Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children.

OBJECTIVES: To implement and evaluate the effectiveness of the community participatory program between school and family based on ecological system theory and participatory action research. The intervention covers three levels at the individual, family and school levels and involves educating students and parents by using technology, reducing sedentary behaviours, increasing exercise and changing to healthy food environments at school and at home. DESIGN: A quasi-experimental design was used in this study. SETTING: Public primary school in Thailand. SUBJECTS: The participants in the study included 138 school-age children in grades 2-6 with their parents/guardians. The control group consisted of 134 school-age children at a school of the same size with their parents/guardians. RESULTS: Results show that nutritional status was significantly improved within the experimental group (P value = 0·000) and between groups during follow-up (P value = 0·032). Students' knowledge about obesity and non-communicable chronic diseases (NCD) prevention, as well as physical activity and exercise behaviours, in the experimental group was significantly higher than that in the control group (P value = 0·000 and 0·044, respectively). Parents' perceptions of child obesity and family modelling behaviours in the experimental group were also significantly higher than that in the control group; P value = 0·013 and 0·000, respectively). CONCLUSION: The community participation program was found to be successful. Not only students, families and schools improved health behaviours and healthy food environments at home and school, but the students' long-term nutritional status also improved.

Culturally-grounded mother-daughter communication-focused intervention for Thai female adolescents.

Teenage pregnancy-prevention interventions have fallen short in significantly decreasing risk of pregnancy for Thai populations. The "breaking the voice" ("rak luk khun tong pood") culture-appropriate teenage pregnancy-prevention program was developed using community-based research. Qualitative analyses of focus group data identified salient factors related to sexual communication and behavior. The integration of focus group results with theoretical constructs guided the development of an intervention to reduce risky sexual behavior by increasing communication between mothers and their adolescent daughters. A total of 157 mother-daughter dyads from congested areas in Bangkok participated in pilot testing of the intervention by the use of a survey. The findings indicated a significant increase in the frequency of and number of sexual risk communication (P < .05). There was a significant increase in perceived power in relationship control, ability to prevent sexual risk, assertiveness, and ability to decrease sexual risk among daughters (P < .05). "Breaking the voice" represents a female-focused and culturally-relevant intervention to combat teenage pregnancy.

Promoting the Wellness of Older Adults through Integrated Health-Promoting Programs and Supportive Peers: A Quasi-Experimental Study in Semi-Urban Communities of Northeastern Thailand.

INTRODUCTION/OBJECTIVES: Thailand has approached an aged society in which the proportion of older adults rose from 5% in 1995 to 20.7% in 2022 and is projected to increase to 27.2% in 2030. Older adults face health risks and challenges, requiring supportive care. This research aimed to promote the wellness of older adults through Integrated Health-Promoting Programs and Supportive Peers (IHPP-SP) in semi-urban communities. METHODS: A one-group pretest-posttest quasi-experimental study was conducted among 229 older adults from 22 communities. The interventions covered analyzing community situations and determinants, designing and developing IHPP-SP, enhancing the capabilities of supportive peers, and establishing a support system. Mean and proportion differences were analyzed using the paired t-test and McNemar test. RESULTS: After implementing IHPP-SP, the mean score significantly increased for happiness (P = .004), Activities of Daily Living: ADLs (P = .034), and family support (P < .001), but did not differ regarding depression (P = .413). The proportion of healthy behaviors significantly increased for tobacco use (P = .035), dietary intake (P = .018), and physical activity (P < .001), but not for alcohol consumption (P = .377). CONCLUSIONS: The IHPP-SP provided potential benefits to promote the wellness of older adults.

