ผลของโปรแกรมการจัดการตนเองต่อพฤติกรรมป้องกันการกำเริบของโรคในเด็กวัยรุ่นโรคเอสแอลอี

Panissara  Kitchareanrungroj; Chayanuj  Chaiyaratana; Nantaga  Sawasdipanich; Tawatchai  Deekajorndech

doi:10.60099/jtnmc.v39i01.266616

Authors

Panissara Kitchareanrungroj Program in Pediatric Nursing, Srisavarindhira Thai Red Cross Institute of Nursing, Bangkok, Thailand
Chayanuj Chaiyaratana Department of Pediatric Nursing, Srisavarindhira Thai Red Cross Institute of Nursing, Bangkok, Thailand.
Nantaga Sawasdipanich Department of Pediatric Nursing, Srisavarindhira Thai Red Cross Institute of Nursing, Bangkok, Thailand
Tawatchai Deekajorndech Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

DOI:

https://doi.org/10.60099/jtnmc.v39i01.266616

Keywords:

preventive relapse behaviors, self-management program, Systemic Lupus Erythematosus (SLE), adolescents

Abstract

Introduction Systemic Lupus Erythematosus (SLE) is characterized by variations in the immune system leading to the production of autoantibodies, resulting in tissue damage, often prevalent in adolescents. Proper and continuous management by adolescents with SLE can help prevent disease relapse and shorten hospital stays.

Objective To examine the effect of the self-management program on preventive relapse behaviors in adolescents with SLE.

Design Two-group pretest-posttest quasi-experimental research

Methodology The participants consisted of 40 adolescents with SLE, aged 10 – 18 years, receiving care at nephrology and rheumatology pediatric clinics in a super tertiary hospital in Bangkok. They were purposively selected based on inclusion criteria, then were purposively assigned to either control or experimental group, each comprising 20 patients. The control group received standard nursing care, while the experimental group received standard nursing care and a self-management program. The self-management program, based on Creer’s self-management of chronic illness framework, focused on providing knowledge, practicing self-management skills, and engaging in the self-management process. Data collection instruments included a personal information form, a questionnaire on SLE knowledge for adolescents, and a questionnaire on preventive relapse behaviors. Content validity testing yielded validity indices of .88 and .95, while reliability testing obtained a Kuder-Richardson 20 coefficient of .74 and a Cronbach's alpha coefficient of .73. Data were analyzed using descriptive statistics, Chi-square test, Dependent t-test, and Independent t-test, with a significance level set at .05.

Result After the experiment, the mean score of preventive relapse behaviors in the control group significantly higher than before the experiment (t = -2.656, p = .016). In the experimental group, mean score for preventive relapse behaviors after the program (M = 2.334, SD = 0.296) was significantly higher than before the program (M=2.072, SD = 0.475), (t = -3.285, p = .002). There was no significant difference in mean scores of preventive relapse behaviors between the experimental group (M = 2.334, SD = 0.296) and the control group (M = 2.188, SD = 0.326, t = -1.481, p = .074). These results indicate that the program was not effective in modifying preventive relapse behaviors in adolescents with SLE.

Recommendations While the self-management program did not have a significant effect on preventing relapse behaviors, there appears to be an inclination towards higher efficacy. Therefore, it is advisable for nurses to design targeted programs aimed at empowering adolescents with SLE to effectively and appropriately self-manage across three key areas: eating behaviors, taking medications, and practicing general activities.

References

Tangnararatchakit K, Pattaragarn A, Saisawat P, Srisuwan K, Chanakul A, Piyaphanee N, et al., editors. Fluid, electrolyte problems and kidney disease in children. 5th ed. Bangkok: Natikul; 2017. (in Thai)

Sumboonnanonda A, Pattaragarn A, Piyaphanee N, editors. Systemic lupus erythematosus in pediatric and adolescents. Bangkok: Faculty of Medicine Siriraj Hospital, Mahidol University; 2013. (in Thai)

Charras A, Smith E, Hedrich CM. Systemic lupus erythematosus in children and young people. Curr Rheumatol Rep. 2021;23(3):20. https://doi.org/10.1007/s11926-021-00985-0 PMID: 33569643

Tang SP, Lim SC, Arkachaisri T. Childhood-onset systemic lupus erythematosus: Southeast Asian perspectives. J Clin Med. 2021;10(4):559. https://doi.org/10.3390/jcm10040559 PMID: 33569643

King Chulalongkorn Memorial Hospital, Medical Records and Statistics Department. Medical records and inpatient statistics. Bangkok: King Chulalongkorn Memorial Hospital; 2018-2022. (in Thai)

Jongvilaikasem P, McNeil EB, Dissaneewate P, Vachvanichsanong P. Improvement of survival rates in the last decade in Thai childhood-onset systemic lupus erythematosus. Pediatr Rheumatol Online J. 2018;16(1):62. https://doi.org/10.1186/s12969-018-0274-5

