Subgroup Behaviors and Factors Influencing Compliance With COVID-19 Preventive Measures Among Undergraduate Students in Southern Thailand.

Objective: To investigate clusters of students' COVID-19 preventive behaviors and their associated factors. Methods: We surveyed undergraduate students using an online questionnaire at a regional university in southern Thailand, between April and June 2022. Statistical analyses included latent class analysis and multinomial regression analysis. Results: Three latent classes were identified: moderately consistent practitioner (7.5%), high compliance overall (48.9%), and good compliance with routine safeguards (43.6%). Females tended to have high compliance overall (RRR 2.46 95% CI 1.23-4.94), and higher academic performance was associated with high compliance overall and good routine safeguards. Perceived threats from COVID-19 were associated with good compliance with routine safeguards (RRR 4.21 95% CI 1.70-10.45). Benefits of actions and clear cues to action were associated with high overall compliance (RRR 5.24 95% CI 2.13-12.90). Students who perceived feasibility were more likely to be moderately consistent practitioners. Conclusion: The common clusters of the students' preventive behaviors were high compliance overall and good compliance with routine preventions. Female, academic performance, perceived threats, and perceived benefits and cues to action were associated with compliance.

Effect of online infographics for enhancing health literacy among patients with type 2 diabetes in primary care unit during the COVID-19 pandemic: a randomized controlled trial.

BACKGROUND: Health literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM. METHODS: This randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher's exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar's chi-square tests were used. RESULTS: The median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups. CONCLUSIONS: Novel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion. TRIAL REGISTRATION: The Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study.

BACKGROUND: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. OBJECTIVE: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. METHODS: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (≥23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. RESULTS: Of the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. CONCLUSIONS: The MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals.

Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge.

BACKGROUND: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. OBJECTIVE: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. METHODS: A secondary data analysis was performed using data collected from the "MED PSU×ThaiSook Healthier Challenge," a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). RESULTS: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was -3.85% (IQR -3.40% to -4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of -1.08% (IQR -2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). CONCLUSIONS: More than half of the "MED PSU×ThaiSook Healthier Challenge" participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction.

Prevalence and Associated Factors of Delayed Diagnosis of Type 2 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Cohort Study.

Objective: To determine the prevalence and associated factors of delayed diagnosis of type 2 diabetes mellitus (DM) among outpatients in a tertiary hospital. Methods: This retrospective cohort study was conducted among outpatients aged ≥35 years with twice fasting plasma glucose (FPG) levels ≥126 mg/dl between 1 January 2018, and 31 December 2020. The prevalence and pattern of delayed diagnosis of DM were defined using the Thai Clinical Practice Guideline (CPG) for Diabetes, 2017, and the American Diabetes Association (ADA) 2017. The cut-off time for FPG level confirmation of 3 months was used to evaluate delayed diagnoses and associated factors. Multiple logistic regression was used to identify variables associated with delayed diagnoses. Results: Of 260 participants, 96.9% and 85.4% had delayed diagnoses as defined by the Thai CPG and the ADA, respectively. Factors significantly associated with delayed diagnosis were hypertension, non-cash insurance, and >10 years of physician experience. Conclusion: Undiagnosed diabetes and diagnosis delay should be a concern in tertiary settings. Senior physicians should focus on patients with higher FPG levels, particularly those who have hypertension, and use non-cash insurance schemes.

Changes in preventive behaviour after COVID-19 vaccination in Thailand: a cross-sectional study.

