The Development of a Rapid Health Impact Assessment Model for Songkhla Special Economic Zone (SEZ) Policy in Southern Thailand.

BACKGROUND: Rapid Health Impact Assessment (Rapid HIA) for Special Economic Zone (SEZ) has not been undertaken in Thailand. We aimed to develop a Rapid HIA model for policymaking by using Songkhla SEZ as a study model. METHODS: Four-stage of the research and development based on HIA process were used: 1) drafting the model using literature reviews and focus group discussions, 2) collecting additional information from 24 stakeholders, and conducting an in-depth interview with six informants, 3) verifying the model by drawing agreements on the model from 17 related agencies and experts, and 4) confirming the validity of the final model using seven experts. The study were conducted from Jan 2018 to Feb 2019. Content analysis and constant comparison were used to analyze the data. RESULTS: A four-step assessment model was obtained. They included public screening, scoping, assessing, and reviewing and influencing. Public screening is deduced from a meeting with organizations and related personnel. Public scoping is an outcome of literature reviewing and meeting with stakeholders and academics. The assessment step focuses on secondary data from related agencies and a participatory workshop with stakeholders and academics. Finally, a meeting with stakeholders and academics, including internet broadcasting, is the reviewing and influencing process. CONCLUSION: This Rapid HIA model was specifically developed for SEZ policy. Reviewing and influencing steps were combined, whereas the monitoring and evaluation step was removed for further operations. This model depends on the official appointment of the steering committee. HIA practitioners should be experienced academics from higher educational institutions.

Policy Literacy, Barriers, and Gender Impact on Accessibility to Healthcare Services under Compulsory Migrant Health Insurance among Myanmar Migrant Workers in Thailand.

Accessibility to health service and experience of healthcare are important factors for public health policymaking. The current study aimed to describe the status of accessibility and barriers to getting care as well as policy literacy among Myanmar migrant workers and ultimately to identify the predictors of accessibility to healthcare services among this population through Thailand's Compulsory Migrant Health Insurance (CMHI). A cross-sectional survey was used to collect data from 240 Myanmar migrant workers who were 18 years or older, resided in Songkhla Province, and had Compulsory Migrant Health Insurance. The instrument was a set of questionnaires consisting of a Personal Data Form, Policy Literacy Questionnaire, Barriers to Get Care Questionnaire, and Accessibility to Healthcare Services Questionnaire. Descriptive statistics, correlation analysis, and multiple regression analysis were used to analyze data. The majority of participants had a high level of policy literacy (36.3%), barriers to get care (34.2%), and accessibility to health care services (35.8%). Policy literacy (ß = 0.35, p < 0.001), barriers to get care (ß = -0.32, p < 0.001), and gender (p < 0.001) were significant predictors of accessibility to healthcare services and could explain 43.2% of the total variance. To increase the accessibility to healthcare services among migrant workers with Compulsory Migrant Health Insurance, public health policymakers are recommended to cooperate more with healthcare staff and the workers' employers to enhance the distribution of information about the health insurance to decrease barriers to get care.

Exploring caregivers' perspectives on improving care for older people at the end of life in Thailand.

BACKGROUND: Older people in Thailand receive general medical and social care at the end of life, and many rarely access palliative services. In light of this, improving the quality of care for the ageing population relies on addressing the needs of family caregivers, who provide the majority of care in a home setting. Understanding caregivers' perspectives when caring for a friend or relative will help to improve the quality of care that they provide. AIM: To explore caregivers' perspectives on improving care for older people in Thailand in the palliative stage. METHODS: A qualitative study using in-depth interviews and observation of 10 older people in the palliative stage and their caregivers was undertaken. Data were analysed using content analysis. FINDINGS: Data analysis revealed three themes: caregivers cared to repay the older person's previous kindness, caregivers cared and changed their caregiving behaviour to minimise the older person's perception of being abandoned or being a burden, and to follow Thai ancestral traditions, so that the older person could die peacefully. CONCLUSION: This study provides specific instructions for those who provide care for older Thai people in the palliative stage. Finding ways to address caregivers' perspectives on improving care quality could enhance the experience of care recipients.

Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial.

