Enhancing Health Literacy Through a Community Participation Model for Patients with Uncontrolled Type 2 Diabetes in Uthai Thani Province

Abstract

Type 2 Diabetes Mellitus is a critical public health issue both globally and nationally. Diabetes affects multiple dimensions including physical, psychological, social, and economic well-being, particularly among patients with uncontrolled blood glucose levels. This research and development study aimed to develop a community participation model to enhance Health Literacy for improving glycemic control among uncontrolled Type 2 Diabetes Mellitus patients in Uthai Thani Province. The Frameworks integrated three concepts. Health Literacy, Social Support, and the Health Belief Model. The research was conducted in three phases from August 2024 to February 2025. Phase 1 assessed the situation and needs of 385 patients and 12 health network stakeholders. Phase 2 developed and tested the BUDDY Model in two sub-district health promoting hospitals, each for 12 weeks, involving 30 patients and 30 Village Health Volunteers (VHVs) per site. Phase 3 evaluated outcomes and extracted lessons learned.

Findings from Phase 1 indicated Health Literacy among patients was at moderate levels (65.6%), with the highest scores in knowledge/understanding (69.0%) and the lowest in self-management (60.4%), highlighting a gap between knowledge and practice. In Phase 2 The development of the BUDDY Model, which is the result of using the Appreciation Influence Control (AIC) process, has 5 components: Building Knowledge & Skills, Understanding Patient Needs, Driving Behavioral Change, Decision Making Support, and Your Health Empowerment. The intervention significantly improved Health Literacy, attitudes, and self-care behaviors (Z = -2.85 to -3.31, p < 0.05), notably increasing physical activity by 39.3%, though HbA1C reduction was minimal at 0.4% (p > 0.05), possibly due to the short intervention duration for biochemical changes. Both the pilot and expansion areas showed similar results, with mean differences not exceeding 5%. Phase 3 revealed high satisfaction and participation rates (84.0–90.0%), with strengths in home visits and resistance band use, but limitations in elderly patients' digital literacy skills with LINE application and the short intervention period.

Recommendations include enhancing digital skills among the elderly and establishing sustained VHV support systems. Additionally, the BUDDY Model should be integrated into primary healthcare systems, cost-effectiveness analyses should be conducted compared to complication treatments, personal and environmental factors influencing success should be studied, and the model should be expanded to other non-communicable diseases to ensure long-term sustainability.