Self-assessment of attitudes towards conditions to provide safe abortion among new medical graduates in Thailand, 2018: an application of cross-sectional survey with factor analysis.

BACKGROUND: Unsafe abortion is one of the major public health problems in Thailand. Although the penal code of Thailand and the Thai Medical Council permit doctors to perform safe abortion in certain conditions, little is known about the attitudes that new medical doctors have towards abortion. The objectives of this article are to explore the attitudes towards abortion in certain conditions among new medical graduates and to identify factors related to those attitudes. METHODS: A cross-sectional survey was conducted in 2018 among 2017 medical graduates who attended the annual workplace selection forum. The participants came from the two main tracks of admission to Thai medical schools: normal track and special track physicians, namely, the Collaborative Project to Increase Production of Rural Doctors (CPIRD). Of these 2017 graduates, 926 returned the questionnaire with complete information. Descriptive analysis, factor analysis, and multi-variable regression analysis were performed. RESULTS: We found that most physicians agreed to perform abortions in the context of life-threatening conditions for mothers and children, but not under conditions directly related to physical health (such as pregnancy with socioeconomic problems or pregnancy in adolescents). CPIRD doctors were less amenable than normal track doctors in providing abortions if the reason for the termination of pregnancy was related to socioeconomic problems. CONCLUSION: The study suggests that a proactive campaign for new medical graduates to raise awareness and mutual understanding of abortion services should be exercised. The CPIRD curricula relating to safe abortion should enhance the capacity of medical graduates to deal with pregnant women who face not only a physical health-related problem, but also socioeconomic difficulties and well-being as a whole.

Healthcare providers' perspectives on integrating NCDs into primary healthcare in Thailand: a mixed method study.

BACKGROUND: In response to an increased health burden from non-communicable diseases (NCDs), primary health care (PHC) is effective platform to support NCDs prevention and control. This study aims to assess Thailand's PHC capacity in providing NCDs services, identify enabling factors and challenges and provide policy recommendations for improvement. METHODS: This cross-sectional mixed-method study was conducted between October 2019 and May 2020. Two provinces, one rich and one poor, were randomly selected and then a city and rural district from each province were randomly selected. From these 4 sites in the 2 provinces, all 56 PHC centres responded to a self-administrative questionnaire survey on their capacities and practices related to NCDs. A total of 79 participants from Provincial and District Health Offices, provincial and district hospitals, and PHC centres who are involved with NCDs participated in focus group discussions or in-depth interviews. RESULTS: Strong health infrastructure, competent staff (however not with increased workload), essential medicines and secured budget boost PHC capacity to address NCDs prevention, control, case management, referral and rehabilitation. Community engagement through village health volunteers improves NCDs awareness, supports enrolment in screening and raises adherence to interventions. Village health volunteers, the crucial link between the health system and the community, are key in supporting health promotion and NCDs prevention and control. Collaboration between provincial and district hospitals in providing resources and technical support enhance the capacity of PHC centres to provide NCDs services. However, inconsistent national policy directions and uncertainty related to key performance indicators hamper progress in NCDs management at the operational level. The dynamic of urbanization and socialization, especially living in obesogenic environments, is one of the greatest challenges for dealing with NCDs. CONCLUSION: PHC centres play a vital role in NCDs prevention and control. Adequate human and financial resources and policy guidance are required to improve PHC performance in managing NCDs. Implementing best buy measures at national level provides synergies for NCDS control at PHC level.

A cross sectional study of unmet need for health services amongst urban refugees and asylum seekers in Thailand in comparison with Thai population, 2019.

BACKGROUND: Although the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population. METHODS: A cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n = 2941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past 12 months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need. RESULTS: Overall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1 and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations. CONCLUSION: The prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.

Extreme exploitation in Southeast Asia waters: Challenges in progressing towards universal health coverage for migrant workers.

Rapeepong Suphanchaimat and colleagues present the plight of migrant workers in the fishing industry in Southeast Asia and discuss challenges in providing for their health and safety.

Building the evidence base for stigma and discrimination-reduction programming in Thailand: development of tools to measure healthcare stigma and discrimination.