Pinheiro SVB, Dias RF, Fabiano RCG, de Almeida Araujo, Silva CSE. Pediatric lupus nephritis. J Bras Nefrol. 2019;41(2):252-65. https://doi.org/10.1590/2175-8239-jbn-2018-0097 PMID: 30465590

Lertwongpaopun W, Tilokskulchai F, Sindhu S, Pattaragan A, Chai-Aroon T. Factors associated with kidney damage among Thais with lupus nephritis. PRIJNR. 2016;20(4):309-19. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/55348/56986

Panthu K, Maneewong J, Phorang R. Factors associated with relapsed patients with systemic lupus erythematosus (SLE). Journal of Health and Nursing Education. 2021;27(2):168-84. Available from: https://he02.tci-thaijo.org/index.php/Jolbcnm/article/view/252381/173893 (in Thai)

Sakdisthanont S-, Siripul P. Self-management in adolescents with systemic lupus erythematosus (SLE). Journal of Nursing Science and Health. 2018;41(2):11-9. https://he01.tci-thaijo.org/index.php/nah/article/view/113466 (in Thai)

Harry G, Huggins J, Crosby L, Modi A. Adolescents perspectives on living with childhood-onset systemic lupus erythematosus. LS&M. 2019;6 Suppl 1:A29-30. https://doi.org/10.1136/lupus-2019-lsm.40

Lozano P, Houtrow A. Supporting self-management in children and adolescents with complex chronic conditions. Pediatrics. 2018;141 Suppl 3:S233-41. https://doi.org/10.1542/peds.2017-1284h PMID: 29496974

Urairat P, Puwarawuttipanit W, Sriyuktasuth A, Teerapornlertratt T. Factors influencing relapse prevention behaviors in lupus nephritis patients. Journal of Nursing Science. 2012;30(3):55-63. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/10469/9469 (in Thai)

Creer TL. Self-management of chronic illness. In: Boekaerts M, Pintrich PR, Zeidner M, editors. Handbook of self-regulation. London: Academic Press; 2000. p. 601-29. https://doi.org/10.1016/B978-012109890-2/50047-0

Cunningham NR, Fussner LM, Moorman E, Aydin POA, Brunner HI, Kashikar-Zuck S. Development and pilot testing of the treatment and education approach for childhood-onset lupus (TEACH): a cognitive behavioral treatment. Pediatr Rheumatol Online J. 2019;17(1):9. https://doi.org/10.1186/s12969-019-0307-8 PMID: 30777090

Wiemann CM, Graham SC, Garland BH, Hergenroeder AC, Raphael JL, Sanchez-Fournier BE, et al. Development of a group-based, peer-mentor intervention to promote disease self-management skills among youth with chronic medical conditions. J Pediatr Nurs. 2019;48:1-9. https://doi.org/10.1016/j.pedn.2019.05.013 PMID: 31195183

Ting T V, Kudalkar D, Nelson S, Cortina S, Pendl J, Budhani S, et al. Usefulness of cellular text messaging for improving adherence among adolescents and young adults with systemic lupus erythematosus. J Rheumatol. 2012;39(1):174-9. https://doi.org/10.3899/jrheum.110771 PMID: 22089460

Scalzi LV, Hollenbeak CS, Mascuilli E, Olsen N. Improvement of medication adherence in adolescents and young adults with SLE using web-based education with and without a social media intervention, a pilot study. Pediatr Rheumatol Online J. 2018;16(1):18. https://doi.org/10.1186/s12969-018-0232-2 PMID: 29540181

Nabundit R, Tangvoraphonkchai J. The effects of innovation in providing health information and health game on self - care behaviors for adolescent SLE patients admitted in hospital. Journal of Nursing Science & Health. 2012;35(1):10-7. Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/1876/1566 (in Thai)

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: Lawrence Eribaum Associated; 1988.

Srisatidnarakul B. The methodology in nursing research. 5th ed. Bangkok: Faculty of Nursing: Chulalongkorn University; 2010. (in Thai)

Polit DF, Yang FM. Measurement and the measurement of change: a primer for the health professions. Philadelphia: Wolters Kluwer; 2016.

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-63. https://doi.org/10.1016/j.jcm.2016.02.012 PMID: 27330520

DeVellis RF. Scale development: theory and applications (applied social research methods). 3rd ed. California: SAGE; 2011.

Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Harlow: Pearson Education; 2013.

Sakdisthanont S, Siripul P. Needs of adolescents with SLE disease. Journal of Nursing Science & Health. 2014;37(3):1-8. Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/29424/ 25299 (in Thai)

Nithitantiwa P, Udomsapaya W. Food consumption behavior among Thai adolescents, impacts, and solutions. Journal of Prapokklao Nursing College. 2017;28(1):122-8. Available from: https://he01.tci-thaijo.org/index.php/pnc/article/view/117888/90429 (in Thai)