Using the Health Belief Model to Predict Tuberculosis Preventive Behaviors among Tuberculosis Patients' Household Contacts During the COVID-19 Pandemic in the Border Areas of Northern Thailand.

Objectives: The COVID-19 pandemic has exacerbated the rate of tuberculosis (TB) infection among close contacts of TB patients in remote regions. However, research on preventive behaviors, guided by the health belief model (HBM), among household contacts of TB cases is scarce. This study aimed to employ the HBM as a framework to predict TB preventive behaviors among household contacts of TB patients in the border areas of Northern Thailand. Methods: A cross-sectional study with multi-stage random sampling was conducted in Chiang Rai Province. The study included 422 TB patients' household contacts aged 18 years or older who had available chest X-ray (CXR) results. A self-administered questionnaire was used to conduct the survey. Results: The participants' mean age was 42.93 years. Pearson correlation analysis showed that TB preventive behavior scores were significantly correlated with TB knowledge (r=0.397), perceived susceptibility (r=0.565), perceived severity (r=0.452), perceived benefits (r=0.581), self-efficacy (r=0.526), and cues to action (r=0.179). Binary logistic regression revealed that the modeled odds of having an abnormal CXR decreased by 30.4% for each 1-point score increase in preventive behavior (OR=0.696; 95% CI, 0.610-0.794). Conclusions: HBM constructs were able to explain preventive behaviors among TB patients' household contacts. The HBM could be used in health promotion programs to improve TB preventive behaviors and avoid negative outcomes.

Health Literacy, Self-Care Behaviors, and Biochemical Parameters Among Hypertensive Patients with Renal Complications in the Tai Lue Ethnic Community of Thailand.

Purpose: Hypertension (HT) can cause renal complications or deterioration of kidney function. HT management is very important because it reduces the severity of illnesses. This study aimed to investigate the relationship between health literacy (HL), self-care behaviors (SCB), and biochemical parameters in hypertensive patients with renal complications. Methods: A cross-sectional study of 405 hypertensive patients with renal complications among Tai Lue people living in Thailand was conducted using simple random sampling. Face-to-face interviews with questionnaires were used to collect information. Blood pressure (BP) and biochemical parameters, such as fasting blood sugar (FBS) and estimated glomerular filtration rate (eGFR), were measured. Results: The participants' mean age was 68.3 years. A significant correlation was found between HL score, SCB score, systolic BP (SBP), diastolic BP (DBP), FBS, and eGFR (p<0.01). Multiple linear regression revealed that eating salty foods was a risk factor for SBP in males and for SBP and DBP in females. Body mass index (BMI) (B = 0.54), sweet food consumption (B = 13.90), and SCB score (B = -0.29) were significantly associated with FBS level (R2 = 17.8%, p<0.05). Employment (B = 2.55), eating bland food (B = 4.07), receiving information from family (B = 3.53), SCB (B= 0.31), and age (B = -0.51) were all significant factors for eGFR (R2 = 35.0%, p<0.05). Conclusion: HL and SCB levels were associated with the health of hypertensive patients with renal complications in the Tai Lue ethnic community. The significance of organizing health education programs is to emphasize increasing HL to lead to self-care decisions and reduce complications in patients, resulting in improved SCB and quality of life in the future.

Association between Perceived Protection Motivation, Preventive Behaviors, and Biomarkers among Diabetic Patients in Rural Areas of Thailand.