BACKGROUND: HIV-related stigma and discrimination (S&D) are recognized as key impediments to controlling the HIV epidemic. S&D are particularly detrimental within health care settings because people who are at risk of HIV and people living with HIV (PLHIV) must seek services from health care facilities. Standardized tools and monitoring systems are needed to inform S&D reduction efforts, measure progress, and monitor trends. This article describes the processes followed to adapt and refine a standardized global health facility staff S&D questionnaire for the context of Thailand and develop a similar questionnaire measuring health facility stigma experienced by PLHIV. Both questionnaires are currently being used for the routine monitoring of HIV-related S&D in the Thai healthcare system. METHODS: The questionnaires were adapted through a series of consultative meetings, pre-testing, and revision. The revised questionnaires then underwent field testing, and the data and field experiences were analyzed. RESULTS: Two brief questionnaires were finalized and are now being used by the Department of Disease Control to collect national routine data for monitoring health facility S&D: 1) a health facility staff questionnaire that collects data on key drivers of S&D in health facilities (i.e., fear of HIV infection, attitudes toward PLHIV and key populations, and health facility policy and environment) and observed enacted stigma and 2) a brief PLHIV questionnaire that captures data on experienced discriminatory practices at health care facilities. CONCLUSIONS: This effort provides an example of how a country can adapt global S&D measurement tools to a local context for use in national routine monitoring. Such data helps to strengthen the national response to HIV through the provision of evidence to shape S&D-reduction programming.

A final-year nursing student survey: rural attitudes, perceived competencies and intention to work across five Asian countries.

BACKGROUND: Shortages and maldistribution of nurses remain significant problems in many countries. Having appropriate intervention strategies to retain nurses in underserved areas, where they are most needed, are crucial for health system strengthening. This study aimed to quantify attitudes to working in rural areas, perceived competencies, and intention to work among final-year nursing students, and to analyze the associations between those factors and their background characteristics across five countries in the Asia-Pacific Network for Health Professional Education Reforms (ANHER), namely Bangladesh, China, India, Thailand, and Vietnam. METHODS: A descriptive comparative cross-sectional survey was conducted between July 2012 and July 2013, using a self-administered questionnaire to assess students' attitudes towards working in rural areas, their perceived competencies, and their intended job choices. A total of 10,169 final-year nursing students in five countries were selected. Bivariate models were constructed to compare students' characteristics. Statistically significant variables were further analyzed using multivariate models. RESULTS: Most nursing students in five countries had rural backgrounds. Students in India (67.1%) and Thailand (65.1%) held more positive attitudes towards working in rural areas. Students in Bangladesh (78.8%) and India (62.6%) believed that their schools prepared them well, and inspired them, to work in rural areas. The 'Lifelong learning' competency was ranked highest by students in all five countries, ranging from 76.2 to 91.7%. Their perceived competencies were significantly related to their background of having graduated from rural high schools and being admitted to study through rural recruitment. Rural upbringing and rural recruitment were significantly associated with more positive attitudes towards rural areas (p-value < 0.5). A majority of students in China (83.8%), Thailand (67.7%) and Vietnam (86.5%) intended to work in the public sector immediately after graduation. CONCLUSIONS: These findings from five Asian countries confirm that nursing students with rural upbringing and recruitment had more positive attitudes toward rural areas and were more likely to choose working in rural areas after graduation. This study provides additional evidence from country implementation to support the value of WHO recommendations of effective strategies to address issues of rural retention by focusing on the recruitment of students with a rural background.

Factors associated with the choice of public health service among nursing students in Thailand.

