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.

Health promotion for middle-aged Isan women, Thailand: a participatory approach.

It is increasingly clear that non-communicable diseases (NCDs), including cancer, diabetes, hypertension and atherosclerosis, are important not only for the developed but also the developing world. Prevention efforts depend on community-based interventions and for these to be successful a participatory approach is necessary. The present paper describes experiences with middle-aged females living in a village in Isan, the Northeastern area of Thailand, focusing on the steps necessary to develop trust between researcher and subjects, the actual conditions of the women involved and their problems. From this base a number of interventions are planned taking into account the wishes of the villagers themselves, including a project to facilitate participation in physical exercise, a prime measure for prevention of cancer and other NCDs.