The prevalence of diabetes mellitus (DM) is increasing rapidly worldwide. Without proper management, DM can have serious complications. We aimed to investigate the association between protection motivation theory (PMT) constructs, self-care behaviors, and biomarkers among diabetic patients in a community in northern Thailand. A cross-sectional study was conducted. Simple random sampling was used to select 422 subjects from patients enrolled in primary care in Chiang Rai Province. Data were collected using questionnaires and blood sampling to measure fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). Pearson's correlation and multiple linear regression were used to analyze the data. The diabetic subjects' age was 62.25 years (standard deviation [SD] = 8.90), and the duration of diabetes was 9.07 years (SD = 7.23). Positive correlations were found between the DM knowledge score and the PMT score (r = 0.812, p < 0.01) and between the PMT score and the preventive behavior score (r = 0.817, p < 0.01). The preventive behavior score was negatively correlated with FBS (r = -0.319, p < 0.01) and HbA1c (r = -0.625, p < 0.01) and significantly associated with income (B = 0.15) and the PMT score (B = 0.71), accounting for 67.0% of the variance. Age (B = -0.73), sleep problems (B = 10.71), and the preventive behavior score (B = -1.15) were statistically significantly associated with FBS (R2 = 14.3%). Four variables, the female gender (B = -0.26), being married (B = -0.24), sleep problems (B = 0.42), and the preventive behavior score (B = -0.09), were statistically significantly associated with HbA1c levels (R2 = 41.6%). Health education programs should primarily target awareness of disease severity, complications, and self-efficacy enhancement to generate intention and behavior change. This may delay or reduce the occurrence of diabetes-related complications in people with type 2 diabetes.

Effect of Health Literacy Intervention on Glycemic Control and Renal Function Among Thai Older Adults at Risk of Type 2 Diabetes Mellitus.

Purpose: Diabetes patients with low health literacy often have poor health and clinical outcomes. The study aimed to assess the effectiveness of a health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus (T2DM). Methods: A quasi-experimental study was carried out in rural areas of Phayao Province in northern Thailand. The participants were older adults with T2DM who recorded blood glucose levels ranging from 140 to 180 mg/dL and who were not receiving prescribed medication. The intervention lasted 12 weeks, and data were collected at three points: baseline, post-intervention, and at 3 months' follow-up. The study outcomes included the measurement of fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and glomerular filtration rate (eGFR) levels after the intervention. A linear mixed model and generalized estimating equations model were used to assess the intervention effect for continuous and binary outcomes, respectively. Results: From baseline to post-intervention, FBS and HbA1c decreased more in the intervention group than in the control group by 8.2 mg/dL (p < 0.001) and 0.1% (p = 0.029), respectively, whereas eGFR increased by 8.0 mL/min/1.73m2 (p < 0.001). The absolute effect of the intervention at follow-up was -9.8 units for FBS, -0.4 units for HbA1c, and 14.0 units for eGFR. Abnormal HbA1c level (≥6.5%) of the intervention group was reported as 70.3% at baseline, 31.3% at post-intervention, and 9.4% at follow-up. Compared to baseline levels, the T2DM patients who received the intervention were 0.31 times less likely to have abnormal HbA1c levels than the control subjects at follow-up (p = 0.003) who received no intervention. Conclusion: Our findings suggest that this intervention may potentially improve diabetes self-management and prevention behaviors, thereby reducing the diabetes burden in rural communities in northern Thailand.

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities.

BACKGROUND: Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities. METHODS: A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). RESULTS: The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%). CONCLUSION: Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.

Ergonomic Risk Factors for Musculoskeletal Disorders among Ethnic Lychee-Longan Harvesting Workers in Northern Thailand.

Musculoskeletal disorders (MSDs) are one of the leading causes of occupational injuries and disabilities. The purpose of this study was to assess the prevalence of MSDs and occupational factors affecting MSDs among ethnic lychee-longan harvesting workers in northern Thailand. A cross-sectional study was conducted in the areas of three upper northern provinces of Thailand. The study areas are located in the highlands and rural plains, where many ethnic minority groups live, including Indigenous, Mien, Karen, and Lua. The majority of them work in a farm of perennial fruit trees, mainly lychee and longan. During the harvest season, 404 participants were recruited for the study using the convenience sampling technique. Data were collected using questionnaires that included general information, an ergonomic risk assessment, and a standardized Nordic questionnaire for assessing MSDs in 10 body parts. The average age of lychee-longan harvesting workers was 48.8 years. Almost all (99.5%) reported MSDs in one or more body regions in the previous seven days of work. The prevalence of MSDs was highest in the hands (82.9%), followed by the shoulders (82.2%) and the neck (79.7%). The total ergonomic risk scores, which included awkward posture, heavy carrying and lifting, repetitive activity, land slope, and equipment, were found to be significantly associated with MSDs in part of the neck (AOR = 1.17, 95%CI = 1.11-1.23), shoulder (AOR = 1.15, 95%CI = 1.10-1.21), elbow (AOR = 1.18, 95%CI = 1.12-1.24), hand (AOR = 1.12, 95%CI = 1.07-1.18), finger (AOR = 1.33, 95%CI = 1.24-1.44), upper back (AOR = 1.14, 95%CI = 1.09-1.20), lower back (AOR = 1.16, 95%CI = 1.11-1.22), hip (AOR = 1.11, 95%CI = 1.06-1.15), knee (AOR = 1.18, 95%CI = 1.12-1.24), and feet (AOR = 1.21, 95%CI = 1.15-1.28) when adjusting for ethnicity, sex, age, BMI, and work experience. Many parts of ethnic workers' bodies have been affected by occupational injuries, with a high risk of upper extremity injury. As a result, using an ergonomic approach to improving the working environment and appropriate posture movement is very beneficial in preventing MSDs among ethnic harvesting workers.

