Enhancing the Quality of Life of Cleft Lip and Palate Patients Through a Home Visit Program: A Case Study of Adolescents Without Primary Caregivers and at Risk of Substance Abuse at the Tawanchai Center, Northeastern Thailand

Abstract

Background and Objective: This study is about the application of primary health care system and comprehensive care on individuals with cleft lip and palate who lack a primary caregiver, are at risk of substance abuse, and have inadequate follow-up treatment. Home visits by a multidisciplinary team to monitor, identify, and address issues are essential for improving their quality of life.

Methods: A descriptive case study to explore and address issues using a home visit program for adolescents with cleft lip and palate who lack primary caregivers and are at risk of substance abuse. This study employs purposive sampling to select participants who have discontinued follow-up care at the Tawanchai Center. The instruments used in the study include a home visit program and four sets of questionnaires: 1) quality of life questionnaire (41 items) 2) children’s depression inventory (CDI), Thai version (27 items) 3) The adolescent coping orientation for problem experience (ACOPE) and the children’s revised impact of event scale (CRIES-13), Thai version (13 items). 4) service user history record from the social work unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The home visits and data collection were conducted over a 3-hour period in November 2024. Descriptive statistics, including percentages, means, and standard deviations, were used to analyze the data.

Results: The study results found that the patient, a 14-year-old male in lower secondary school, had undergone surgical repair for cleft lip and palate. However, a large fistula remained in the alveolar cleft, affecting his speech clarity. He was undergoing orthodontic treatment at the time of assessment. The patient reported moderate satisfaction with quality of life across four dimensions, scoring an average of 3.27 ± 0.6155. The family impact score was also at a moderate level, averaging 2.79 ± 1.1425. Regarding depression, the patient scored 11 points, indicating no depression and normal emotional status at the time of evaluation. For post-traumatic stress, the patient scored 22 points, suggesting no post-traumatic stress disorder (PTSD) and an adequate ability to cope with stress. The patient’s primary caregiver at home was his uncle, while his homeroom teacher accompanied him for follow-up medical appointments. No substance use was reported. However, the living environment was unsafe and unhygienic.

Conclusion: Home visits help uncover the root causes of patients' problems, providing empirical data that can be used to improve their quality of life.