BACKGROUND: Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA. PURPOSE: This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population. MATERIALS AND METHODS: A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs). RESULTS: Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found. CONCLUSION: Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.

The effect of a community-based spiritual life review program on Indonesian elders' resilience

Objective: This quasi-experimental, pre-/post-test study aimed to examine the effect of a community-based spiritual life review program on the resilience of elders residing in a disaster-prone area. Method: Fifty-two participants who met the inclusion criteria were recruited from three villages in the Kutaraja sub-district in Banda Aceh, Indonesia. The participants were randomly assigned to an experimental group and a control group. The participants' names were listed and then randomly selected by a random number generator. The experimental group underwent a community-based spiritual life review program, which included a review of their spiritual lives, the appreciation of feelings, affirmation by the religious leader, a reevaluation of their lives, and a reconstruction of their lives to recognize their memories and present feelings. Results: The elderly resilience scores were evaluated four weeks after the program was implemented. The control group received the same program after the study was finished. The participants in the experimental group significantly improved their resilience levels after completing the program (p < .05). There was a slight increase in the resilience scores from the pre-test to the post-test in the experimental group compared with the control group (p < .05). Conclusions: Future studies should add implementation sessions and avoid photos that would induce participants' traumatic memories or experiences during the spiritual life review

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Supportive Communication to Facilitate Chinese Patients' Adaptation to a Permanent Colostomy: A Qualitative Case Study Approach.

This study, which is a part of action research, aims to explore how supportive communication can impact individuals' adaptation to a permanent colostomy in a Chinese cultural context. Two Chinese rectal cancer patients with complexity and difficulty in living with a permanent colostomy were selected using a qualitative case study approach. The researcher (H.T.) interacted with the participants along their journey from the preoperative period until the third postoperative month after discharge via face-to-face or telephone interviews. Content analysis was applied. Supportive communication was characterized by "communication as a supportive tool," which consisted of 4 elements: respect, description, empathy, and empowerment. The nursing strategies included (1) developing a collaborative relationship with patients and families; (2) understanding patients' concerns and problems; (3) discussing potential solutions; (4) encouraging patients to take action; (5) bringing out emotional expression; (6) normalizing negative emotions; and (7) protecting hope. The findings of this study informed that supportive communication is a valuable tool for nurses to provide informational and emotional support to Chinese patients in order to enhance their adaptation to living with a permanent colostomy. Developing an operational manual to enhance supportive communication for patients with colostomy is suggested.

Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving.

Development and psychometric testing of the active aging scale for Thai adults.

BACKGROUND: Active aging is central to enhancing the quality of life for older adults, but its conceptualization is not often made explicit for Asian elderly people. Little is known about active aging in older Thai adults, and there has been no development of scales to measure the expression of active aging attributes. PURPOSE: The aim of this study was to develop a culturally relevant composite scale of active aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity. METHODS: EIGHT STEPS OF SCALE DEVELOPMENT WERE FOLLOWED: 1) using focus groups and in-depth interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative measures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test-retest reliability. RESULTS: Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach's alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test-retest reliability were confirmed. CONCLUSION: The AAS-Thai demonstrated acceptable overall validity and reliability for measuring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings.

Personal awareness and behavioural choices on having a stoma: a qualitative metasynthesis.

AIMS AND OBJECTIVES: To answer how personal awareness and behavioural choices on having a stoma have been described and interpreted in previous qualitative studies. BACKGROUND: Over the past two decades, there has been an accumulation of the qualitative studies concerning the experiences of individuals living with a stoma. Synthesising the findings of these studies would be able to improve the understanding among health providers. DESIGN: Qualitative metasynthesis. METHODS: The literature was obtained through searching CINAHL and PubMed databases for papers published in English, and China National Knowledge Infrastructure database for papers published in Chinese from 1990-March 2012. Sixteen articles were selected using the predefined criteria. RESULTS: Three themes about personal awareness and behavioural choices on having a stoma were identified: altered self, restricted life and overcoming restrictions. The results showed the impacts of having a stoma through the analysis on connections between personal awareness and behavioural choices. CONCLUSIONS: Having a stoma means that the individuals have to learn to be aware of and accustomed to changes and restrictions in their everyday lives. The individuals take behavioural efforts to overcome these restrictions involving: deciding on whether to reveal or conceal their stomas to others based on the possibility of being accepted or rejected, using internal resources, seeking and receiving external supports. RELEVANCE TO CLINICAL PRACTICE: The description and interpretation on personal awareness and behavioural choices associated with having a stoma is useful for nurses in providing practical, informational and emotional supports to help the individuals successfully adapt to their lives with a stoma.