A Transtheoretical Model-Based Online Intervention to Improve Medication Adherence for Chinese Adults Newly Diagnosed With Type 2 Diabetes: A Mixed-Method Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is increasing in China, with medication non-adherence being a significant contributor to uncontrolled T2DM. The Transtheoretical Model (TTM) has shown effectiveness in chronic disease management, but few studies have applied it in online interventions for T2DM medication adherence. AIM: The study aimed to develop and investigate the effects of a TTM-based online health education program on promoting positive stage of change (SOC) movement, improving self-efficacy and medication adherence, as well as reducing HbA1c levels in newly diagnosed patients with T2DM. METHODS: This sequential mixed-method study was conducted from April 2023 to March 2024. Using the TTM framework, the study initially explored 32 participants' experiences with hypoglycemic medications, health information acquisition, and perspectives on online programs. Then, a quasi-experimental study design was conducted. Two communities were randomly assigned as the intervention (n = 91) and comparison (n = 98) groups, with 189 newly diagnosed middle-aged T2DM patients from various SOC. The intervention group received short videos health education and participated in WeChat group discussions, compared with usual care in the comparison group. Data were collected at baseline, 3-month, and 6-month follow-ups. RESULTS: The intervention group was more likely to achieve positive SOC movement (P < .001, Adj OR = 13.69 95% CI = 6.76-27.71) compared to the comparison group. The intervention group also had significantly higher mean CDMSS-11 and MMAS-8 scores at 6 months (P = .03 and <.001, respectively) and more likely to achieve clinically significant glycated Hemoglobin (HbA1c) change at 3 months (P < .001, Adj OR = 3.91, 95% CI = 1.77-8.63) and at 6 months (P < .001, Adj OR = 5.62, 95% CI = 2.70-11.69) compared to the comparison group. CONCLUSION: These findings support that applying the TTM to develop an online program could promote behavior change, improve self-efficacy and medication adherence, and could lead to better glycemic control in newly diagnosed T2DM patients.

Factors influencing happiness of the grandmothers raising grandchildren in rural areas of Northern Thailand.

OBJECTIVE: To study the factors influencing happiness of grandmothers raising grandchildren in the rural areas of Northern Thailand. MATERIAL AND METHOD: Cross-sectional survey research was conducted among 400 grandmothers, aged 50-79 years, who raised their grandchildren in the rural areas of Northern Thailand. Participants were selected by cluster sampling. Data were collected through a structured interview from April to July 2009 and analyzed by frequency, percentage, Pearson product moment correlation coefficient, and Multiple regression analysis. RESULTS: Nearly half (46.8%) of grandmothers raising grandchildren had high level of happiness, followed by moderate level (40.4%) and low level (12.8%). The factors, which significantly influenced the happiness of the grandmothers, were self-esteem, social support, and family relationships (p-value < 0.05). In addition, self-esteem, social support, and family relationships could significantly predict happiness of the grandmothers by 48.1%. Self-esteem had the highest predictive power of happiness among grandmothers. CONCLUSION: The factors influencing happiness of grandmothers raising grandchildren were self-esteem, social support, and family relationships. To promote happiness of grandmothers, responsible organizations should establish activities that enhance the grandmother's self-esteem, provide sufficient social support, and promote good family relationships.

Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial.

Objective: To examine the effectiveness of a family-based program for post-stroke patients and their families. Methods: A cluster randomized controlled trial design was used. Participants were randomly selected in the experimental group (3 districts) and the comparison group (3 districts), with 62 families recruited. Sixty-two persons with new stroke and families (family caregivers and family members) who met the inclusion criteria were assigned to two groups, 31 in each group. Using the Neuman System Model as a framework, we implemented the stressors assessment and family-based intervention into the program. Participants in the comparison group received usual care, and those in the experimental group underwent a stressors assessment and received the family-based program. Measurement of functional status, depression, and complications in post-stroke patients and family function in family caregivers and family members, as well as caregiver burden and caregiver stress in family caregivers, were assessed at baseline, 4 weeks, and 12 weeks after enrollment. Data analysis included descriptive statistics, the chi-square test, Bonferroni test, and repeated measures analysis of variance. Results: After participating in a 12-week family-based program, post-stroke patients in the experimental group showed statistically significant improvements in their functional status and decreased depression compared to the comparison group (P < 0.05). The family function of the experimental group was significantly improved, and caregivers' burden and stress were decreased compared to the comparison group (P < 0.05). Three patients in the experimental group and seven in the comparison group experienced complications. Conclusions: The study findings suggest that the present family-based program improved family function in family caregivers and family members and decreased caregiver burden and stress in family caregivers. The program also improved functional status and reduced depression in post-stroke patients. It is suggested the duration of the program be extended to assess its sustainable effectiveness.