COVID-19-related knowledge influences mental health, self-care behaviors, and quality of life among elderly with non-communicable diseases in Northern Thailand.

Background: A growing body of research shows that individuals with non-communicable diseases (NCDs), such as hypertension, diabetes, hypercholesterolemia, and heart disease, are more likely to suffer from severe COVID-19 and, subsequently, death. The purpose of this study was to assess the influence of COVID-19-related knowledge on mental health, healthcare behaviors, and quality of life among the elderly with NCDs in Northern Thailand. Methods: In this cross-sectional study, the participants were 450 elderly people with NCDs, living in the Chiang Rai province, Northern Thailand. Random sampling was applied to select the subjects. Data collection included demographic information, COVID-19-related knowledge, healthcare behaviors, the Suanprung Stress Test-20, the Thai General Health Questionnaire (GHQ-28) for the assessment of mental health, and the Thai version of the World Health Organization Quality of Life-BREF. Results: Almost half of the participants (45.6%) had poor knowledge about COVID-19. More than half of the sample had high stress (52.0%) and a low score in healthcare behaviors (64.9%), while approximately one-third of the participants had mental health problems (34.0%). The overall quality of life during the COVID-19 pandemic was moderate (70.7%). The score of COVID-19-related knowledge was significantly correlated with scores of stress (r = -0.85), mental health (r = -0.74), healthcare behaviors (r = 0.50), and quality of life (r = 0.33). Multiple linear regression found that history of COVID-19 detection and COVID-19-related knowledge were associated with scores of stress and quality of life (p < 0.05). Multiple logistic regression showed that history of COVID-19 detection (OR = 4.48, 95% CI = 1.45-13.84) and COVID-19-related knowledge (OR = 0.23, 95% CI = 0.17-0.31) were associated with mental health problem (p < 0.05). Discussion: The findings emphasize the importance of COVID-19-related knowledge concerning the improvement of self-care behaviors and quality of life in the elderly population with NCDs during the pandemic, especially due to the high rate of stress and mental health problems documented in our sample. Health education interventions for this vulnerable population should be organized.

Using the Health Belief Model to Predict Vaccination Intention Among COVID-19 Unvaccinated People in Thai Communities.

Background: The coronavirus disease 2019 (COVID-19) pandemic has become one of the biggest challenges to individual health and the public health system worldwide. COVID-19 morbidity and mortality are increasing, impacting almost every country including Thailand. This study used the Health Belief Model (HBM) as a framework to examine the intention of unvaccinated people living in northern Thailand to receive COVID-19 vaccines. Methods: This cross-sectional study was conducted during October and November 2021. A total of 1,024 participants who are currently living in four northern provinces of Thailand, Chiang Mai, Chiang Rai, Lamphun, and Phayao, were recruited to participate in the study. The questionnaire was developed using an HBM structure to obtain information about the perceived severity, perceived susceptibility, self-efficacy, perceived benefits and barriers, cues to action, and preventive behaviors relating to COVID-19 vaccination and the decision to become vaccinated. Multiple linear regression was used to analyze the data. Results: The unvaccinated participants were an average of 44.45 ± 16.63 years of age and more than half were women (54.5%). The COVID-19 preventive behavior score used perceived severity (B = 0.26), self-efficacy (B = 0.51), perceived benefits and barriers (B = 0.11), and cues to action (B = 0.18) after adjusting for age, underlying disease, and body mass index (R 2 = 42.5%). The COVID-19 vaccination decision score was positively correlated with perceived severity (B = 0.13), perceived susceptibility (B = 0.25), perceived benefits and barriers (B = 0.21), and cues to action (B = 0.27) after adjusting for underlying disease (R 2 = 38.7%). Discussion: The results demonstrated the usefulness of using the HBM structure to understand individual intention to receive a COVID-19 vaccine. Communities should consider a COVID-19 health campaign and programs that use the HBM model as a framework for altering perceptions and beliefs about the COVID-19 vaccine and improving vaccination rates among unvaccinated people in rural northern Thailand.

