Research and Development Health System Journal
https://he02.tci-thaijo.org/index.php/RDHSJ
<p>วารสารวิจัยเเละพัฒนาระบบสุขภาพเป็นวารสารที่ใช้เผยแพร่ผลงานวิชาการและผลศึกษาวิจัย ทางด้านการพัฒนาคุณภาพงานสาธารณสุขเเละคุณภาพชีวิตนำไปสู่ผู้ปฏิบัติงาน <br />บุคลากรทางด้านสาธารณสุข และทางการเเพทย์ ทั้งในระดับประเทศเเละระดับนานาชาติ รวมไปถึงประชาชนผู้ที่สนใจทั่วไป</p> <p>ISSN 3027-6845 (Print)</p> <p>ISSN 3027-6853 (Online)</p> <p> </p> <p> </p>Research and Development Health System Journalth-THResearch and Development Health System Journal3027-6845<p><span style="font-weight: 400;">เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวารสารศูนย์ดัชนีการอ้างอิงวารสารไทย ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ</span><span style="font-weight: 400;">บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวารสารศูนย์ดัชนีการอ้างอิงวารสารไทย ถือเป็นลิขสิทธิ์ของวารสารศูนย์ดัชนีการอ้างอิงวารสารไทย หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากวารสารศูนย์ดัชนีการอ้างอิงวารสารไทยก่อนเท่านั้น</span></p>THE RELATIONSHIP BETWEEN SELF-MANGEMENT AND STRESS AMONG CAREGIVERS OF STROKE PATIENT IN THE MUNICIPAL OF COMMUNITY MUEANG DISTRICT, SARABURI PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275932
<p>Stroke is a major public health problem that can lead to disability, stress, and high mortality if not properly managed. This descriptive study aimed to study (1) The stress level of stroke caregivers, (2) The self-management level of stroke caregivers, and (3) The relationship between self-management and stress of stroke caregivers. The sample consisted of 94 caregivers of stroke patients in the municipal community, Mueang Saraburi District, Saraburi Province. The tools used for data collection included general information questionnaires, stress assessment forms, and self-management assessment forms. Data were analyzed using descriptive statistics and hypothesis analysis using Pearson's correlation coefficient.</p> <p>The research results found that the stress level of caregivers of stroke patients was low, and the self-management level of caregivers was high. And caregiver self-management was significantly negatively correlated with stress levels at the p-value < 0.01 level (r = -0.576). It is recommended that qualitative research be conducted to identify the causes or risk factors that cause stress, as well as ways to address these problems, in order to plan self-management for caregivers of stroke patients.</p>Sorot Piraksasakmongkon chueatongParichat ThaphueakPreamlupthai DansawadJinjutha PhupraeChanakan toyingChompoonuch Deechoei
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-202025-10-20183698110.64962/rdhsj.v18i3.2025.275932THE RELATIONSHIP BETWEEN CHILDHOOD AND ADULT OBESITY AND HYPERTENSION ADULTHOOD: REGIONAL HEALTH 7, THAILAND
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275044
<p>Overweight and obesity are major contributors to chronic diseases, especially hypertension, which is a leading cause of death from cardiovascular and cerebrovascular conditions globally. In Thailand, evidence linking childhood obesity to adult hypertension is limited. This retrospective cohort study in Regional Health 7 involved 5,110 adults aged ≥ 30 years without a prior hypertension diagnosis, who could recall their childhood weight status. Data on nutrition and health behaviors were obtained through questionnaires, while current anthropometric and blood pressure measurements were recorded. Multiple logistic regression was used to examine factors associated with adult hypertension, with statistical significance set at p-value < 0.05.</p> <p>Of the participants, 54.3% were female, with a mean age of 53.1±11.89 years. Childhood obesity was reported by 307 (6%) individuals, and 1,530 (29.9%) were currently obese. Participants who were obese in both childhood and adulthood had a 2.44-fold increased risk of hypertension (95% CI: 1.55–3.86). Those obese only in childhood had risk (2.43 times; 95% CI: 1.51–3.92), while those who became obese in adulthood had a 1.74-fold higher risk (95% CI: 1.41–2.16), compared to individuals never obese. Insufficient vegetable intake and alcohol consumption were also significantly associated with hypertension.</p> <p>These findings emphasize the cumulative impact of health risk behaviors over the life course. Childhood obesity, in particular, is associated with long-term health risks such as hypertension. Public health strategies should prioritize early obesity prevention and health promotion from childhood, supported by the development of lifelong personal health records for effective long-term monitoring.</p>Kanya Janpol