Effectiveness of Program to Slow Progression of Chronic Kidney Disease Among T2DM With HT With CKD 3 in the Community: A Randomized Controlled Trial.

Chronic kidney disease (CKD) is a significant threat to the quality of life of the global population. Thus, slowing kidney disease progression is considered vital in the treatment of CKD patients. The study aimed to evaluate the effectiveness of a program designed to slow the progression of CKD among Type 2 diabetes mellitus patients with HT with stage 3 CKD (CKD 3) in Thailand by adopting the information-motivation-behavioral skills (IMB) model and applying technology. This study was conducted as a cluster randomized controlled trial. The program activities comprised: (i) providing disease information and teaching behaviors to slow the progression of kidney disease to patients and family members via a 2-h session; (ii) teaching practical behavioral skills for appropriate diet and exercise to patients and family members via a 2-h session; (iii) enhancing personal motivation via the Line application and motivational interviewing via telephone calls; (iv) enhancing social motivation with the support of a family member; (v) employing technology to monitor behaviors and increase patient motivation; and (vi) assessing behaviors that were not practical, exploring barriers to behavior modification, and teaching further practical behavioral skills via the Line application. The data were analyzed using percentages, means, standard deviations, chi-square tests, t-tests, and a 2-way repeated-measures analysis of variance. The results showed that after the experiment, the experimental group had significantly higher mean scores in terms of knowledge, perceived benefits, perceived severity, self-efficacy, and behaviors to slow the progression of kidney disease than the control group (P < .05). Further, the experimental group had significantly better clinical outcomes (SBP, DBP, eGFR, BUN, creatinine, albuminuria, FBS, and HbA1c) than the control group (P < .05). In summary, the findings indicate that the program improved clinical outcomes, especially kidney function, effectively slowing the progression of kidney disease.

The physical health and self-esteem of the grandmother raising grandchildren in rural areas of Thailand.

OBJECTIVE: To study the physical health and self-esteem, including factors that influence the self-esteem of grandmothers raising grandchildren in the rural areas of Northern Thailand. MATERIAL AND METHOD: A cross-sectional survey research was conducted among 400 grandmothers, aged 50-79 years, who raised their grandchildren in the rural areas of Northern Thailand. Participants were selected by cluster sampling. Data were collected through a structured interview from April to July, 2009 and analyzed by frequency, percentage, Pearson's product moment correlation coefficient and multiple regression analysis. RESULTS: 73.8% of grandmothers in the survey currently had health problems, 56.2% had a chronic disease of which hypertension was the most common and yet 44.5% displayed high self-esteem. The factors identified as influencing self-esteem were family relationships, age and social support. These factors provided 35.4% in predicting the self-esteem of grandmother who raised grandchildren with family relationship had the highest predictive value. CONCLUSION: The present study suggested the responsible organizations should organize the program to strengthen the family relationship and social support activity for the grandmother that will lead to the better health and heightening self-esteem.

Effectiveness of a model of risky sexual behavior prevention among adolescent boys in Thailand.

The objectives of this study were to identify predictable factors affecting risky sexual behavior and to evaluate the effectiveness of a risky sexual behavior prevention program among boys one and two months after the program. The Information-Motivation-Behavioral skills (IMB) model program was carried out among 74 adolescent boys aged 10-13 years and 74 of their parents in Phitsanulok Province, Thailand. Repeated analysis was employed to analyze the program's effectiveness. After the program, mean scores for comfort in talking about sex, self-efficacy, and skills in condom use increased significantly (p<0.05), and mean scores regarding knowledge about sexually transmitted infections and skills in decision making decreased significantly (p<0.05) compared to baseline. Boys participating in this program improved their condom use skills and comfort talking about sex at two months follow-up (t=3.82, p<0.001; t=3.10, p=0.003, respectively). These results provided evidence for applicability of a prevailing theory-based intervention within the local cultural context.