Health Behavior, Level of Hemoglobin A1c, and Quality of Life Among Agricultural Workers of Various Ethnicities in Thai Border Communities.

BACKGROUND: Little is known about the glycated hemoglobin (HbA1c) levels and quality of life (QoL) in ethnic minority agricultural workers. We investigated the links among health behaviors, HbA1c levels, and QoL ethnic agricultural workers living in rural areas. METHODS: A cross-sectional study was conducted in three northern Provinces of Thailand. Agricultural workers of Indigenous, Hmong, Karen, and Lua communities were recruited. The number of 468 samples were selected using multistage sampling. Data collection was done from interviews using questionnaires, and blood samples were taken. RESULTS: We revealed 56.8% of participants to be female, with an average age of 49.6 years. Also, 56.0 and 34.8% of participants had low and moderate levels of knowledge on non-communicable diseases, respectively. In addition, 56.8 and 30.6% of participants had moderate and low health behaviors, respectively. Also, 51.5% had a HbA1c level (≥6.5%). We found that 64.7, 22.9, and 12.4% had moderate, low, and high QoL, respectively. Multiple linear regression analysis revealed that having an underlying disease and knowledge score were both significantly related to the health behaviors score (p < 0.05), accounting for 68.6% of the variance. Five variables (ethnicity, BMI, having an underlying disease, smoking, and health behaviors) were significantly related to the HbA1c level (p < 0.05), accounting for 24.6% of the variance. Education, health behaviors, and HbA1c level were significantly associated with QoL (p < 0.05). These three factors could explain 79.4% of the variance in QoL among ethnic agricultural workers. CONCLUSION: Health behaviors of ethnic minority agricultural workers influenced their HbA1c level and QoL. Effective health behaviors modification programs should be developed in accordance with the problems and needs among ethnic minority agricultural workers to enhance their QoL.

Knowledge of COVID-19 and Its Relationship with Preventive Behaviors and Vaccination among Adults in Northern Thailand's Community.

(1) Background: the 2019 coronavirus disease outbreak (COVID-19) has posed a major threat to public health and had a significant impact on all areas of people's lives. Vaccines against COVID-19 have been developed to control the disease, and an array of personal hygiene measures has been introduced. As a result, information that will support and promote vaccination among populations as well as other health measures against COVID-19 are urgently needed. The goal of this research was to look into the knowledge about COVID-19 and how it relates to preventive behaviors and vaccination among people living in rural areas of northern Thailand. (2) Methods: a cross-sectional study was performed in four upper northern provinces of Thailand. A total of 1524 participants were recruited using the probability sampling technique. Questionnaires were distributed to collect data on general health information, as well as knowledge and preventive behaviors regarding COVID-19. (3) Results: more than half (55.9%) of the participants were female and had not received the COVID-19 vaccine (67.2%). Their mean age was 44.13 years. The majority had moderate COVID-19 knowledge and engaged in preventive behaviors (65.5% and 42.0%, respectively). A linear regression model showed that the COVID-19 knowledge score was related to the COVID-19 preventive behaviors score, with a standardized coefficient of 0.510, after adjusting for age, underlying disease, and body mass index (B = 2.64; 95%CI = 2.42, 2.87). Binary logistic regression revealed that after controlling for age, education, occupation, financial status, and current disease (AOR = 1.87; 95%CI = 1.64-2.13), the score of COVID-19 knowledge was significantly associated with having the COVID-19 vaccine. (4) Discussion: knowledge of COVID-19 is very important for people in rural regions to engage in COVID-19 prevention behaviors and vaccination. Relevant government agencies and health network partners should support proactive education campaigns emphasizing the risk of contracting the disease and its severity in order to promote vaccination against COVID-19 among unvaccinated groups. These campaigns can highlight COVID-19's positive benefit-risk balance in the short and long term and ensure public safety measures against COVID-19.

