Barriers and Facilitators to Implementing Immediate Postpartum Contraceptive Implant Programs: A Formative Implementation Research.

Objective: This study sought to identify the factors that act as barriers and facilitators to developing and implementing Immediate postpartum (IPP) insertion of contraceptive implants service according to the Consolidated Framework for Implementation Research (CFIR). Methods: We conducted in-depth interviews and focus group discussions to explore IPP contraceptive implantation programs implemented in community, regional, and university hospitals in Thailand. The CFIR was used to guide the data collection and analyses. Results: All CFIR domains were found to have an impact on planning and implementation. Out of 38 constructs, nine were identified as either barriers or facilitators, and four were determined to be both. Barriers included an insufficient training budget, lack of policy to support non-teenagers, disconnect among organizations, and lack of knowledge on the part of the clients. Facilitators included the relative advantage of implants over other contraceptive methods, reimbursement policy, laws that promote teenage autonomy, setting IPP implants as a key performance indicator (KPI), identifying project champions, and educating clients through antenatal counseling or multimedia intervention. Conclusion: Barriers and facilitators to the successful implementation of an IPP contraceptive implant program were identified. In order to successfully implement this service, modifiable barriers should be overcome and facilitators should be strengthened. Strategies tailored to the local context should be developed to ensure the sustainability of the program. Educating clients is crucial and need both hospital- and community interventions.

Community- Based Approaches to Cancer Prevention in Rural Thailand Based on Experiences of Accredited Health Professionals.

This qualitative research aimed to describe important components of community based approaches of cancer prevention from working experiences of accredited health professionals in Thai rural communities. METHODS: Data were collected from 23 communities with 23 accredited health professionals as key participants using in-depth interview and focus group discussions (FGDs) in each community. Other informants were community leaders, community health volunteers and community people. Content analysis was applied for data analysis. RESULTS: Community based approaches for cancer prevention from the experiences of accredited health professionals were composed of 2 themes: approaches for community-based cancer prevention and methods for cancer-based prevention in the community. The approaches for community-based cancer prevention was composed of 4 components: 1) primary prevention focusing on health education; 2) secondary prevention include: life style modification, vaccination, advocacy of cancer screening, early detection, and prompt refer; 3) tertiary prevention focusing on primary care, and 4) research collaboration focusing on net working.  Methods for cancer-based prevention in the community were different based on types of cancer.  The 3 factors determined to be associated with community based approaches for cancer prevention were: 1) primary care policy; 2) hometown workplace; and 3) health practice skill. CONCLUSION: Community based approaches for cancer prevention should concentrate on building a literate community involvement to empower both health care providers and residents. From our evidence, dedicated community associates health professionals have a major role to play.

Using Action Research to prevent work-related illness among rubber farmers in Northeastern Thailand.

OBJECTIVES: This research aimed to enhance self-care among rubber farmers for preventing work-related illness. DESIGN AND SAMPLE: The project used Action Research's four phase iterative process: fact-finding to understand the problems, action planning, action plan implementation, and evaluation and reflection on action plan impacts. Sixty-six participants (46 rubber farmers and 20 community stakeholders) were purposively recruited from two villages in the top 10 rubber producing provinces in Northeastern Thailand. MEASURES: Demographic and work-related illness data were collected in face-to-face structured interviews, Focus group interviews and participant observations were used to collect data in each project phase. Night group meetings were held throughout the research phases. The intervention included training workshops and establishing a community health education team for ongoing farmer support. RESULTS: Results showed improved farmer self-care behaviors and establishment of a community health education team to encourage farmers to care for themselves properly. CONCLUSION: Community nurses, other health personnel, and the Thai government can build on initiatives like this to strengthen occupational health and safety practices and services policy for rubber farmers.

Health behavior after a multiprofessional intervention and training for ongoing volunteer-based community health programme intervention in the North-East of Thailand: what changed and what not?

This qualitative research within the project entitled "Multiprofessional Intervention and training for Ongoing Volunteer-based Community Health Programs in the Northeast of Thailand (MITV-NET) " was aimed at explaining changes of health behavior of community people in the Northeast after the intervention. The participants comprised 15 community volunteers and 27 villagers. Data were collected by indepth interview, focus group discussion, participation and non-participation observation, and note taking. Analyses were conducted in parallel with data collection, through content and comparative analysis. It was found that the health behavior fell into 2 categories: easy-to-change and difficult-to-change. The former involved fun activities joined by community people that improved their health or made them recover from illnesses after a short period without becoming addicted. These activities could be done by themselves, for example, exercising and cooking. The difficult-to- change health behavior is habitual, for example, chewing betel nuts or eating uncooked food. The following factors were found affecting behavioral changes: 1) underlying disease; 2) enjoyment in doing activities; 3) habitual behaviour; 4) improved health in a short period; 5) ability of community leaders and volunteers; and 6) community health-supporting resources. It is suggested that improving people's health requires cooperation of community people through fun activities and some initial external support. People who persist in bad habits should be encouraged to stop by showing them health deteriorating effects.

Evaluation of health education in the Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme in the north-east of Thailand.

