Identification of Potential Leverage Points for Self-Management Support Intervention in Thais with Type 2 Diabetes.

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.