BACKGROUND: Despite the fact that public and private nursing schools have contributed significantly to the Thai health system, it is not clear whether and to what extent there was difference in job preferences between types of training institutions. This study aimed to examine attitudes towards rural practice, intention to work in public service after graduation, and factors affecting workplace selection among nursing students in both public and private institutions. METHODS: A descriptive comparative cross-sectional survey was conducted among 3349 students from 36 nursing schools (26 public and 10 private) during February-March 2012, using a questionnaire to assess the association between training institution characteristics and students' attitudes, job choices, and intention to work in the public sector upon graduation. Comparisons between school types were done using ANOVA, and Bonferroni-adjusted multiple comparisons tests. Principal component analysis (PCA) was used to construct a composite rural attitude index (14 questions). Cronbach's alpha was used to examine the internal consistency of the scales, and ANOVA was then used to determine the differences. These relationships were further investigated through multiple regression. RESULTS: A higher proportion of public nursing students (86.4% from the Ministry of Public Health and 74.1% from the Ministry of Education) preferred working in the public sector, compared to 32.4% of students from the private sector (p = <0.001). Rural upbringing and entering a nursing education program by local recruitment were positively associated with rural attitude. Students who were trained in public nursing schools were less motivated by financial incentive regarding workplace choices relative to students trained by private institutions. CONCLUSIONS: To increase nursing workforce in the public sector, the following policy options should be promoted: 1) recruiting more students with a rural upbringing, 2) nurturing good attitudes towards working in rural areas through appropriate training at schools, 3) providing government scholarships for private students in exchange for compulsory work in rural areas, and 4) providing a non-financial incentive package (e.g. increased social benefits) in addition to financial incentives for subsequent years of work.

A literature review: the role of the private sector in the production of nurses in India, Kenya, South Africa and Thailand.

BACKGROUND: The demand for nurses is growing and has not yet been met in most developing countries, including India, Kenya, South Africa, and Thailand. Efforts to increase the capacity for production of professional nurses, equitable distribution and better retention have been given high strategic priority. This study examines the supply of, demand for, and policy environment of private nurse production in four selected countries. METHODS: A scoping systematic review was undertaken to assess the evidence for the role of private sector involvement in the production of nurses in India, Kenya, South Africa, and Thailand. An electronic database search was performed, and grey literature was also captured from the websites of Human Resources for Health (HRH)-related organizations and networks. The articles were reviewed and selected according to relevancy. RESULTS: The review found that despite very different ratios of nurses to population ratios and differing degrees of international migration, there was a nursing shortage in all four countries which were struggling to meet growing demand. All four countries saw the private sector play an increasing role in nurse production. Policy responses varied from modifying regulation and accreditation schemes in Thailand, to easing regulation to speed up nurse production and recruitment in India. There were concerns about the quality of nurses being produced in private institutions. CONCLUSION: Strategies must be devised to ensure that private nursing graduates serve public health needs of their populations. There must be policy coherence between producing nurses for export and ensuring sufficient supply to meet domestic needs, in particular in under-served areas. This study points to the need for further research in particular assessing the contributions made by the private sector to nurse production, and to examine the variance in quality of nurses produced.

Psychosocial Problems Among Primary School Children in Thailand During the COVID-19 Pandemic, 2022.

Background: During the COVID-19 pandemic, primary school children are particularly vulnerable as restriction measures have caused a huge impact on their health and well-being. This study aims to assess the prevalence of mental health among primary school children in Thailand during the COVID-19 pandemic and identify factors associated with psychosocial problems. Methods: A survey was conducted among 701 Thai parents of primary school children from January to March 2022 - when teaching modalities between onsite and online learning were alternated. Parents were requested to assess the mental health of their youngest child at primary school age level. Psychosocial problems were measured by the Strengths and Difficulties Questionnaire (SDQ) with a total score of 40, based on 4 domains (emotion, behavior, hyperactivity, and relationship). Independent variables included (1) parental/household factors, (2) children characteristics, and (3) online learning-related issues. The dependent variable was the prevalence of children with a total score of 14-40, which indicates at risk and/or having mental health problems. The analysis was performed using logistic regression model. Results: Thai parents reported that 41.1% of children had psychosocial problems. Children in a single-parent family (adjusted odds ratio [AOR] = 1.7; 95% confidence interval (CI) = 1.1-2.8), male children (AOR = 1.7, 95% CI = 1.2-2.4), and children who did not receive adequate assistance for online learning from their parents (AOR = 2.1, 95% CI = 1.1-4.0) significantly faced greater odds of mental health problems. Conclusion: The prevalence of Thai primary school children confronting psychosocial difficulties during the COVID-19 pandemic increased, with significant concern. Public health interventions that aim to protect the mental health of primary school children during the pandemic should be introduced and targeted male children and those living with a single parent. Social support that facilitates online learning for children whose parents have limited capacity in supporting them should be implemented.