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-11183264010.64962/rdhsj.v18i3.2025.275044PREVALENCE OF DYSLIPIDEMIA AND ASSOCIATED FACTORS AMONG MEDICAL PERSONNEL IN MAHAVAJIRALONGKORN THANYABURI HOSPITAL
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275934
<p>Dyslipidemia is a significant risk factor for cardiovascular disease, with healthcare workers particularly vulnerable due to occupational characteristics. This study aimed to investigate the prevalence and factors associated with dyslipidemia among hospital staff at Mahavajiralongkorn Thanyaburi Hospital. A cross-sectional descriptive study was conducted using data from the annual health examination in 2024 of 210 hospital staff. Data were analyzed using descriptive statistics and logistic regression. Dyslipidemia was defined according to NCEP ATP III criteria.</p> <p>The study found a dyslipidemia prevalence of 66.7%. Total Cholesterol and LDL-Cholesterol abnormalities were 54.3% and 58.1%, respectively. Factors significantly associated with dyslipidemia included age ≥39 years (OR = 1.89, 95% CI: 1.05-3.40, p-value = 0.033) and manual workers compared to clinical staff (OR = 1.86, 95% CI: 1.13-3.12, p-value = 0.040). Other factors including gender, education level, blood pressure, blood glucose, body mass index, and liver enzymes showed no significant association (p-value > 0.05).</p> <p>In conclusion, dyslipidemia prevalence was high among hospital staff. Key risk factors were age ≥39 years and manual worker positions. Targeted health promotion programs focusing on these high-risk groups should be developed for cardiovascular disease prevention.</p>Suriya KhueachantaChayanan Nantapech
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-11183829510.64962/rdhsj.v18i3.2025.275934EFFECTS OF THE PROGRAM DEVELOPMENT OF COMPETENCY IN EMERGENCY PATIENT CARE AT THE SCENE OF AN INCIDENT FOR EMERGENCY MEDICAL RESPONDER CHUMPHON BURI DISTRICT, SURIN PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275378
<p>This research is a Quasi-Experimental Research. (One Group Pretest-Posttest Design). This research aimed to study the Effects of program development on competency in emergency patient care at the scene of an incident for Emergency Medical Responders in Chumphon Buri District, Surin Province. The study population consisted of 40 individuals. The study samples comprised 34 volunteers for emergency medical care. The questionnaire was used in 3 parts. Participated in the program 3 times (6 weeks): 1. preparation, 2. Experience training (4 weeks), and 3. evaluation and reflection. Data analysis using descriptive statistics and paired t-test statistics.</p> <p>The results showed that knowledge score after the program (M = 28.13, S.D. = 0.47) was statistically significantly higher than before the program (M = 22.38, S.D.= 3.95) at p-value < 0.001 and the emergency patient care performance score at the scene of the accident for emergency medical volunteers before and after the program (M = 227.93, S.D. = 8.11) was statistically significantly higher than before the program (M = 187.34, S.D.= 22.18) at p-value < 0.001.</p> <p>Suggestion: It should be used in other service unit networks. Develop the capacity to assess and care for emergency patients through the Fast Track program. To receive urgent treatment and prevent life-threatening conditions.</p>Lerdkeaw LerdkeawThawatchai Yeunyow
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-1118311410.64962/rdhsj.v18i3.2025.275378THE EFFECT OF 3Rs PROGRAM ON KNOWLEDGE, MOTIVATION, AND BEHAVIOR IN HOUSEHOLD WASTE MANAGEMENT OF PEOPLE IN KHOKSI SUBDISTRICT, SAWANG DAEN DIN DISTRICT, SAKON NAKHON PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275994
