The challenges faced by this study included:
1. The closeness between VHVs and patients
had sometime caused problems in providing
supports because of the lack of confdence in VHVs
or the patients took the supports lightly. To solve
such problems, VHVs asked for supports from health
staff who confrmed with the patients the advice of
the VHVs.
2. Peers inclined to use direct support which
may cause dependency among the patients. The
competencies in assessing the patients’ conditions
and empowering skills needed to be enhanced among
VHVs.
3. Seasonal variation had great impacts on
patients’ self-care behaviors. About 40% of them were
farmer and their daily routine including eating and
sleeping schedules had changed and reduced during
planting and harvesting seasons and made it diffcult
for them to maintain self-care behaviors.