- Title
- Community-dwelling rural Thai peritoneal dialysis patients: an explanatory sequential mixed-methods study
- Creator
- Kankom, Wassana
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Masters Research - Master of Philosophy (MPhil)
- Description
- The prevalence of end stage kidney disease (ESKD) is increasing significantly in Thailand and worldwide. Over a decade ago, Thailand launched the PD First Policy to support low-income Thai patients to receive continuous ambulatory peritoneal dialysis (PD). Without treatment, ESKD patients have a shortened lifespan. Effective self-management of chronic conditions such as ESKD can reduce morbidity and mortality and maintain a satisfactory quality of life for the patient. Peritoneal dialysis is recognised as a complex treatment for older PD patients experiencing additional challenges with the self-management of PD related to comorbidities and ageing. Few studies have sought to understand older patients’ experiences of PD self-management, especially in low-income environments, and it has been reported that older Thai PD patients have poorer clinical outcomes than younger PD patients. A mixed-method explanatory sequential study using the participant-selection model was conducted to understand the health-related quality of life, PD clinical outcomes and self-management of older PD patients in rural Thailand. This study recruited 101 older PD patients in the first quantitative phase to investigate health-related quality of life, including physical and mental health and clinical outcomes. The quantitative data revealed that the average age of the study population was 63.63 years, 85.1% had an income below Thailand’s poverty line, 98% had less than three years of education, and approximately 41% received assistance to complete their PD. PD patient participants reported low scores for quality of life measures associated with physical and mental health measures. Forty-nine per cent reported scores on the Geriatric Depression Scale suggestive of depression; most PD patients reported limited difficulty managing their daily activities; however, 12% reported being dependent on one another 23 for washing themselves. Many PD patients presented with pathology results attributed to an increased risk of morbidity and mortality in PD. Twelve PD patients were selected for the second phase to explore their experiences with self-management based on their scores on the HRQOL measure and their history of peritonitis in the previous year. The families of these older PD patients were also interviewed, as were 11 PD and community nurses. Three themes emerged from the patient and family interviews: PD Support, Managing PD Needs and Living with PD. Four themes emerged from the PD and community nurses: Thailand’s PD First Policy, Providing Support, Family Support and Older People are Different. These interviews demonstrated that the patients and their families experienced difficulties managing PD at home, and the nurses supported these findings. A comprehensive discussion integrating quantitative and qualitative data was conducted to enhance the understanding of older PD patients’ self-management in rural Thailand. This discussion outlined the processes and factors that facilitated and/or were barriers to PD self-management in these patients. Recommendations for future research have been provided in many areas to further examine and improve PD self-management, which will positively impact the quality of life and clinical outcomes of these patients.
- Subject
- community-dwelling; rural Thai; peritoneal dialysis; an explanatory sequential mixed-methods
- Identifier
- http://hdl.handle.net/1959.13/1477364
- Identifier
- uon:49970
- Rights
- Copyright 2023 Wassana Kankom
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 594 KB | Adobe Acrobat PDF | View Details Download |