<p>This quasi-experimental study aimed to examine the effects of 3Rs program on knowledge, motivation, and behavior in household waste management of people in Khoksi Subdistrict, Sawang Daen Din District, Sakon Nakhon Province. The study sample consisted of household representatives, assigned to an experimental group and a control group, with 50 participants in each group. This study in March to May 2024. The experimental group received the 3Rs program, which was designed based on the 3Rs principles and applied theories of The Information-Motivation-Behavioral Skill Model and Self-Efficacy Theory. Data collection tools included a questionnaire and household waste recording form. Data were analyzed using descriptive statistics, Paired-Samples T-Test, Independent-Samples T-Test, and Repeated-Measures ANOVA.</p> <p>The research results found that after participating in the 3Rs program, the experimental group showed statistically significant improvements (p-value < 0.001) in knowledge, motivation, self-efficacy, and household solid waste management behavior based on the 3Rs principles, compared both to their baseline and to the control group. Furthermore, after the intervention and during the follow-up period, the amount of household solid waste in the experimental group significantly decreased (p-value < 0.001) compared to both before the intervention and to the control group. </p> <p>Therefore, these principles should be appropriately applied in each area to reduce household and community waste in the future.</p>Virinchanok PhongninSoraya Saenmanot1Piyabhorn Phawchamnan
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-1118310.64962/rdhsj.v18i3.2025.275994EFFECTS OF PROGRAM APPLYING GAMIFICATION CONCEPT ON EXERCISE BEHAVIOR AMONG PRIMARY SCHOOL STUDENTS IN SAMUT PRAKAN PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275445
<p>Physical inactivity among primary school children remains a significant issue affecting long-term health. Although gamification has been widely studied in other countries, there is still a lack of research in Thailand applying gamification to promote health behaviors in children.</p> <p>To examine the effects of a gamification-based program on exercise behavior among primary school students. The sample consisted of 60 grade 5 students from two schools in Samut Prakan province, divided into an experimental group and a control group (30 students each). In the experimental group, 53.33% were female and 46.66% were male. In the control group, 56.66% were male and 43.33% were female. The majority of participants were 11 years old. None of the experimental group had chronic diseases, while 13.33% of the control group reported health conditions.</p> <p>The results After participating in the program, the experimental group showed a significant increase in exercise knowledge from 9.97±3.17 to 23.24±1.30 (t = 21.92, p-value < 0.001) and in exercise behavior from 34.13±4.62 to 39.53±0.68 (t = 6.23, p-value < 0.001). The results suggest that a gamification-based program can effectively enhance exercise knowledge and promote exercise behavior in primary school students.</p>jarujinda kumvilanonAim-utcha WattanaburanonNipa MaharachpongPajaree Abdullakasim
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-11183152510.64962/rdhsj.v18i3.2025.275445DEVELOPMENT OF HEALTH FOOD FOR DIABETES MELLITUS PATIENTS, NAKHON PHANOM PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/276016
<p>This research aims to study knowledge and develop healthy food recipes for diabetic patients, and assess user satisfaction, using a Participatory Action Research (PAR) approach. The situation study phase consists of 12 provincial cultural officials and local scholars. The recipe development phase consists of 2 nutritionists, 12 local food experts, 7 nurses, and 1 print technologist and designer. The evaluation period consisted of 20 diabetic patients and 10 health personnel. Purposive sampling, research instruments included knowledge synthesis forms, focus group summaries, and satisfaction questionnaires. Data were analyzed using content analysis and descriptive statistics, including means and standard deviations.</p> <p> The research findings showed that 1) Knowledge of dietary care, such as portion calculation, nutritional status assessment, cooking demonstrations, individualized counseling, and motivational interviewing. 