location: nan, 'Thailand 
year: 2020 source: HSRI 
title: Proposed Policy for health management of older persons with Diabetes and Hypertension using health literacy in Primary Care Cluster context: Case study in PCC, Phetchaburi province 
abstract:The development of guideline for health management of the older people with diabetes and hypertension based on health literacy model in the context of Primary Care Cluster (PCC) plays a vital activity for effective control of A1c and blood pressure (BP) levels to decrease or retard the complication occurrence. Currently, there is no approach for promotion of the older people’s health literacy with family participation in health management despite the fact that the family’s role in providing helping and supports in every stage of self-management suits in a Thai context. The primary objective of this study was to examine health management situation of the older people with diabetic and hypertension in the context of PCC ; to develop the survey instrument for assessment the health literacy in health management of the older people with diabetic and hypertension patients in the context of PCC; to assess the effectiveness of health literacy program in health management of the older people with diabetic and hypertension in the context of PCC; and to develop policy recommendations on health literacy in health management of the older people with diabetic and hypertension The sample consists of 140 early older people and stakeholders in PCC. The quantitative and qualitative methods were conducted in this study. Questionnaires and in-depth interviews were used for data collection. The results were founded as follows: 1) The health management mean scores in the older people with diabetes and hypertension was moderate level (x ̅= 2.15). The aspect with the highest mean score was ‘Continuing care’ (x ̅= 2.53), following by aspects with a moderate level of mean score, namely, ‘Stress management’ (x ̅= 2.22), ‘Drug use pattern’ (x ̅= 2.13) and ‘Food consumption behavior’ (x ̅= 2.12). The ‘Exercise’ is the aspect with the lowest mean score (x ̅= 2.01) 2) With regard to health literacy in health management of the older people with diabetes and hypertension in the context of PCC, the overall of health literacy level was found to be insufficient at 52.72% (n= 78) and sufficient at 44.28% (n= 62), respectively. 3) Regarding the effectiveness of health literacy program in health management of the older people with diabetic and hypertension in the context of PCC, the average A1c in the experimental group was lower than the control group with statistically significant differences (p < 0.01). The average systolic blood pressure (SBP) of the experimental group was lower than the control group with statistically significant differences (p < 0.001). Likewise, health management mean scores of the experimental group were higher than the control group with statistically significant differences (p < 0.001). With regard to the health literacy, there were statistically significant differences between the intervention and control groups (p < 0.001).Concerning, the average of A1c, systolic and diastolic blood pressure, as well as health management and health literacy mean scores were significantly higher than before receiving the program at statistic significant level of p < 0.001. Indeed, the average A1c and systolic and diastolic blood pressure was decreased by 7.20%, 16.46% and 18.03%, respectively. In addition, the health management and health literacy means scores were increased by 4.80% and 7.20%, respectively.4) With respect to policy recommendations on health literacy in health management of the older people with diabetes and hypertension, the PCC should enhance family members’ role in providing support and care as well as supervision to older people considering food consumption, exercise and more engagement with physical activities, drug use, stress management and continual self-care. This will eventually enable the older people and his/her family to manage diabetes and hypertension or possible complications.