BACKGROUND: Protective behaviours (e.g., mask-wearing, handwashing, avoiding social gatherings) and mass vaccination are effective ways to control the coronavirus disease 2019 (COVID-19) pandemic. Previous studies found that people who get vaccinated may change their protective behaviours. The Thai government has endorsed several mix-and-match vaccine regimens to eliminate the insufficiency of each vaccine brand. This study aimed to determine levels of protective behavioural changes after COVID-19 vaccination and its relationship with various vaccine regimens in Thailand. METHODS: A descriptive cross-sectional study was conducted between September 13, 2021, and January 14, 2022. Data were collected using an online questionnaire distributed via social media platforms and posters in public places in Thailand. The questionnaire comprised six items for demographic characteristics, seven items for COVID-19 vaccine regimens, and four items for protective behaviours. The vaccinated Thai population aged ≥ 18 years were surveyed. Statistical analyses included a Chi-squared test, Wilcoxon signed rank test, and multivariate logistic regressions. RESULTS: Of the 469 participants, more than half were females (67.4%), single (57.4%), and lived in an urban area (67.2%). Significant differences were observed with regard to median scores in handwashing (5.0 vs. 5.0, p-value < 0.001), physical distancing (4.0 vs. 5.0, p-value = 0.019), and avoiding social activity (4.0 vs. 5.0, p-value = 0.010) in pre- and post-vaccination situations. Approximately 70-90% of the participants did not report changes in protective behaviours after vaccination. Overall, 17.4%, 13.9%, and 12.7% of participants showed improvements in avoiding social activity, physical distancing, and handwashing respectively. Multivariate analysis revealed that improvements in protective behaviours were significantly associated with the age group (between 18 and 24 years), non-healthcare worker status, and those who lived in urban areas. No significant evidence of vaccine regimens was found relative to improved protective behaviours. CONCLUSION: This evidence revealed that Thai people maintain their protective behaviours after vaccination but rather improved them. Moreover, demographic data were significantly associated with improved protective behaviours, but various vaccine regimens were not. These findings might be useful for implementing policies to maintain personal protective behaviours after vaccination against COVID-19.

Self-Reported COVID-19 Vaccine Hesitancy and Willingness to Pay: A Cross-Sectional Survey in Thailand.

This study aimed to estimate the prevalence and influencing factors of COVID-19 vaccine hesitancy and willingness to pay in Thailand. A descriptive cross-sectional study was conducted from 13 September 2021 to 14 January 2022. Data were collected using an online questionnaire consisting of demographic characteristics, COVID-19 vaccine hesitancy (delay in acceptance and denying vaccination), determinants of vaccine hesitancy (complacency, convenience, and confidence), and willingness to pay. The general Thai population aged ≥18 years were surveyed. Among 705 respondents, 10.4% reported hesitancy, with significant determinants being low complacency and confidence in the vaccine; low convenience was not a significant determinant. Multivariate analysis revealed vaccine hesitancy among women, those with higher education, non-healthcare workers, and those who lived in rural areas. Furthermore, 77.2% of respondents were willing to pay, with the majority willing to pay in the range of THB 501-1000 ( USD 1 = THB 33) per dose. Increased monthly income, no impact of COVID-19 on income, and time period (before mRNA vaccine availability) significantly affected willingness to pay.

Effectiveness of Innovation Media for Improving Physical Distancing Compliance during the COVID-19 Pandemic: A Quasi-Experiment in Thailand.

To flatten the curve of COVID-19 infections, with no effective pharmacological interventions or vaccine available in the imminent future, public health responses must continue to rely on non-pharmacological interventions. We developed three innovation media to promote physical distancing compliance (i.e., a fearful picture, a red one-way arrow sign, and a norm-speech sticker). This study aimed to compare physical distancing compliance between our interventions and conventional interventions. Our study was a quasi-experiment, and we observed a representative sample of university canteen customers via closed-circuit television (CCTV). Each intervention was monitored over non-prime-time hours, per day, on 6-9 August 2020. Among the 400 participants (100 participants in each group), their age group, gender, and physical distancing practices were observed in a university canteen. The number of failures of physical distancing ranged between 93.8% and 17.6%, and on average between 84.2% and 34.2%, dependent on the intervention and the marking point. There were no statistically significant differences in promoting physical distancing compliance between our interventions compared with conventional interventions. However, the participants tended to practice physical distancing at the back of the queue more than at the front, regardless of the interventions.