03/20/2026
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Chakrit Sattayarom on "Predictors of Rational Use of Medicines among Older Adults with Type 2 Diabetes Visiting Primary Care Units in Thailand."

Date: Friday, April 3, 2026
Time: 9 a.m.-noon
Location: This will be a virtual defense via Zoom. Those interested in attending should contact Chakrit_Sattayarom@student.uml.edu and committee chair Comfort_Enah@uml.edu at least 24 hours prior to the defense to request access to the meeting.

Committee

  • Comfort Enah, Ph.D., RN, FAAN. Donna Manning Endowed Chair and Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell
  • Ramraj Gautam, Ph.D., FAGHE. Teaching Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell
  • Jason Rydberg, Ph.D. Associate Professor, School of Criminology and Justice Study, University of Massachusetts Lowell

Abstract

Introduction: The aging population and growing burden of type 2 diabetes mellitus (T2DM) have increased polypharmacy, regimen complexity, and medication-related harms in primary care. In Thailand, primary care units (PCUs) are the main setting where older adults with T2DM receive ongoing prescriptions, refills, and counseling. For Thai older adults living with T2DM who use PCUs, rational use of medicines (RUM) is therefore an essential practical process that can enhance health outcomes. . However, evidence on RUM in Thailand using multilevel frameworks remains
limited.

Aims: This dissertation aimed to (1) synthesize evidence on multilevel factors associated with RUM among older adults with T2DM using the Socio-Ecological Model (SEM) and (2) test SEM-level predictors of RUM among older Thai adults with T2DM visiting PCUs in Thailand.

Designs: An integrative review and a quantitative cross-sectional study.

Methods: The integrative review followed Whittemore and Knafl’s approach and searched six databases (2015–2025). Included studies were appraised using the Mixed Methods Appraisal Tool (MMAT) and synthesized by SEM levels. The cross-sectional study recruited 242 older adults (60–80 years) with T2DM from PCUs in Suphan Buri Province, Thailand. Measures assessed intrapersonal factors (e.g., RUM knowledge, health literacy, health beliefs), interpersonal support, patient–provider communication, access to healthcare, and perceived clinical practice guidelines/drug regulation. Data were analyzed using descriptive statistics, bivariate tests, and five-block hierarchical multiple regression aligned with SEM levels.

Findings: The integrative review included 17 studies and showed that RUM is shaped by interacting determinants across all SEM levels, including health literacy/knowledge and beliefs
(intrapersonal), family support and communication (interpersonal/institutional), access and community resources (community), and affordability and regulation (policy). In the survey, participants’ mean age was 69.57 years (SD = 4.14), and the mean RUM score was 51.92 (SD = 11.04). Age was negatively associated with RUM, while knowledge, health literacy, health beliefs, family/social support, patient–provider communication, access to healthcare, and perceived guideline/regulation were positively associated with RUM. In the final hierarchical model, these multilevel predictors explained substantial variance in RUM (R² = 0.74; adjusted R² = 0.71). Older age and female gender were negative predictors, whereas income, education, knowledge, health literacy, health beliefs, family/social support, communication, access, and perceived guideline/regulation were positive predictors (p < .01).

Conclusion: RUM among Thai older adults with T2DM is best understood as a multilevel behavior. Practical improvement in PCUs should combine literacy-sensitive education and belief-focused counseling with caregiver engagement, communication strengthening, improved access, and consistent guideline/regulatory messaging. This integrated direction supports safer medication use and can reduce medication-related harm in older adults living with T2DM.

Keywords: rational use of medicines; type 2 diabetes mellitus; older adults; primary care; Social Ecological Model