Effects of a social support family caregiver training program on changing blood pressure and lipid levels among elderly at risk of hypertension in a northern Thai community.

Hypertension is becoming increasingly prevalent among the elderly. Family caregivers play an important role in caring for elderly people and empowering them to care for themselves. This study's goal was to see how social support training for family caregivers affected changes in hypertension, total cholesterol, and high-density lipoprotein (HDL), and how such support led to the prevention of hypertension behaviors among the elderly in rural areas. This was a quasi-experimental study with 268 elderly people at risk of hypertension and their caregivers. Sixty seven pairs of elderly people and their caregivers were assigned to the intervention and control groups. Baseline data were collected in November 2020. The intervention group received the Social Support Family Caregiver Training Program (SSFCTP), while the control group received a regular program from the local health authority. The activity lasted 12 weeks, with home visits and telephone check-ups along the way, and data collection took place after the program ended. The final data were collected three months after the end of the intervention. An analysis of repeated measures ANOVA showed the overall effect of the SSFCTP on knowledge, self-efficacy, health care behaviors, and blood pressure among elderly people during three different time periods (p<0.05). Furthermore, the intervention program had a time-dependent effect on knowledge, blood pressure, and total cholesterol levels (p<0.05). In terms of caregiver outcomes, there was an overall difference among the degrees of knowledge, self-efficacy, and behaviors toward health care displayed by elderly hypertensive patients during the three different time periods (p<0.05). The average knowledge and self-efficacy of the participants improved after the intervention. As a result, better self-care behaviors and lower blood pressure and total cholesterol levels were observed among the elderly participants after the intervention. The programs emphasized the importance of caregivers' roles in providing social support, boosting confidence, and encouraging participation in caring, monitoring, and assisting the elderly in controlling blood pressure and other health issues.

Risk Factors Associated with Fall Awareness, Falls, and Quality of Life Among Ethnic Minority Older Adults in Upper Northern Thailand.

BACKGROUND: Falls are a major public health issue and one of the leading causes of morbidity and mortality among the older adults in many countries. Falls and their consequences have an impact on people's quality of life, particularly the older adults. However, there have been very few studies on falls among ethnic minority groups living in rural areas. The aim of this study was to examine factors related to fall awareness, falls, and quality of life among ethnic minority older adults living in northern Thailand. METHODS: A cross-sectional study was conducted among 462 older adults from ethnic minority groups living in rural communities in Phayao and Lamphun provinces of northern Thailand using a multi-stage sampling technique. The data were collected through face-to-face interviews, with structured questionnaires covering health information, fall awareness, and quality of life (WHOQOL-OLD). The factors were determined using simple linear regression and binary logistic regression. RESULTS: The mean age of the participants was 68.2, Karen (35.5%), Mien (24.2%), indigenous (20.8%), and Hmong (19.5%). In the previous 12 months, 20.6% of elders had experienced a fall, and 4.5% of them had experienced multiple falls. More than half of the elders had moderate fall awareness and quality of life (71.6% and 68.6%, respectively). Univariate analysis revealed that minority group, sociodemographic characteristics, sleep duration, and fear of falling were all found to be associated with fall awareness, falls, and quality of life score (p<0.001). There was a significant relationship among fall awareness, falls, and quality of life score (p<0.001). Compared to those who had not fallen in the previous year, the quality of life of the older adults who had fallen was about 11 points lower. CONCLUSION: Several independent variables were discovered to be fall risk factors and quality of life indicators. It is critical to recognize the risk factors to promote fall prevention programs that are appropriate for the older adults among ethnic minorities. Therefore, public health agencies and local government should be aware of the problem and initiate an implementation program and policy to prevent falls and improve the quality of life among ethnic minority older adults.

