Main Article Content
This study was designed to develop a model of self-management for children with thalassemia.
Participants were selected from in-patient and out-patient clinics in an Eastern regional hospital. This
research had two development/design phases: 1) Analysis of the situation -- qualitative data were
collected from in-depth interviews with 11 children, then 88 children were selected by purposive
sampling and quantitative data were collected via a health literacy questionnaire, medical adherence
questionnaire, and self-management behaviors questionnaire; 2) Model development – based on
analysis and synthesis of phase I data. Data were analyzed by descriptive statistics, stepwise multiple
regression, and content analysis.
Phase I qualitative data revealed that major themes of the self-management experiences of
children with thalassemia were: 1) Self-management for daily life; 2) Self-management for emotional
problems, and; 3) self-management support. The quantitative data showed medical adherence and
health literacy together accounted for 17.4% of the variance. The self-management model that emerged
consisted of: 1) Input, including child’s perspective of self-management, medical adherence, health
literacy and self-management behaviors, and family and health care team aspects; 2) Process,
consisting of readiness, developing ability of self-management, and self-management support, and;
3) Output, defined as child’s health status and quality of life.
The self-management model could be used to guide self-management program development
for children with thalassemia. The key successes derived from collaboration between family and health
care providers make the model possible and sustainable.
April, K.T., Feldman, D.E., Zunzunegui, M.V., & Duffy, C.M. (2008). Association between perceived treatment adherence and health-related quality of life in children with juvenile idiopathic arthritis: Perspectives of both parents and children. Patient Prefer Adherence, 2, 121-8.
Ashwill, J.W., & Droske, S.C. (1997). Nursing Care of Children: Principles and Practice. Philadelphia: W.B. Saunders Company. Bloom, B.S., Hastings, J.T., & Madaus, G.F. (1971). Handbook on formative and summative evaluation of student learning. New York: McGraw-Hill.
Cakaloz, B., Cakaloz, I., Polat, A., Inan, M., & Oguzhanoglu, N.K. (2009). Psychopathology in Thalassemia major. Pediatr Int, 51(6),825-8. doi.org/10.1111/j.1442-200X.2009.02865.x
Ceci, A., Baiardi, P., Catapano, M., Felisi, M., Cianciulli, P., De Sanctis, V., . . . & Maggio, A. (2006). Risk factors for death in patients with beta-thalassemia major: results of a case-control study. Haematologica, 91(10),1420-1421.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). NJ: Lawrence Erlbaum Associated, Publishers.
Creer, L.T. (2000). Self-management of chronic illness. In M. Boekaert, P.R. Pintrict, & M. Zeidner (Eds.), Handbook of self-regulation (pp. 601-629). California: Academic Press.
Davis, T., Crouch, M., & Long, S. (1991). Rapid estimate of literacy levels of adult primary care patients. Fam Med, 23, 433-435.
DeWalt, D.A., Dilling, M.H., Rosenthal, M.S., & Pignone, M.P. (2007). Low parental literacy is associated with worse asthma care measures in children. Ambul Pediatr, 7(1),25-31.doi:10.1016/j.ambp.2006.10.001
Feldman, D.E., de Civita, M., Dobkin, P.L., Malleson, P., Meshefedjian, G., & Duffy, C.M. (2007). Perceived adherence to prescribed treatment in juvenile idiopathic arthritis over a one-year period. Arthritis Rheum, 57(2), 226-33.
Grey, M., Knafl, K., & McCorkle, R. (2006). A framework for the study of self- and family management of chronic conditions. Nurse Outlook, 54(5), 278-286. doi:10.1016/j.outlook.2006.06.004
Hockenberry, M.J., & Wilson, D. (2015). Wong’s nursing care of infants and children (10th ed.). St. Loius: Missouri.
Imiwat, M. (2012). The effects of the health education program on health behavior development of Thalassemia children. Rajabhat Chiang Mai Research Journal,13(1), 115-128. [In Thai].
Klunklin, P. (2017). Nursing care of children for health promotion. Chiang mai: Smartcoating and Service. [In Thai].
Kuttarasang, R., Sananreangsak, S., & Teerarungsikul,
N. (2017). Effect of family management
promotion program on maternal management
and health status of school-age children
with Thalassemia. Thai Journal of Nursing,
66(3), 1-10. [In Thai].
Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic
inquiry. Newbury Park, CA: Sage Publication,
Lorig, K.R. & Holman, H.R. (2003). Self-management
education: History, definition, outcomes,
and mechanisms. Ann Behav Med, 26(1),
Medical statistic of Chonburi Hospital (2019). The
report of a medical statistic. Chonburi:
Chonburi Hospital. [In Thai].
Ministry of Public Health. (2018). “Thalassemia”.
Genetic diseases in Thailand (Cited on 2020
Apr 5). Available from https://pr.moph.go.th
/?url=pr/detail/all/02/116500. [In Thai].
Nutbeam, D. (2000). Health literacy as a public
health goal: A challenge for contemporary
health education and communication
strategies into health 21st century. Health
Promotion International, 15(3), 259-267.
Nutbeam, D. (2008). The evolving concept of
health literacy. Soc Sci Med, 67(12), 2072-
Parker, R.M., Baker, D.W., Williams, M.V., & Nurss,
J.R. (1995). The test of functional health
literacy in adults: A new instrument for
measuring patients’ literacy skills. J Gen
Intern Med, 10(10): 537-41
Perez, M.G., Feldman, L., & Caballero, F. (1999).
Effects of a self-management educational
program for the control of childhood
asthma. Patient Education and Counseling,
Pitchalard, K., & Moonpanane, K. (2013).
Improvement of a continuing care model
in child with Thalassemia and caregivers.
Nursing Journal, 40(3), 97-108. [In Thai].
oss, L. A., Frier, B. M., Kelnar, C. J., & Deary, I. J.
(2001). Child and parental mental ability
and glycaemic control in children with Type
1 diabetes. Diabet Med, 18(5), 364-369.
Sananreangsak, S., Lapvongwatanal, P., Virutsetazin,
K., Vatanasomboon, P., & Gaylord, N. (2012).
Predictors of family management behavior
for children with thalassemia. Southeast
Asian J Trop Med Public Health, 43(1),
Sanee, A. (2014). Self-management program in
chronic diseases. Journal of The Thai Army
Nurses, 15(2), 129-134. [In Thai].
Viprekasit, V. (2013). Comprehensive management
for Thalassemia. Journal of Hematology
Transfusion Medicine, 23(4), 303-320. [In Thai]
Wattana, C., Srisuphan, W., Pothiban, L., &
Upchurch, S.L. (2007). Effects of a diabetes
self-management program on glycemic
control, coronary heart disease risk, and
quality of life among Thai patients with
type 2 diabetes. Nursing & Health Sciences,
9(2), 135-141. [In Thai].
Wattana, C. (2015). Self-management support:
strategies for promoting disease control.
Journal of Phrapokklao Nursing College,
26(Suppl1), 117-127. [In Thai].
Yusuk, P., Sananreangsak, S., & Teerarungsikul, N.
(2019). Factors related to maternal
management for children with thalassemia.
JOPN, 11(1), 151-62. [in Thai].