Development of a model for parent-adolescent daughter communication about sexuality.

This study aimed to develop a model for parent-adolescent daughter communication about sexuality (PDCS). The subjects were 18 mother-doughter pairs. The females were 12-13 years old studying in the 7th grade of a secondary school in Bangkok. The model had 3 parts: (1) the process of PDCS development, (2) the essential components, characteristics and patterns of PDCS and (3) the impact of the program. The model was examined using both quantitative (paired t-test) and qualitative (content analysis) methods. The inputs, assessing the guardian and adolescent female factors, included sexuality knowledge, understanding of the daughter's sexual development, attitudes regarding talking about sexuality, perceptions regarding communication and the maternal-daughter relationship, and uncomfortable feelings and confidence in ability to talk about sexuality. The processes included: (1) raising awareness and enhancing positive attitudes about PDCS, (2) establishing sexual knowledge and development, (3) establishing a maternal-daughter relationship and (4) training in reciprocal PDCS skills. The output was modification of maternal and daughter communication skills that occurred during the shared discussion and reflection process. The outcomes reflected 4 aspects: feelings toward PDCS, characteristics of PDCS, sexual knowledge, and maternal-daughter relationship. The model was successful in guardian implementation and networking were established on their own with the cooperation of both subjects in accordance with their likenesses, abilities, and competencies. There was little assistance needed from the researcher or teacher to support self reliance with the PDCS.

Differences of sexual behavior predictors between sexually active and nonactive female adolescents in congested communities, Bangkok metropolis.

OBJECTIVE: To test the differences among the predictors between sexually active and non-active female adolescents. STUDY DESIGN: Descriptive research. MATERIAL AND METHOD: The participants included 581 Thai female adolescents: 262 sexually non-active and 319 sexually active (average age = 19.7 years). They completed questionnaires measuring self-discrepancy, depression, power in relationships (decision making dominance and relationship control), sexual self-efficacy (ability to say no, assertiveness, precaution), cognitive strategies (gain thinking: relationship, development, curiosity; punishment avoidance thinking: negative consequence, ethical-related, fear-related), and sexual behavior. The t-test and the Hierarchical Regression were employed for data analyses. RESULTS: Among the sexually active, 68.8% had vaginal or anal sexual intercourse (11.7%) without using a condom. Significant enabling predictors among the sexually active included sexual self-efficacy (precaution), and gain thinking (relationship), whereas punishment avoidance thinking (negative consequence) had a negative influence: it accounted about 11.0%. Among sexually non-active, alcohol consumption, power in a relationship (decision making dominance), and gain thinking (relationship) accounted for 26.9% of the variance in explaining sexual behavior. CONCLUSION: A specific link between sexual self-efficacy and cognitive strategies will be drawn to develop a program for the sexually active. Implications for behavioral modification addressing alcohol drinking and power in a relationship should be discussed among the sexually non-active.

Risk behaviors for HIV/AIDS among youth in rural area of Myanmar.

In some areas of Myanmar up to 1.8 percent of young people aged 15-24 are living with HIV. This study was to describe risk behaviors on HIV/AIDS among youth in rural area of Myanmar. Multistage random sampling was used. A sample of 210 youths aged 15-24 were interviewed. Majority of respondents (70%) were in low level of HIV/AIDS risk behavior. Among those who had sex experiences (30%), more than half had sex before marriage, only 15.9% of them always use condom and 27% of them have had more than one partner. Age, marital status, occupation, monthly income and level of knowledge were found to be significantly associated with level of risk behaviors. Education programs on HIV prevention should be conducted extensively among youths as community based program and also in schools to reinforce health promoting behaviors.

Blood lead level and blood pressure of bus drivers in Bangkok, Thailand.