2) Health-oriented recipes were developed, including Fish Hotpot, Sour Fish Soup, Spicy Minced Fish Salad, Isaan-style Hotpot, Steamed Egg Sac Curry, Steamed Fermented fish, Steamed Chicken with Herbs, Herbal Mixed Vegetable Curry, Steamed Fish with Herbs Wraps, Isaan-style Local Chicken Soup, Isaan-style Eggplant Salad, and Calameae shoot Curry using local ingredients and traditional methods. 3) The overall satisfaction of participants toward the recipe format was at a high level (<img id="output" src="https://latex.codecogs.com/svg.image?\bar{X}" alt="equation" />= 4.50, S.D. = 0.78), and their satisfaction with the practical application was at the highest level (<img id="output" src="https://latex.codecogs.com/svg.image?\bar{X}" alt="equation" />= 4.69, S.D. = 0.87). The overall satisfaction score was at the highest level (<img id="output" src="https://latex.codecogs.com/svg.image?\bar{X}" alt="equation" />= 4.60, S.D. = 0.83).</p> <p>The developed healthy recipes can serve as a guideline for health promotion and sustainable health tourism development in Nakhon Phanom Province.</p>Jarintorn KotepromPatchanee SomkumlungNadnapa Arayasinlapathon
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-11-072025-11-0718312513810.64962/rdhsj.v18i3.2025.276016EXERCISE FOR THE ELDERLY WITH APPLIED EXERCISE HANDBOOK TO PROMOTE PHYSICAL FITNESS AT KHAO SAM YOD MUNICIPALITY, LOPBURI PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275563
<p>This study aimed to 1) design and develop an exercise manual for the elderly using an adapted exercise approach to promote physical fitness, and 2) examine the effects of implementing exercise activities based on the manual on the physical fitness of elderly individuals. The sample consisted of 20 elderly participants who engaged in a structured physical activity program for eight weeks, three sessions per week, with each session lasting one hour.</p> <p>The research instruments included 1) an exercise manual for the elderly incorporating adapted exercises to enhance physical fitness, and 2) a physical fitness assessment form designed by the Department of Health to evaluate fall risk in the elderly. Data were analyzed using mean, standard deviation, and paired t-tests to determine the statistical significance of differences in physical fitness scores before and after the intervention.The findings revealed that: (1) The developed exercise manual demonstrated strong content validity, with a Content Validity Index (CVI) of 0.94, and high reliability, with a Cronbach’s alpha coefficient of 0.84. (2) There were statistically significant improvements (p-value < 0.05) in the average scores of all physical fitness components after the intervention, compared to the pre-intervention scores.Recommendation: It is recommended that similar physical activity promotion programs for the elderly be extended to other communities in order to enhance health and reduce the risk of falls among the aging population.</p>pongsathorn Phaijit
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-11183415310.64962/rdhsj.v18i3.2025.275563THE EFFECTS OF AN EARLY CHILDHOOD DEVELOPMENT PROMOTION PROGRAM WITH PARENTAL PARTICIPATION AT THE DONCHIMPLEE SUBDISTRICT CHILD DEVELOPMENT CENTER, BANG NAM PRIAO DISTRICT, CHACHOENGSAO PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/276279
<p>This quasi-experimental research one-group pretest and posttest design. The objective of this research was to investigate the effects of an Early Childhood Development Promotion Program with a focus on parent participation at the Donchimplee Subdistrict Child Development Center, Bang Nam Priao District, Chachoengsao Province. The study population consisted of 35 early childhood students at Donchimplee Subdistrict Child Development Center. The program included parental education, skill training, and home-based developmental activities implemented for one month. Early Childhood Development was assessed twice, before and after participation in the program. Data were collected using a parental knowledge and behavior questionnaire regarding early childhood development promotion, and the child development assessment form based on the Developmental Surveillance and Promotion Manual (DSPM). Data were analyzed using McNemar’s test and paired t - tests.