ) Solve his/her own problems Before experiment After experiment Copyright 2005 by Dr. Chanuantong Tanasugarn Changes due to Empowerment levels Diabetic patientsCancer patients Experimental Group N=105 Comparison Group N= 105 Experimental Group N= 14 Comparison Group N = 15 FrequencyPercentageFrequencyPercentageFrequencyPercentageFrequencyPercentage 6) Know how to help other people Before experiment After experiment ) Want to help other people Before experiment After experiment ) Want to join other people who have the same disease Before experiment After experiment Table 8: Level of empowerment changed after participating in the life goal, lifestyle and social network analysis process Test of significance between experiment and comparison groups of the DM group T-test value = at 0.04 p value. Copyright 2005 by Dr. Chanuantong Tanasugarn Discussion After discussing with patients through focus group discussion, data revealed that the Life goal analysis had helped in reminding patients of what was important to them and how the disease could obstruct or facilitate their goal. What they do in their life, life style, can also affect their goal, therefore they can take control over their lives through what they do in their daily living. The social network analysis information also helps the patients see feasible support which they have and can utilize. It gives them power to control over their social and physical environment with concrete ideas discussed and supported by the health staff. This area of discussion has never been part of the professional practice. Copyright 2005 by Dr. Chanuantong Tanasugarn Discussion The forms used in this study have become a tool for soliciting information and for sharing information between a patient and a patient care team. Positive information such as patients life goal has put the discussion on the patients perspective view of life. This helps increase 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. They become confident after realizing that the patient care team listens to them and allows them to make adjustments and set goals about their disease condition and life. Copyright 2005 by Dr. Chanuantong Tanasugarn Discussion Patient care team : Point of View The patient care team has expressed through focus group discussions with the team that these forms helps them be systematic and focused in their discussion. It also helps the professionals in getting the patients to participate and it makes these professionals feel relived since they do not have to make decisions alone. They also feel that the patients do comply with their decisions which makes both parties happy. Copyright 2005 by Dr. Chanuantong Tanasugarn Acknowledgement This study was possible due to supports given by Diabetic and Cancer patients of Buddhachinaraj Hospital Diabetic Patient care team and Cancer Patient care team Health Education Staff of Buddhachinaraj Hospital And Financial support from Planning and Development Division Buddhachinaraj Hospital.