Self-Reported Anxiety and Depression among Parents of Primary School Children during the COVID-19 Pandemic in Thailand, 2022.

One significant concern during the COVID-19 pandemic is parents' mental health, which may consequently affect children's health and well-being. The objective of this study is to investigate generalized anxiety and depression in parents of primary-school-aged children and identify risk factors for mental health problems. A cross-sectional survey comprising 701 parents of primary school children in five of Thailand's major provinces was carried out from January to March 2022. Generalized anxiety and depression levels were assessed using the GAD-7 and PHQ-9. Logistic regression was performed to determine the effects of independent variables on anxiety and depression. Results showed that the prevalence of generalized anxiety and depression was 42.7% and 28.5%, respectively, among Thai parents. Three strong associative factors included: (1) having a youngest child with mental health problems; (2) not assisting their children every day; and (3) drinking alcohol. These findings show that the parents must deal with several difficulties when trying to maintain work and parenting duties while being confined at home during emergency situations. The government should provide sufficient assistance to parents who lack skills in handling children with emotional and behavioral problems. Meanwhile, health promotion to reduce alcohol consumption should continue to be an area of focus.

Characteristics of distance education interventions and related outcomes in primary school children during COVID-19 pandemic: A systematic review.

The COVID-19 pandemic containment measures such as school closures remarkably disrupt the educational system, from in-person learning to remote or distance education with different interventions. This study aimed to identify the characteristics of interventions in remote or distance education during the COVID-19 pandemic and evaluate the outcomes of each intervention. A systematic review was conducted between October 2021 and May 2022 using four databases. Finally, 22 studies met the eligibility criteria and were included for data analysis. Most of the interventions were synchronous student-centered approaches followed by asynchronous student-centered approaches and mixed-learning through online channels such as desktop- and web-based modality. Remote or distance education is effective in academic development in any learning approach while having mixed effects in student attitudes and perceptions. Academic-related behaviors were most engaged by students in synchronous student-centered approaches. Finally, difficulties or burdens, and mental health or social interaction were similar for all learning approaches in technological problems and support systems from families and teachers. Synchronous student-centered approaches should be the main method of education, but other approaches can be used to complement based on the students' needs. Finally, educational infrastructure and support from teachers and parents are also necessary in remote or distance education. Further studies are needed to focus on primary school students, especially in low-income regions, and apply a randomized study design.

Access to Healthcare and Social Protection among Migrant Workers in Thailand before and during COVID-19 Era: A Qualitative Study.

Thailand is a popular host nation for international migrant workers, particularly those from Cambodia, Lao PDR, and Myanmar. Thailand has introduced approaches to protect their rights for health and social welfare, using various mechanisms over many years. However, the implementation of these policies is dynamic and has been influenced by national security, economic necessity, and public health concerns. The aim of this study was to explore how Thailand designs and implements health and social welfare policies for migrants in Thailand, both before and during COVID-19. A qualitative analysis was used alongside interviews with 18 key informants in various sectors in this field. Thematic coding was applied. Results show that there were seven key themes emerging from the analysis, including: (i) sustainability of the HICS; (ii) people dropping out from the Social Security Scheme (SSS); (iii) quality of health screening in the Memorandum of Understanding (MOU) migrants; (iv) health screening problems and state quarantine management in response to COVID-19; (v) managing the migration quota and dependency on migrant workers; (vi) influx of migrants in the backdrop of COVID-19; and (vii) poor living conditions of migrants and the impact of COVID-19. The majority of interviewees agreed that undocumented migrants is a critical concern that impedes access to migrants' health and social welfare. This situation was especially pronounced during the second wave of COVID-19 in Thailand, which took hold in migrant communities. In the short term, the poor living conditions of migrants urgently need to be addressed in order to contain and mitigate this crisis. In the long term, there needs to be an improved health system design that includes migrants, regardless of their immigration status. This requires intersectoral policy coherence, including the hastening of nationality verification to sustainably mitigate undocumented migrants.

Family Health among Families with Primary School Children during the COVID Pandemic in Thailand, 2022.