This study aims to evaluate blood lead level (PbB) and blood pressure of bus drivers in Bangkok, Thailand, after the phasing out of lead in gasoline. The subjects comprised of 439 male bus drivers whose age ranged between 23 and 59 yr with the mean age of 42 +/- 8 yr. Average working experience was 10 +/- 7 yr. The mean of the systolic and diastolic blood pressure were 131 +/- 17 and 81 +/- 11 mmHg, respectively. PbB ranged from 2.5 to 16.2 microg/dl with the mean PbB of 6.3 microg/dl. Prevalence rate of systolic and diastolic hypertension among bus drivers were 23.0% and 18.2%, respectively. There were significant correlations between PbB and blood pressure both in systolic and diastolic blood pressure after controlling for age, BMI, alcohol consumption, smoking and physical exercise. However, the data on psycho-social factors which may affect on blood pressure of bus drivers were not available. Therefore, further study is needed to clarify the relationship between blood pressure and psycho-social stress among bus drivers in Bangkok. These findings suggested lead exposure at low PbB is related to increases in blood pressure.

A Community Based Program for Family Caregivers for Post Stroke Survivors in Thailand.

PURPOSE: The purpose of this study was to evaluate the effectiveness of the post-stroke care program within the community setting in Thailand. METHODS: This quasi-experimental study was a nonequivalent control group pre-test and post-test design. A total of 62 pairs of post-stroke patients and their family caregivers were recruited to the study (31 pairs per group). The intervention consisted of a four-week program that included distributing pertinent information, providing skill practice during post-stroke care sessions and utilizing strategies to enhance motivation and behavioral skills of family caregivers based on the information-motivation-behavioral skills model. The family caregivers' post-stroke care skills were evaluated. The patients' activities of daily living (ADLs) and complications were evaluated at baseline and immediately and 2-month post-intervention. Statistical analysis included chi-square test, Fisher's exact test, independent t-test, and two-way repeated measures' analysis of variance. RESULTS: After participating in the program, family caregivers in the experimental group significantly improved their post-stroke care knowledge and skills as compared to those in the control group (F = 585.81, p < .001). ADLs among post-stroke patients in the experimental group significantly increased over time and were higher than those in the control group (F = 46.01, p < .001). Moreover, complications among patients in the experimental group were less than those in the control group. CONCLUSIONS: The post-stroke care program improved family caregivers' post-stroke care skills which resulted in improved functional status and decreased complications among post-stroke patients.

Sexuality among women recipients of a pancreas and kidney transplant.

Significant improvements in health and quality of life generally follow organ transplantation; however, there is evidence that women who have received transplants experience difficulty with sexual function. The specific nature and extent of this difficulty has not been documented. The purpose of this study was to describe sexual functioning and sexual self-esteem among women recipients of a simultaneous pancreas and kidney transplant. Perceived effect of the transplant on sexuality was also explored. Participants completed a questionnaire that measured their sexual functioning (including sexual difficulties), sexual self-esteem, illnesses, medications, and perceived effect of the transplant on sexuality. Data analysis revealed that only 39% of the women would be classified as having normal sexual functioning. The majority reported either some difficulty with sexual function (34%) or sexual dysfunction (27%). About one third of the women reported that transplantation had only positive effects on their sexuality, whereas 28% reported negative effects, and 29% reported no effect.

Situational factors involved in college students' safer and risky sexual encounters.

OBJECTIVE: To ascertain the differences between the situational factors of risky and safer sexual encounters in college students. DESIGN: Descriptive. SETTING: Community-dwelling college students from a large Midwestern university. PARTICIPANTS: Participants were 84 college students ages 18 to 20 years. Fifty-five were female (67.5%), the majority (95.2%) were White, and all reported being heterosexual. MAIN OUTCOME MEASURE: Use of safer or risky practices in last or most memorable sexual encounter. RESULTS: Important situational characteristics of safer encounters were negative ambiance of the place, type of partner, unattractive qualities of the partner, communication with the partner, and having the encounter because of feeling desire. Important situational characteristics of risky encounters were a cozy ambiance, partner's attractiveness inducing desire, asking directly for the encounter, and encounters occurring after celebration or partying. CONCLUSIONS: Many characteristics were similar for both risk groups. However, practitioners can tailor interventions to make clients aware of factors that were more prevalent in risky sexual encounters, such as having the encounter with a boyfriend or girlfriend and having an encounter after drinking alcohol and partying.