</p> <p>The research findings revealed that an early childhood showed a significant improvement in early childhood development (p-value = 0.001) after participation in the program. And parental knowledge in promoting early childhood development significantly increased after participating in the program (p-value < 0.001) and parental behaviors in promoting early childhood development also significantly increased after participating in the program (p-value < 0.001).</p> <p>The key components of this program include the Parental School, joint parent-child activities, and storybook lending. These activities contributed to improvements in children’s developmental outcomes, as well as enhanced parental knowledge and behaviors that promote child development.</p>Duangnapa PongkaKiraphol KaladeeWarangkana Chankong
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-11-102025-11-1018315416710.64962/rdhsj.v18i3.2025.276279EFFECTS OF A KNOWLEDGE AND ATTITUDE ENHANCEMENT PROGRAM TO MODIFY RISK BEHAVIORS RELATED TO KRATOM USE AMONG FARMERS IN KHAO PANG KRAI SUBDISTRICT, HUA SAI DISTRICT, NAKHON SI THAMMARAT PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275592
<p>This research employed a quasi-experimental design with a one-group pretest-posttest aimed at examining the effects of a knowledge and attitude enhancement program on modifying risky behaviors related to kratom use among farmers in Khao Pang Krai Sub-district, Hua Sai District, Nakhon Si Thammarat Province. The sample consisted of 40 farmers from the aforementioned area, selected through purposive sampling. The study utilized a three-phase measurement approach: baseline (pre-program), 8 weeks post-intervention, and 12 weeks follow-up. Data collection instruments included structured questionnaires and the knowledge and attitude enhancement program intervention. Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (Paired-Samples t-test and repeated-measures ANOVA).</p> <p>The results revealed that 70.0% of participants were male. Comparisons across the three time points indicated statistically significant differences (p-value < 0.05) in knowledge, attitudes, and risk behaviors. At 12 weeks, all participants (100.0%) demonstrated a high level of knowledge, while 92.5% and 87.5% exhibited moderate levels of attitudes and risk behaviors, respectively.</p> <p>In conclusion, the intervention program effectively increased knowledge, improved attitudes, and reduced risky behaviors related to kratom use in a sustained manner by emphasizing knowledge development, awareness building, and health behavior modification through structured health education processes. Study limitations include the absence of a control group, a small sample size from a single geographic location, and a potentially insufficient follow-up duration for long-term assessment.</p>Jeerarat AunpenAussadawut YothasupapSiriyaporn JanchooWarisa SangaphachokArtittaya LerngphasertLaksami Buasamrit
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-111839611010.64962/rdhsj.v18i3.2025.275592FFECTIVENESS OF THE SYSTEM AND MECHANISM FOR REPORTING EPIDEMIOLOGICAL DISEASE SURVEILLANCE IN NONG BUA LAMPHU PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/276629
<p>This study is a quasi-experimental research study. The objective is to develop a system and mechanism for reporting infectious diseases that require epidemiological surveillance in Nong Bua Lamphu Province to evaluate the effectiveness of the developed system and mechanism. Data were collected using questionnaires and in-depth interviews between August 5, 2024 and August 16, 2025. Descriptive statistics were analyzed and inferential analysis was performed using Paired t-test statistics.</p> <p>The study results found that after the trial of the system and mechanism, epidemiologists had higher knowledge scores on the epidemiological communicable disease surveillance system after the trial than before the trial (Mean diff 2.27, 95% CI = 2.54-4.16) with statistical significance at 0.05. Their attitudes towards using the system after the trial were higher than before the trial (Mean diff 3.94, 95% CI = 3.75-5.04) with statistical significance at 0.05. Developing a system and mechanism for reporting communicable diseases requiring epidemiological surveillance enables all levels of stakeholders to access information easily, conveniently, and quickly, and keep abreast of the situation of communicable diseases requiring surveillance in Nong Bua Lamphu Province.</p> <p>Developing a system and mechanism for reporting infectious diseases requiring epidemiological surveillance enables stakeholders at all levels to easily, conveniently, and quickly access information, keep abreast of the situation of infectious diseases requiring surveillance in Nong Bua Lamphu Province, and establish policies for planning and supporting infectious disease surveillance appropriately based on the local context, as well as reduce morbidity and mortality rates that impact health.</p>Nattayakorn Monkhan
