Development of a Community Network-Based Care Model for Chronic Psychiatric Patients: The "4 Build, 2 Use" Innovation Nasiew Sub-district, Mueang Chaiyaphum District

Abstract

            This research aimed to develop and evaluate a care model for chronic psychiatric patients through a community network based on the "4 Creating, 2 Using" approach in Na Siao sub-district, Mueang Chaiyaphum. This was a 7-month participatory action research study divided into three phases: 1) community analysis and participatory innovation design, 2) innovation trial, and 3) evaluation. The target group included 44 chronic psychiatric patients, 44 caregivers, and 28 community network members. The evaluation was conducted using a personal information questionnaire, the Patient Health Questionnaire-9 (PHQ-9), interviews, and focus groups, both before and after the intervention. Quantitative data were analyzed using descriptive statistics and paired t-tests, while qualitative data were analyzed using content analysis.

            The results showed that the "4 Creating" approach, developed by the community network, consisted of: 1) Creating Safety (Safe Space Café, Neighborly Care, Mental Health First Aid), 2) Creating Calm (Community Meditation Garden, Evening Yoga), 3) Creating Hope (Sharing Platform, Mental Health Mentors), and 4) Creating New Opportunities (Discussion Forum, "Erase the Shame," New Opportunities in the Community). The "2 Using" approach focused on leveraging community potential and relationships. The intervention resulted in a significant decrease in the average PHQ-9 score from 6.95 to 3.18 (95% CI: 2.07, 5.48). The percentage of patients with minimal or no symptoms increased from 45.4% to 81.8%, with no patients remaining in the moderate or severe categories.

            The "4 Creating, 2 Using" approach is a potential innovation for reforming community mental health systems. By genuinely utilizing local resources and participatory processes, it can create sustainable change. Despite methodological limitations, it provides a crucial foundation for contextually appropriate development in Thailand. Further scaling and expansion are therefore necessary.