Despite evidence suggesting that the COVID pandemic has negatively affected the mental health and well-being of school aged children and parents, there are limited studies describing the state of family well-being. This study aimed to use the family health lens to assess the well-being of Thai families with primary school children and to identify its associated factors. A cross-sectional survey was conducted during January and March 2022, a period of school closure when onsite education was replaced by online education from time to time. The family health scale (FHS) questionnaire survey was carried out among 701 parents of Thai families with primary school children. The questionnaire comprised 10 questions regarding family belief, health, relationships, financial security, and housing environment. Independent variables included: (1) parental/household factors; (2) online learning related issues; (3) children's mental health; and (4) parents' health behaviors. Multinomial logistic regression was undertaken. Results showed that half of Thai families (54.6%) reported having moderate health status. Factors that were associated with lower levels of family health, such as poor or moderate levels, included families with a child that had mental health problems (adjusted odd ratio (AOR) = 5.0 [95% CI = 2.6-9.5] for poor v. excellent, and AOR = 2.7 [95% CI = 1.9-4.0] for moderate v. excellent), single parents (AOR = 2.5 [95% CI = 1.2-5.2] for poor v. excellent), a higher number (≥3) of children (AOR = 2.1 [95% CI = 1.0-4.0] for moderate v. excellent), and smoking parents (AOR = 6.5 [95% CI =1.2-34.8] for poor v. excellent). During health emergencies, health policy for providing adequate assistance to single parents, especially those that have a child with mental health problems, is of utmost importance. The design of health promotion activities and interventions should be targeted not only at single families, but also families with higher numbers of children and parents who smoke at home.

Analysis of Policies to Protect the Health of Urban Refugees and Asylum Seekers in Thailand: A Qualitative Study and Delphi Survey.

The health of urban refugees and asylum seekers (URAS) in Bangkok has been neglected and health policies for USAR have not materialized. This study aimed to explore the views of stakeholders on policies to protect URAS well-being in Thailand. This study conducted a mixed-methods approach comprising both in-depth interviews and Delphi survey. The interview findings revealed six main themes: (1) the government position on URAS; (2) opinions on Thailand becoming a party of the 1951 Refugee Convention; (3) NGOs on health promotion for URAS; (4) options on health insurance management for URAS; (5) working potential of URAS; and (6) uncertainty of future life plans for URAS. The Delphi survey showed that URAS should have the right to acquire a work permit and be enrolled in the public insurance scheme managed by the Ministry of Public Health. Moreover, the ideology of national security was more influential than the concept of human rights. The ambiguity of the central authorities' policy direction to take care of URAS creates haphazard legal interpretations. The Delphi survey findings suggested the need for a more inclusive policy for URAS, however actual policy implementation requires further research on policy feasibility and acceptance by the wider public.

Health Status and Barriers to Healthcare Access among "Son-in-Law Westerners": A Qualitative Case Study in the Northeast of Thailand.

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands' health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers' observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals' quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

Situation of Self-Reported Anxiety and Depression among Urban Refugees and Asylum Seekers in Thailand, 2019.

Academic evidence on the health of urban refugees and asylum seekers (URAS) in Thailand is extremely sparse, especially for neglected problems such as mental health disorders. This study aimed to investigate the prevalence of anxiety and depression and factors associated with these problems among URAS in Bangkok. A cross-sectional study was conducted in 2019. The URAS were randomly selected from the roster of the Bangkok Refugee Centre (BRC). A self-administered questionnaire was used and 180 samples were recruited. Descriptive statistics and multivariable logistic regression were used for the analysis. We found a prevalence of 70.0% for anxiety and 39.5% for depression. Compared to Southeast Asia and China, URAS from other regions were 3.4 times (95% CI 1.5-7.5, p < 0.05) and 4.0 times (95% CI 1.1-14.0, p < 0.05) more likely to experience anxiety and depression, respectively. URAS with chronic co-morbidities (OR = 3.4, 95% CI 1.2-9.4, p < 0.05) and being divorced or widowed (OR = 11.1, 95% CI 2.1-57.2, p < 0.05) faced greater odds of depression than those without co-morbidities and being single. Related health authorities should play a proactive role in providing mental healthcare services for URAS, with greater consideration for those of certain nationalities and with chronic diseases.

Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014-2018.

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014-2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05-1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

Access to Non-Communicable Disease (NCD) Services Among Urban Refugees and Asylum Seekers, Relative to the Thai Population, 2019: A Case Study in Bangkok, Thailand.

BACKGROUND: The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially in the area of chronic non-communicable diseases (NCD). The objectives of this study were to i) examine NCD prevalence; ii) access to NCD services; and iii) factors associated with access to NCD services among urban refugees and asylum seekers (URAS) in comparison with the Thai population. METHODS: A cross-sectional study, using a self-administrative questionnaire adapted from the Thai Health and Welfare Survey (HWS), was conducted in 2019. URAS were randomly selected from the register of the Bangkok Refugee Center. One hundred and eighty-one URAS participated in the survey. The data were combined with 2941 Thai records from the HWS. The population scope was confined to Bangkok. Bivariate analysis by Chi-square, Fisher's exact, and Mann-Whitney U-tests was conducted to examine difference in demographic and access to NCD services between URAS and Thais. Multivariable logistic regression was performed to identify factors associated with access to NCD services. RESULTS: Overall, URAS were young, less educated, and poorer than Thais. The trend of NCDs was similar to the Thai population, except mental health disorders appeared to be more prevalent in URAS. Almost half of the URAS did not receive any formal treatment. Being insured, abiding with Buddhism, and living in more affluent households were factors associated with better access to NCD services. URAS from Asian countries had greater access to NCD care than those from non-Asian countries. CONCLUSION: Policymakers should consider expanding the insurance coverage to URAS, similar to coverage for Thai populations. Additional studies on refugees' health status and service utilization in other settings outside Bangkok are strongly recommended.

A Cross-Sectional Study on Disparities in Unmet Need among Refugees and Asylum Seekers in Thailand in 2019.

The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially on the topic of unmet need. The aim of this study is to examine the level of unmet need among URAS in Thailand, focusing on out-patient (OP) and in-patient (IP) care. A cross-sectional study was conducted between October and December 2019. Stratified random sampling was undertaken and a total of 181 participants were included. A bivariate analysis was used to explore the level of unmet need among different URAS groups. Multivariate logistic regression was undertaken to examine the association between potential correlations and unmet need of IP and OP care. The majority of participants were female and aged below 30 years, with a low educational background and poor economic status. Most of them had experienced an illness in the past month before the interview, and some suffered from chronic diseases. The prevalence of both OP and IP unmet needs was more frequent among URAS from Arab countries. Furthermore, being from Arab countries indicated a strong link with OP and IP unmet need. Additionally, having illness over the past six months and chronic diseases were found to be significant determinants of IP unmet need. Our analysis showed that nationality had a strong association with both IP and OP unmet need, especially among those from Arab countries. Therefore, culturally appropriate health services should be considered to promote healthcare access among diverse groups of URAS. Further qualitative studies on barriers to accessing OP and IP care, such as communication, interpretation, and social dimensions, are required.

Health Literacy and Its Related Determinants in Migrant Health Workers and Migrant Health Volunteers: A Case Study of Thailand, 2019.

Migrant health workers (MHWs) and migrant health volunteers (MHVs) are key health workforce actors who play a substantial role in improving the health of migrants in Thailand. The objective of this study was to explore the factors associated with health literacy in MHWs and MHVs in Thailand. A self-administered questionnaire was conducted from December 2018 to April 2019 in two migrant-populated provinces. A total of 40 MHWs, 78 MHVs, and 116 general migrants were included in the survey. Results showed that a higher education level was associated with a greater health literacy score. MHWs were more likely to have a higher health literacy score (5.59 points difference) than general migrants. The province per se and type of affiliations did not significantly contribute to the difference in the health literacy score of each individual. Most MHWs received health information from health professionals, health staff, and the internet, while MHVs and general migrants received information from health professionals, MHWs/MHVs, family/friends, and posters/leaflets. This study suggests that a higher education level should be used as a criterion for recruitment of MHWs and MHVs. Access to interactive health information like health professionals should be promoted as the main source of information to ensure better health literacy among MHWs and MHVs.