Factors Associated with Health Literacy, Self-Efficacy, Social Support, and Oral Health Care Behaviors Among Elderly in Northern Border Community Thailand.

BACKGROUND: Oral health problems among elderly people are an important public health issues worldwide. Oral healthcare is essential to the health and well-being of elders and is one of the key indicators determining their quality of life. This research aimed to study oral health literacy, self-efficacy, social support, and demographic characteristic factors associated with the oral health care behaviors of elderly people living in the rural areas of northern Thailand. METHODS: This research was a cross-sectional study that recruited 406 elderly participants using convenience and snowball samplings. Participants' names were obtained from the registration list of the Java Health Center Information System (JHCIS) program, where they received a health service between 2018 and 2020. Data were obtained through face-to-face interviews with participants, while they were waiting to receive a health service or through a phone interview. Linear regression was analyzed to determine the factors associated with oral healthcare behaviors. RESULTS: The majority of participants (85%) had inadequate functional health literacy, 52% had moderate self-efficacy toward oral health behaviors, 91.9% had moderate social support, and 53% admitted to moderate oral health behaviors. The results from the model show that self-efficacy, social support, and oral health literacy are positively associated with oral health care behaviors among the elderly (p-value < 0.05). The multiple regression model can account for 47.2% of the variance in oral health care behaviors. CONCLUSION: Improving oral health care behaviors among elderly people should be considered by health care providers and those who provide social support. Self-esteem, communication skills among service providers and service receivers, and self-management of oral healthcare should receive special attention. Moreover, social support and relevant agencies can help promote oral healthcare by collaborating with other healthcare providers for better oral health outcomes among elderly people.

Factors Associated with Self-Esteem, Resilience, Mental Health, and Psychological Self-Care Among University Students in Northern Thailand.

BACKGROUND: The severity of mental health issues among university students in rural areas can affect the outcomes of their studies. The purpose of this study was to identify factors associated with self-esteem, resilience, mental health, and psychological self-care among university students. METHODS: We conducted a cross-sectional survey of 729 undergraduate students by a self-administered questionnaire. Using convenience sampling, the participants were chosen from four majoring in Public Health at University of Phayao in Northern Thailand. RESULTS: Approximately 82% of university students had mental health problem. Backward logistic regression analysis showed that 1) a good relationship with family had a significantly positive effect on self-esteem (p-value <0.05); 2) a good relationship with friends was significantly associated with high resilience (p-value <0.05); 3) having a disease/s and a relationship with family had a significant effect on mental health problem (p-value <0.05); 4) being female, perceived normal weight, and a good relationship with family were significantly related to high psychological self-care (p-value <0.05). CONCLUSION: Gender, incurrent disease, perceived weight status, relationship with friends and family were associated with self-esteem, resilience, mental health, and psychological self-care among university students. Our findings can be incorporated in a support policy and integrated into the public health curriculum. University administrators and faculty have an opportunity to formulate an intervention program and provide services that could mitigate mental health problems and improve the well-being of students at their university.

Knowledge and Behaviors Toward Health Care for Elderly Patients with Hypertension, and Quality of Life Among Informal Caregivers in Northern Thailand.

BACKGROUND: Informal caregivers play an important role in caring for patients with chronic conditions. Little is known about the quality of life among caregivers of patients with chronic illnesses in Thailand. The purpose of this study was to investigate the relationships among knowledge and behaviors toward health care for elderly patients with hypertension, and the quality of life among informal caregivers. METHODS: A total of 402 informal caregivers for their elderly co-habitants suffering from hypertension were randomly selected to participate in this cross-sectional study. Data collection was performed in rural areas of Phayao province, located in the northern part of Thailand. Self-administered questionnaires were employed, which covered knowledge and behaviors toward health care for elderly patients with hypertension, and the Thai version of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. RESULTS: The scores of knowledge and behaviors toward health care for elderly patients with hypertension, and the quality of life were at low and fair levels. In the multivariable linear regression model, the results showed that four variables - age, caregiver's relationship to the patient, knowledge, and behaviors toward health care for elderly patients with hypertension - were significantly related to quality of life among caregivers (p < 0.05). CONCLUSION: Knowledge and behaviors toward health care for hypertensive patients influence the quality of life among informal caregivers. The caregivers in rural communities should be encouraged to become educated on the stages of hypertension, preparation for taking care of the elderly with high blood pressure, and effective behavioral care for patients, in order to improve the quality of life of both caregiver and patient. In addition, health care providers should have clear guidelines for development of the health care system to enhance the potential care and quality of life among informal caregivers.