The diamond level health promoting schools (DLHPS) program for reduced child obesity in Thailand: lessons learned from interviews and focus groups.

Overweight and obesity prevalence among children is increasing globally. Health promoting school policy has been initiated in Thailand to tackle this problem. The schools that best conduct obesity management programs are rated as diamond level health promoting schools (DLHPS). However, the methods used by these schools and their efficacies have not been well-documented. This qualitative study aims to analyze the processes and activities used by four DLHPSs in obesity management programs. In-depth interviews were used to obtain information from school directors, teachers, and cooks, whereas focus group discussions were used for students. School-based obesity management programs have resulted from health promoting school policy and the increasing prevalence of overweight students. Teamwork has been a key strategy in program implementation. Policy diffusion and division of labor have been effected by school directors. A monitoring process is put in place to ensure program delivery. The most evident success factor in the present study has been intersectoral cooperation. Challenges have included confusion about the criteria in obtaining the DLHPS status, parental involvement, and students' resistance to consume vegetables and other healthy foods. From the student focus groups discussions, three activities were most valued: class health and nutrition learning; provision of healthy foods and drinks, together with removal of soft drinks and seasoning from the cafeteria; and exercise for health. Intersectoral cooperation is the key success factor for the operationality of DLHPS, especially in making healthy foods available and physical activity the norm, at school and home.

Helping teachers conduct sex education in secondary schools in Thailand: overcoming culturally sensitive barriers to sex education.

PURPOSE: The purpose of this quasi experimental study was to evaluate the effects of Culturally Sensitive Sex Education Skill Development, a teacher-led sex education program in secondary schools in Thailand. METHODS: Two public secondary schools in the suburban areas of Bangkok were randomly selected. One was designated as the experimental school and the other as the comparison school. Ninety grade seven and eight teachers, 45 from each school, were selected to participate in the study. Self efficacy theory and culturally appropriate basis were applied to develop the program which included 4 weeks of intervention and 2 weeks of follow up. Primary outcomes were attitudes toward sex education, perceived self efficacy, and sex education skills. Statistical analysis included independent and paired t test, and repeated one-way analysis of variance. RESULTS: At the end of the intervention and during the follow-up period, the intervention group had significantly higher mean scores of attitudes toward sex education, perceived self efficacy, and sex education skills than their scores before (p < .001), and than those of the comparison group (p < .001). CONCLUSION: The results showed that Culturally Sensitive Sex Education Skill Development could enhance attitudes and sex education self efficacy to promote the implementation of sex education among teachers.

Sexual behavior model among young Thai women living in slums in Bangkok, Thailand.

There has been a dramatic drop in age at first intercourse and concurrent rise in HIV infections among young Thai women living in slums. The participants included 492 young Thai women (average age = 19.7 years). They provided detailed self-perception, emotion, sexual self-efficacy, cognitive strategies, and power in relationships. Logistic regression analysis was used to explore sexual behavior model. Findings highlight the extreme vulnerability of Thai female adolescents who engage in risky sexual behaviors: 55.8% were sexually active with 41.8% having vaginal sex without using condom. Significant enabling factors included perceived ability to precautions (odds ratio [OR] = 1.7), relational gain thinking (OR = 1.5), and curious gain thinking (OR = 1.3). The significant protective factors were decision-making dominance (OR = 0.3), perceived ability to say no (OR = 0.7), and ethical-related punishment avoidance thinking (OR = 0.8). These findings contribute to greater understanding of factors involved in sexual risk taking. Implications for behavioral modification addressing cognition and power in relationships are discussed.