12 Years of Participatory Action Research in Diabetes Clinic at Surin Hospital
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Abstract
Objective: To evaluate clinical practices and outcomes of a 12-year pilot project of participatory action research (PAR) in the diabetes clinic at Surin Hospital. The objectives of PAR are to improve clinical outcomes, to prevent early diabetic complications in all participants, and to help them have a better quality of life.
Materials and Methods: All patients including the multidisciplinary team and researchers in the diabetes clinic at Surin Hospital were enrolled. Participatory action research was performed since 1996. This PAR used the paradigms of critical theory and constructivism by using a range of qualitative and quantitative methods. Research methodology is a strategy or plan of action that shapes the choice and use of methods then links them to the desired outcomes.
Results: Ten action researches, two Master’s theses, and associated reports were created over a 12-year period. This PAR developed many applications such as a home healthcare program, a community healthcare network, a multidisciplinary team, 29 diabetes clinics in primary care units (PCU), a health education program for self-care in diabetic patients in Surin province, a program of exercise as a treatment in chronic disease, a foot care program, mobile chest x-ray screening, and mobile retinal screening for diabetic retinopathy using fundus digital camera. Pragmatic social science processes were also introduced at the clinic. Patients with HbA < 7% increased from 26% in 1998 (n = 246) to 47.1% in 2007 (n = 1,034) and 41.6% in 2009 (n = 2,768). Due to this high rate of HbE disorder in Surin province, which can affect HbA measurement, DCIP test was used for screening. 45.4% of diabetic patients with negative DCIP results had HbA1c < 7% (n = 390). Action plans were implemented to decrease the high rate of dyslipidemia, hypertension, overweight, and obesity to meet current standards. In 2009, clinical control was difficult in the majority of patients. 37.2% of diabetic dyslipidemia patients with statin therapy had LDL level <100 mg/dl (n= 1,180). 29.3% of 3,176 patients had both systolic and diastolic blood pressure below 130 and 80 mmHg respectively, and 37.8% had body mass index from 18.5 Kg/m2 to< 23.0 Kg/m
Conclusions: This participatory action research (PAR) is an innovative clinical practice.It was designed on the basis of critical social science which also integrates the theories of positivism and interpretivism. In harmony with the culture and beliefs of the context, this model can construct new knowledge from the experiences of participants. The process of research forms social phenomena in diabetes clinic which gradually changes the behavior of the participants and finally improves the outcomes of clinical care
Keywords: Participatory action research PAR Diabetes mellitus, DM, Surin Hospital, Diabetes dime
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