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-11-202025-11-2018316818010.64962/rdhsj.v18i3.2025.276629RESEARCH AND DEVELOPMENT OF A DIGITAL TRANSFORMATION MODEL TO ENHANCE HEALTH ORGANIZATION MANAGEMENT IN HEALTH REGION 2
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/275730
<p>This research was a research and development study employing a multi-stage evaluation approach, conducted in three phases. Phase 1 examined the current situation and factors influencing digital technology adoption through questionnaires administered to 416 public health personnel. Phase 2 developed a digital transformation model through literature review and in-depth interviews with focus group discussions involving 10 administrators and experts, utilizing the M-PWR concept as a framework for developing the SMART-DT model. Phase 3 tested the model's effectiveness using a quasi-experimental One Group Pre-Post Test Design, comparing before and after implementation among 30 personnel from Sukhothai Provincial Public Health Office.</p> <p>The research findings revealed that the digital transformation model for enhancing public health organization management comprised five main components: 1) Electronic document system implementation, 2) Artificial intelligence application in administration and service delivery, 3) Digital skills development and personnel attitude transformation, 4) Real-time data visualization system establishment, and 5) Digital tool-based workflow transformation, implemented through the Sukhothai AI-Driven Implementation Roadmap. The effectiveness testing of the model showed statistically significant differences between pre- and post-implementation in average time spent on redundant work, personnel satisfaction, personnel digital skills, and attitudes toward digital technology utilization.</p>Tatsanee BoonmunThanyarat Sitthiwong
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-10-112025-10-1118310.64962/rdhsj.v18i3.2025.275730EFFECTIVENESS OF DIABETES PREVENTION IN HIGH-RISK GROUPS BASED ON LIFESTYLE MEDICINE CONCEPT IN KUTCHAP DISTRICT, UDON THANI PROVINCE
https://he02.tci-thaijo.org/index.php/RDHSJ/article/view/276636
<p>The objective of this research was to examine the effectiveness of diabetes prevention development among at-risk groups through the application of lifestyle medicine principles. The study involved 30 participants identified as being at risk of diabetes based on inclusion criteria, selected using simple random sampling. Data were collected using a health status index assessment form developed for this study, with instrument reliability verified by a Cronbach’s alpha coefficient of 0.832. Data analysis was performed using descriptive statistics and paired t-test.</p> <p>The results revealed that most participants were female, aged between 46 and 60 years, held a bachelor’s degree or higher, worked in agriculture, and had relatively low monthly income. Overall, participants demonstrated correct lifestyle behaviors according to lifestyle medicine principles at the highest level (= 3.97, S.D. = 0.07). The dimension with the highest score was quality sleep behavior, rated at the highest level (= 4.00, S.D. = 0.01), while stress management had the lowest score, rated at a moderate level (= 3.92, S.D. = 0.29). The effectiveness of diabetes prevention development among at-risk groups, as indicated by the comparison of health status index scores before and after participation, showed a statistically significant difference at the 0.05 level.</p>Hathai Thadtumlay
Copyright (c) 2025 Kalasin Provincial Public Health Office
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2025-11-072025-11-0718313915310.64962/rdhsj.v18i3.2025.276636