This was a survey research conducted in Northestern Thailand during 2009-2010 and designed to evaluate the success of a health education program by comparing levels of health knowledge in the community before and after the launching of a Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme. The survey questionnaire included items about demographic characteristics and health knowledge. The participants were 1,015 members of various communities, who were randomly selected to be included in the survey before launching the intervention, and 1,030 members of the same communities randomly selected to be included in the survey after the intervention was completed. The demographic characteristics of both groups were similar. Overall knowledge and knowledge of all the diseases, except lung and cervical cancer, were significantly higher after the intervention. In conclusion, a Volunteer-based Community Health Programme has advantages for areas where the numbers of health personnel are limited. The use of trained community health volunteers may be one of the best sustainable alternative means for the transfer of health knowledge.

Situation analysis of risk factors related to non-communicable diseases in Khon Kaen Province, Thailand.

A descriptive cross-sectional study was carried out in Khon Kaen Province during January 1 to June 30, 2008. The aims were to assess: (1) the prevalence of risk factors for chronic diseases such as cancer, diabetes, blood pressure; and (2) health behaviour and health education needs. There were 338 sample subjects aged between 20-60 years, from urban, semi-urban and rural areas. Some 20.4 % of the sample subjects reported that they were unhealthy (10.4% diagnosed with hypertension, 9.8% with diabetes, and 0.9% with cancer). For history of illness in the family, the most common were diabetes (42%), high blood pressure (16.5 %) and cancer (14.8 %), and 66.9% reported stress within the last 6 months. In terms of risk behavior, 82.3% of males smoked cigarettes but only 1.9% of females. The respective figures for alcohol were 68.4% and 26.6%. The majority (61.2) had low physical activity (sitting or standing, little movement). Almost one third (32%) reported testing positive for Opisthorchis viverrini eggs in stool. For health education needs, 64.2%, 54.7% and 42.6% wanted to learn more about cancer, diabetes and hypertension, respectively. For means of health education delivery, 31.7% want to learn from medical doctors, 20.4% from TV, 16.3% from village's broadcasting and 13.6% from health volunteers. Suitable means to delivery health education are needed to convey knowledge to the population. Community health volunteers may be one of the best sustainable alternative methods to transfer knowledge.

Use of lay health workers in a community-based chronic disease control program.

The increasing burden of non-communicable diseases in the developing world, and in particular diabetes, cancer and circulatory diseases, is an unfortunate fact of life. At the same time infection-related diseases, including sexually transmitted HIV-AIDS and HPV-dependent cervical cancer, remain important. One approach to alleviating the resultant stress on national health provision is to expand the knowledge base at the community level with contributions by lay health workers (LHWs). Here we take a brief look at the available literature and propose a model for intervention incorporating two way dialogue with the general populace to find effective means to package expertise in the medical/research community for lay consumption. Our argument is that particular attention should be paid to socioeconomic and behavioural aspects and to disease surveillance at the local level in order to be able to accurately assess the impact of interventions. For this purpose, we need to marshal volunteers from within communities taking account of their problems and motivations. Included are provision of assistance in setting up physical exercise programs, quit tobacco campaigns, alcohol awareness programs, running disease screening exercises and general help by providing advice as to risk and protective factors and clinical treatments, with an special focus on palliative care.

Early experience of sexual intercourse--a risk factor for cervical cancer requiring specific intervention for teenagers.

There is consensus that the main risk factor for cervical cancer development is persistent infection with high-risk group human papilloma viruses (HPVs), together with smoking, and reproductive history. Since sexual behaviour determines exposure to HPVs and the adolescent period may be particularly important in this regard it is of interest to consider behavioural determinants of teenagers. In one survey conducted in Khon Kaen, Thailand, some 62% percent of male and 19.3 % of female respondents aged 13-15 years reported having experienced sexual desire, and 19.1% of male and 4.7 % of female respondents admitted to sexual intercourse. The possibility that this might impact on HPV infection rates, with added risk due to the physical trauma associated with pregnancy and illegal abortions, indicates that more attention needs to education of early teens, not only for avoidance of HIV and AIDS, but also for prevention of cervical cancer.

Adolescent sexual health behavior in Thailand: implications for prevention of cervical cancer.

Since adolescents are now engaging in sexual activity in their early years, sexual behavior needs to be explored to prevent contact with HPVs and other sexually transmitted diseases (STD), including cervical cancer. This qualitative study aimed to explore this question from adolescents' view points in their natural context. The participants were 19 individuals aged 13-19 years living in rural families in Khon Kaen province, Thailand. The preliminary findings indicated that factors contributing to low sexual risk behavior were helping family to do housework, an emphasis on learning, listening to parents, and following their advice. Adolescent behavior leading to high sexual risk included being very close to friends, having a wide social circle, going out for enjoyment at night time, returning home late at night, drinking alcohol, smoking, paying less attention to learning, not listening to parents, and not following their advice. Adolescent sexual behavior was found to comprise: 1) sexual activities themselves; 2) non-disclosure of having sex; and 3) protective behavior. Sexual activities were ranked from low risk to high risk of sexual health. Low risk included having a steady boy/girlfriend, hugging, and kissing. High risk sexual behavior featured unprotected sex, abuse or rape, and abortion. Important influences were: eagerness to learn and try to have sex, mens' sexual desire, peer group value of having sex, and material value. The adolescents demonstrated no willingness to disclose having a boy/girl friend, having sex and negative consequences like becoming pregnant. Sexual protective behavior was up to males, whether they were willing to use a condom, with females having little power to negotiate. The study suggests that inappropriate adolescent risk behavior and social values need to be a focus of attention for education. In particular, families need to take action by early detection of adolescent sexual risk behavior.