Sranacharoenpong Kitti, Hanning Rhona M
Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand.
Prim Health Care Res Dev. 2011 Oct;12(4):357-69. doi: 10.1017/S146342361100020X.
The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs.
Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable.
Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings.
Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the communities they serve. Ultimately, this should support chronic disease prevention in Thailand.
本研究旨在调查泰国清迈省社区医护人员实施糖尿病预防教育项目的障碍与支持因素。该研究还旨在为针对社区医护人员量身定制的糖尿病预防教育项目设计提供初步意见。
泰国面临营养不良问题，但矛盾的是，肥胖和糖尿病等营养过剩疾病的患病率却在上升。由于泰国获得糖尿病预防项目的机会有限，尤其是在农村和半城市地区，因此开发一个相关、经济高效且可持续的健康信息传递系统变得至关重要。
从一个地区的健康中心挑选出12名医护专业人员参与深入访谈。此外，筛查出的糖尿病高危人群参与了访谈（8人）和焦点小组讨论（4组，共23名参与者）。对录音访谈或焦点小组讨论的编码文字记录进行人工分析，并使用NVivo软件进行分析。概念图展示了研究结果。
医护专业人员认为项目成功的潜在障碍包括定期参与的积极性以及项目可持续性缺乏卫生政策支持。医护专业人员发现了将健康促进和疾病预防纳入社区医护人员职责的机会。医护专业人员推荐开展小组研讨会、实践学习活动、案例研究以及视频展示，以便在其文化背景下将知识应用于实践。社区医护人员应获得继续学习的学分。糖尿病高危人群缺乏营养知识、糖尿病风险因素知识以及获取健康信息的资源。他们希望与社区医护人员进行双向沟通。形成性研究支持需要一个有效、可持续的项目，以支持向社区医护人员以及他们所服务社区的高危人群进行知识转化。最终，这应有助于泰国的慢性病预防。
