Main Article Content
The success of changing the behavior of a person requires motivation and readiness
to change of behavior. The purpose of this cross-sectional research was to examine
1) the effect of possible selves on self-management behavior and hemoglobin A1C
controlling for the effect of diabetes knowledge 2) the effect of stage of change on
self-management behavior and hemoglobin A1C controlling for the effect of diabetes
knowledge and3) the effect of interaction between possible selves and stage of change
on self-management behavior and hemoglobin A1C controlling for the effect of diabetes
knowledge. The total sample of 340 type II diabetes patients receiving treatment at
health promotion hospital, Chanthaburi province. The data collection tools consisted of
1) demographic data questionnaire 2) possible selves questionnaire 3) stage of behavior
change questionnaire 4) self-management questionnaire and 5) diabetes knowledge
questionnaire. All instruments were validated by 3 experts and tried out with 20 type II
diabetes patients. The content validity was between 0.87-1 and the reliability between
was .76-.89. The data were analyzed using descriptive statistic and two way MANCOVA.
The results revealed that: 1) there was no effect of possible selves on self-management
behavior and hemoglobin A1C controlling for the effect of diabetes knowledge (Wilks
Lambda= .983, F = 1.051, p=.380) 2) Stage of change signifcantly affected self-management
behavior and hemoglobin A1C when controlling for the effect of diabetes knowledge
(Wilks Lambda= .715, F = 48.142, p <.001) and statistically signifcant difference both selfmanagement behavior (F= 90.910, p<.001, hp2 = .272) and hemoglobin A1C (F = 7.229,
p=.008, hp2 = .029) and 3) Interaction between possible selves and stage of change did
not signifcantly affect self-management behavior and hemoglobin A1C when controlling
for the effect of diabetes knowledge (Wilks Lambda= .996, F = .271, p=.896).
The results of this study confrm that the stage of change inﬂuence self-management
behavior and hemoglobin A1C. Therefore, the healthcare provider should apply the stage
of change approach to modify health behavior of type 2 diabetic patients to control
their hemoglobin A1C.
1. International Diabetes Federation.
Diabetes Atlas (8thed.). Online version
of IDF Diabetes Atlas. [cited 2017
Dec 8]. Available from fle:///D:/My%
2. Bureau of Non Communicable Diseases.
Annual report 2015. Bangkok: Offce
of the Veterans Organization Printing
Offce, under the Royal Patronage;
2016. (in Thai)
3. Mcleod ME. Care of Patients with Diabetes
Mellitus. In: Ignatavicius DD, Workman
LM, editors. Medical-Surgical Nursing:
Patient-Centered Collaborative Care
(6thed.). St.Louis: Saunders Elsevier;
2010. p. 1465-1525.
4. National Statistical Offce. Number of
Deaths Classifed by Cause of Death
and Sex 2007-2014. [cited 2017 April
1]. Available from http://thaincd.com/
information-statistic/non-communicabledisease-data.php?pn=2. (in Thai)
5. Bureau of Policy and Strategy Ministry
of Public Health. Summary of Illness
Report 2014. Bangkok: Offce of the
Veterans Organization Printing Offce,
under the Royal Patronage; 2015.
6. Markus H, Nurius P. Possible Selves.
Am Psychol. 1986; 41(9), 954-69.
7. Prochaska JO, Velicer WF. The
Transtheoretical Model of Health
Behavior Change. Am J Health Promot.
1997; 12(1), 38-48.
8. Chapman-Novakofski K, Karduck J.
Improvement in Knowledge, Social
Cognitive Theory Variables, and
Movement Through Stages of Change
After a Community-Based Diabetes
Education Program. J Am Diet Assoc.
2005; 105(10), 1613-16.
9. Yu P, Xiao X, Wang L, Wang L. Correlation
between Self-Management Behaviors
and Blood Glucose Control in Patients
with Type 2 Diabetes Mellitus in
Community. J Cent South Univ (Med
Sci); 38(4), 425-31.
10. Rotheram-Borus MJ, Ingram BL,
Swendeman D, Adabel Lee A. Adoption
of Self-Management Interventions for
Prevention and Care. Prim Care. 2012;
11. Bains SS, Egede LE. Associations between
Health Literacy, Diabetes Knowledge,
Self-Care Behaviors, and Glycemic
Control in a Low Income Population
with Type 2 Diabetes. Diabetes Technol
Ther. 2011; 13(3), 335-41.
12. Suphunnakul P, Sirinual S, Chayodom
V, Singhadej, O. A Causal Relationship
Model of Factors Inﬂuencing Glycemic
Control among the Elderly with Type
2 Diabetes Mellitus in Sukhothai
Province, Thailand. J Pub Health Dev.
2017; 15(2), 31-42. (in Thai)
13. Hair Jr JF, Black WC, Babin BJ, Anderson
RE. ANOVA and MANOVA. Multivariate
Data Analysis: A Global Perspective
7ed. Upper Saddle River: Pearson
Education, Inc; 2010. p. 439 - 502.
14. Horneffer-Ginter K. Stages of Change
and Possible Selves: 2 Tools for
Promoting College Health. J Am Coll
Health. 2008; 56(4). 351-8.
15. Dunkel C, Kerpelman J. Possible Selves:
Theory, Research, and Application. NY:
Nova Science; 2006.
16. Hooker K, Kaus CR. Possible Selves and
Health Behaviors in Later Life. J Aging
Health. 1992; 4(3), 390-411.
17. Olarikkachat T, Jittanoon P, Srikeaw
M. The Effect of a Behavioral Change
Promotion Program on Health Behaviors
and Blood Lipid of Hotel Staff with
Journal of Nursing. 2016; 36(Sup),
99-116. (in Thai)
18. Cotrell V, Hooker K. Possible Selves of
Individuals with Alzheimer’s Disease.
Psychol Aging. 2005; 20, 285-94.
19. Aloise-Young PA, Hennigan KM, Leong
CW. Possible Selves and Negative Health
Behaviors during Early Adolescence. J
Early Adolescence. 2001; 21(2), 158-81.
20. Sattanako C, Sota C. Effects of Self
Management Program on Glycemic
Control in Patients with Type 2 Diabetes.
Journal of Nursing and Education. 2017;
10(4), 32-47. (in Thai)