Effects of a Kidney Deterioration Retardation Program on Self-management and Clinical Outcomes in Patients with Stage 3 Chronic Kidney Disease, Mae Sariang Hospital, Mae Hong Son Province: An Explanatory Sequential Mixed-Methods Study

Abstract

Chronic kidney disease (CKD) is a growing public health problem, and Mae Sariang District, Mae Hong Son Province has the highest CKD incidence in the province, with ethnic minorities comprising the majority of the population. This explanatory sequential mixed-methods study evaluated a 12-week Lewin's Change Management Model-based kidney deterioration retardation program on self-management behaviors and clinical outcomes, and developed program improvement guidelines for 37 purposively sampled stage 3 CKD patients. Self-management (30-item, 4-domain, Likert 4-level, max 90 points) was measured at weeks 0, 5, 9, 12; eGFR, UPCR, blood pressure and fasting blood glucose were compared pre-post. Qualitative data (n=8; in-depth interviews and focus groups) and Expert Review (n=2 specialists) were conducted. Total self-management scores improved significantly from 46.44 to 66.38 (p<0.001; dz=1.350, very large effect). eGFR showed a favorable trend (p=0.183); 21.6% advanced from G3a to G2. Five qualitative themes and 17 Expert Review-endorsed program improvements across 6 domains were identified. This program provides a scalable model for remote multicultural communities.