Using nursing practice guidelines for the prevention of multidrug-resistant tuberculosis among hospitalized adult patients in Bangladesh.

Multidrug-resistant tuberculosis (MDR-TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well-validated clinical guidelines for the prevention of MDR-TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR-TB (NPG: MDR-TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR-TB during pre- and postimplementation of the guidelines. Significant differences between pretest and post-test mean scores of nursing practice for the prevention of MDR-TB in case finding and case holding were found in three levels of wards, including Level 0 (non-TB), Level 1 (TB) and Level 2 (MDR-TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR-TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.

Productive engagement in older adults: a concept analysis.

This study aimed to clarify the concept of productive engagement as it applies to older adults. The concept analysis was based on Walker and Avant's eight-step method. A literature review of articles published in English between 1990 and 2011 (n = 37) was conducted, using an electronic search of multiple sources. Results revealed that four defining attributes for productive engagement include continuing to work either paid or unpaid, caring for others, engaging in social activities, and growing spirituality. The antecedents of productive engagement are sociocultural factors as well as individual and institutional capacities. Meanwhile, the consequences are increased feelings of usefulness, improved health and well-being, aged successfully, and enhanced quality of life. Model, borderline, and contrary cases are presented to illustrate the concept's defining attributes. Defining the concept of productive engagement provides a basis for nurses and other health professionals to better understand productive engagement in older adults, thus effective strategic plans or programs for promoting productive roles among older adults can be further developed.

Electronic learning and constructivism: a model for nursing education.

Nurse educators are challenged to teach nursing students to become competent professionals, who have both in-depth knowledge and decision-making skills. The use of electronic learning methods has been found to facilitate the teaching-learning process in nursing education. Although learning theories are acknowledged as useful guides to design strategies and activities of learning, integration of these theories into technology-based courses appears limited. Constructivism is a theoretical paradigm that could prove to be effective in guiding the design of electronic learning experiences for the purpose of providing positive outcomes, such as the acquisition of knowledge and decision-making skills. Therefore, the purposes of this paper are to: describe electronic learning, present a brief overview of what is known about the outcomes of electronic learning, discuss constructivism theory, present a model for electronic learning using constructivism, and describe educators' roles emphasizing the utilization of the model in developing electronic learning experiences in nursing education.

Beyond MEDLINE for literature searches.

PURPOSE: To describe strategies for a comprehensive literature search. ORGANIZING CONSTRUCT: MEDLINE searches result in limited numbers of studies that are often biased toward statistically significant findings. Diversified search strategies are needed. METHODS: Empirical evidence about the recall and precision of diverse search strategies is presented. Challenges and strengths of each search strategy are identified. FINDINGS: Search strategies vary in recall and precision. Often sensitivity and specificity are inversely related. Valuable search strategies include examination of multiple diverse computerized databases, ancestry searches, citation index searches, examination of research registries, journal hand searching, contact with the "invisible college," examination of abstracts, Internet searches, and contact with sources of synthesized information. CONCLUSIONS: Extending searches beyond MEDLINE enables researchers to conduct more systematic comprehensive searches.

Influences of partners' views of asthma self-management and family environment on asthmatic adults' asthma quality of life.

Influences of partners' views of the adult asthmatic's self-management and family environment were explored from the perspective of a collaborative care system. Adults (N = 172, 86 couples) completed questionnaires: perceived control of asthma, perceived ability to care for self, asthma quality of life (AQOL), and an asthma opinion survey. Significant relationships between perceptions of adults with asthma (AWA) and partners were found (r ranged from.32 to.74). Multiple regression analysis of partners' perceptions on AWA AQOL yielded a 3-factor solution (R(2) = 39%). Family cohesion had a significant effect on AWA AQOL (F [1, 168] = 4.43, p