The effect of the behavior modification program Dietary Approaches to Stop Hypertension (DASH) on reducing the risk of hypertension among elderly patients in the rural community of Phayao, Thailand.

AIM: The purpose of this study was to evaluate the effect of the Dietary Approaches to Stop Hypertension (DASH) program with self-efficacy on reducing the risk of hypertension among elderly patients in the rural community of Phayao Province in Northern Thailand. PATIENTS AND METHODS: A quasi-experimental study was employed among elderly patients in the rural community of Phayao. Multistage random sampling was used to select a study area with similar characteristics. Ninety elderly participants were placed in the intervention group and 85 elderly participants from the same village were placed in the control group. The intervention group used the behavior modification guidelines of the DASH program with self-efficacy for 3 months, including 45-minute weekly group education meetings, 25-minute group activity training sessions, and a 15-minute individual checklist. A control group received no intervention. Data were collected by using self-administered questionnaires. The analyses included descriptive statistics, the Mann-Whitney U-test, and sample t-testing. Three different time periods were examined using repeated measures ANOVA. RESULTS: More than half of the participants (65.7%) were aged 60-69 years. The results from comparison of the intervention and control groups showed that the perceived severity of hypertension and self-efficacy had increased and preventive behaviors toward hypertension had improved in both groups. There were statistically significant differences after the intervention and at 3-month follow-up (P<0.001). After the intervention, the systolic blood pressure and diastolic blood pressure of the elderly people in the intervention group had decreased (P<0.001). CONCLUSION: The behavior modification guidelines of the DASH program with self-efficacy, were effective in improving the mean score of perceived severity, self-efficacy, and preventive behaviors among elderly participants with a high risk of hypertension. Furthermore, the program was effective in lowering blood pressure and it may be useful in controlling stage 1 hypertension in elderly people.

Factors Related Intention To Smoking Cessation Among Thai People Who Joined Quit Smoking Project For The King: A Cross-Sectional Study Of Northern Thailand.

BACKGROUND: Smoking causes direct and indirect health problems among people. The purpose of this paper is to explore factors influencing intention to cessation smoking among Thai people who joined quit smoking project for the King. METHODS: This cross-sectional study survey. The samples of 626 participants were recruited to the study. They were randomly selected by using stratified multi-stage cluster sampling from community area of Phayao and Nan Provinces. The data was analysed using Pearson product-moment correlation. Factors influencing intention to quit smoking were analysed using multiple linear regression. RESULTS: The results showed that participants' perception towards health consequences of smoking was at low level (35.1%). Participants' communication skills, decision making, and self-management were at fair level (35.5%, 41.8% and 43.0% respectively). There were statistically significant relationships between personal factors and intention to cessation smoking among participants in the quit smoking project (p=.007). It was found that factors including intention to cessation smoking, joining the program, receive invitation to join the program, and participants' willingness to participate in the program had statistically significant relationships with quit smoking (p<.001), (p<.001), (p<.001) and (p<0.009). There were statistically significant relationships of knowledge and communication skills on intention to cessation smoking (p=.030) and (p=.039) respectively. CONCLUSIONS: Furthermore, they are willing to cooperate with public health personnel regarding to prevention and control of smoking. Therefore, quit smoking campaign by using health communication will help approaching people in the public and enhance knowledge and understanding among people in term of health effects and consequences of smoking.

Stress and associated risk factors among the elderly: a cross-sectional study from rural area of Thailand.

Background. Stress is a common mental health problem of the elderly population that affects their quality of life. The objective of this study was to determine the level of stress and associated factors among the elderly living in rural areas of Thailand.  Methods. This was a cross-sectional study conducted in two sub-districts of rural Thailand and interviewed 403 elderly persons.  We used simple random sampling technique from a list of registered elderly individuals and conducted face-to-face interviews using a questionnaire. The questionnaire were piloted, validated and pretested beforehand. Multiple linear regression was applied for data analysis. This study was approved by the Ethical Review Committee of the University of Phayao, Thailand. Results. The mean age of the participants was 68 and two thirds (67%) were female. Less than 43% of the participants had moderate, and one third (34%) had high levels of stress. More than half of participants had low level stress management. Stress was significantly associated with alcohol and illness with a predictive power of 3.0% [(R = 0.173, R Square = 0.030) (p<0.05)]. Conclusion. We conclude that risk factors such as alcohol and illness affect elderly population living in rural areas of Thailand to a major extent in terms of stress.

Association Between Self-Care Behaviors and Quality of Life Among Elderly Minority Groups on the Border of Thailand.

INTRODUCTION: Quality of life among the elderly is an important public health issue. However, few studies have examined the health and quality of life among ethnic minority groups. This research aimed to study the association between self-care behaviors and quality of life among the elderly from ethic minority groups living along the borders of Thailand. METHODS: Three provinces from the northern part of Thailand, including Tak, Nan, and Phayao, were selected for the area of study. The purposive method was employed to select districts within the province. Simple random sampling was used to select samples. A total number of 810 elderly citizens were recruited from ethnic minority groups as a research sample. The assessment questionnaire WHOQOL-OLD was used for interviewing the elderly. RESULTS: The mean age of the elderly in our sample was 68.3 years, representing ethnic groups of Lua (30.9%), Karens (24.6%), Tai Lue (23.3%), and Tai Hmong (21.2%). The level of self-care behaviors of these elderly was moderate (49.5%), low (45.9%), and high (4.6%). More than half of them exhibited the quality of life at a moderate level (69.1%) and low level (26.5%); only a few demonstrated a high level (4.4%). Linear regression analysis revealed that self-care behaviors were positively significantly related to the quality of life among ethnic groups (p-value<0.001). Other variables such as age, ethnic group, education, incurrent disease, and smoking were associated with quality of life among the elderly (p-value<0.05). CONCLUSION: Health promotion to improve health and self-care behaviors among the elderly living along the borders of Thailand should be encouraged through the culture, tradition, and beliefs of particular ethnic groups. Proactive health services and health awareness should be promoted by health agencies and related organizations in order to improve the health, well-being, and quality of life among the elderly people from ethnic minority groups.

The Effect Of Sex Education And Life Skills For Preventive Sexual Risk Behaviours Among University Of Students In Thailand.

BACKGROUND: Currently, the problem of sexual risk behaviour of adolescents has increased worldwide, including Thailand. This study compared the effectiveness of promoting life skills to prevent sexual risk behaviours among university students in the Phayao Province of Thailand. METHODS: A quasi-experimental design was employed with a pre- and post-test study for a sample of freshmen university students. The students were then split into an intervention group comprised of 300 students, with a second group of 250 students from the same faculty as the control group. The intervention group participated in the integrated life skills model for preventing sexual risk behaviours and participatory learning. The educational activities included; lectures, brainstorming, group discussion, roleplaying, game simulations and naming experiences through six weekly life skills training sessions of 90 minutes each. Data were collected by self-questionnaires and analysed using descriptive statistics and independent sample t-testing. Three different time periods were examined using ANOVA repeated measures analysis of variance. RESULTS: Compared between the intervention and control groups determined that implementation of increased knowledge and improved life skills was statistically significant (p<0.001) in the intervention group. The intervention group also showed significantly improved communication skills and behavioural preventive measures towards sexual risk than the control group (p<0.001). CONCLUSIONS: The life skills model also effectively reduced the sexual risk behaviours of students at the university. Therefore, this program was beneficial for the development of strategies to increase self-efficacy and it should be integrated into the universities' curriculum. In the long-term sexual risk behaviour changes must be monitored for programme sustainability.