Journal of Thailand Nursing and Midwifery Council

Editorial Note

Professor Dr. Noppawan Piaseu — 2025-09-30

Effects of the Perceived Self-Efficacy Enhancement Program via Electronic Media on Health Promoting Behaviors Among Primiparous Adolescent Mothers

Thanaporn Prasertsup — 2025-09-23

Introduction Primiparous adolescent mothers undergo significant physical, psychological, and emotional changes that may impact their postpartum health. Engaging in health-promoting behaviors is therefore essential for their well-being. The adoption of appropriate health-promoting behaviors is influenced by various factors. Perceived self-efficacy is a significant factor that strongly correlates with health-promoting behaviors. In the context of adolescent mothers, perceived self-efficacy refers to their ability to perceive and evaluate their own capabilities, which in turn facilitates the planning and successful implementation of health-promoting behaviors. When adolescent mothers possess a high level of perceived self-efficacy, they are more likely to engage in proper health-promoting behaviors, ultimately contributing to improved health.

Objective: This study aims to compare health-promoting behaviors in primiparous adolescent mothers between a control group receiving routine nursing care and an experimental group receiving the perceived self-efficacy enhancement program via electronic media and routine nursing care.

Design This study employed a quasi-experimental with a two-group posttest-only design. The researchers developed a perceived self-efficacy enhancement program based on Pender’s Health Promotion Model, Bandura’s concept of self-efficacy, and literature reviews. The program aims to promote postpartum adolescent mothers’ perception and confidence in their ability to manage and engage in health-promoting behaviors during the postpartum period. The program was delivered through four sources of learning combined with electronic media and consisted of three phases over a six-week postpartum period: Phase 1: within the first 24 hours after childbirth; Phase 2: 48 hours postpartum; and Phase 3: 1-6 weeks postpartum.

Methodology The sample consisted of 32 primiparous adolescent mothers who received care at the obstetrics and gynecological ward in a hospital of a northern province between November 2022 and October 2023. Participants were purposively selected based on the following inclusion criteria: 1) aged 10–19 years; 2) singleton pregnancy with vaginal delivery; 3) no complications during pregnancy, delivery, or postpartum period, such as heart disease, diabetes, hypertension, postpartum hemorrhage, or postpartum infection; 4) infants without birth or postnatal complications, such as birth trauma; 5) ability to communicate in Thai and possession of a smartphone with the LINE application installed; and 6) scores of perceived self-efficacy for health-promoting behaviors ranging from low to moderate (34.00-124.66). Sample size was calculated using G*Power program, with a significance level of .05, statistical power of .95, and an effect size of 0.64 based on previous research, resulting in a total of 32 participants. They were purposively assigned into either a control group or an experimental group, with 16 participants in each group. The experimental group participated in a perceived self-efficacy enhancement program via electronic media combined with routine nursing care, while the control group received only routine nursing care. Research instruments included: 1) a perceived self-efficacy enhancement program via electronic media, consisting of three phases over a six-week postpartum period, incorporating four sources of self-efficacy: mastery experiences; vicarious experiences, verbal persuasion, and physiological and emotional states; 2) a follow-up record form via telephone and the LINE application; and 3) a perceived self-efficacy questionnaire for health-promoting behaviors. Data collection tools included: 1) a personal information questionnaire and 2) a health-promoting behavior questionnaire assessing six dimensions of postpartum health behavior among adolescent mothers: 1) health responsibility, 2) nutrition, 3) physical activity, 4) stress management, 5) interpersonal relationships, and 6) spiritual growth. Data were analyzed using descriptive statistics, Chi-square test, Fisher’s exact test, and Mann–Whitney U test.

Results The median age of participants in the experimental and control groups was 17 and 17.5 years, respectively (IQR = 3.0 and 2.0). The majority were students (56.25% in the experimental group and 50% in the control group) and had completed lower secondary education (56.25% and 68.75%, respectively). Most participants were single (93.75% and 68.75%) and lived in extended families (93.75% and 75.00%). A majority reported having sufficient income (81.25% and 75.00%). The husbands of participants were predominantly aged 20 years or older (68.75% and 62.5%). In terms of occupation, 43.75% of husbands in the experimental group were private-sector employees, while 37.5% of husbands in the control group were laborers. After the program, the experimental group had a statistically significant higher mean score in overall health-promoting behaviors compared to the control group (p < .001). Significant differences were also observed between the two groups in five specific dimensions of health-promoting behaviors: health responsibility, nutrition, interpersonal relationships, spiritual growth, and stress management (p < .05). However, no significant difference was found in the physical activity dimension (p = .060).

Recommendation Midwives can apply the perceived self-efficacy enhancement program via electronic media to promote appropriate health-promoting behaviors among primiparous adolescent mothers. In the field of education, nursing institutions may utilize the findings of this study as approaches for curriculum development plans, aiming to raise nursing students’ awareness of the importance of enhancing perceived self-efficacy in primiparous adolescent mothers. Furthermore, future research should include a follow-up study and focus on the development and evaluation of perceived self-efficacy enhancement programs to promote health behaviors for other groups of postpartum adolescent mothers, such as those who underwent cesarean delivery or experienced preterm birth.

Factors Influencing Early Postoperative Recovery in Older Patients Undergoing Laparoscopic Cholecystectomy

Varunyupa Roykulcharoen — 2025-09-23

Introduction Cholecystectomy is a common surgical procedure in older adults. Postoperative recovery may be complicated by various factors, including surgical wound pain and abdominal distension. Additionally, age-related physiological decline in older adults can contribute to delayed recovery following surgery. Currently, there is a lack of research in Thailand examining the factors that influence early recovery in older patients undergoing laparoscopic cholecystectomy (LC).

Objective This study aims to investigate the factors affecting early recovery in older patients undergoing laparoscopic cholecystectomy.

Design This study employs a descriptive research design using secondary data analysis. A random sampling method was used to select older patients who underwent laparoscopic cholecystectomy during the study period. The research is guided by the Theory of Transition, which conceptualizes recovery as a transition from illness to well-being. Early postoperative outcomes following laparoscopic cholecystectomy are considered an outcome of this transitional process. Early recovery depends on both individual and treatment-related factors, including age, gender, and body mass index (BMI), American Society of Anesthesiologists (ASA) classification, smoking status, comorbidities, use of anticoagulant medications, presence of cholecystitis, duration of surgery and anesthesia, hematological test results, and postoperative outcomes.

Methods The study participants consisted of 229 older patients who underwent laparoscopic cholecystectomy at a hospital in an eastern province of Thailand, between 2016 and 2024. Through random sampling using statistical software, participants were recruited. Data were collected from medical records using a record form developed by the researchers, which demonstrated a content validity index (CVI) of .80. Test retest reliability was .97, while inter-rater reliability was .95. Factors influencing early recovery in older patients following laparoscopic cholecystectomy were analyzed using univariate analysis and binary logistic regression, with a statistical significance level set at .05.

Results A total of 229 patients were included in the study, with a mean age of 68.0 years (SD = 6.6; Min-Max = 60–90 years) and a mean body mass index (BMI) of 25.0 kg/m² (SD = 4.4). Of these, 64.2% were female; 45.0% had chronic cholecystitis; 93.0% had comorbidities; 36.2% had complications; 13.5% underwent emergency surgery; 64.2% were classified as ASA Grade 2. The median duration of surgery was 90 minutes (Q1-Q3 = 70–115 minutes). Conversion to open abdominal surgery was required in 1.31%. Intraoperative adverse events occurred in 21.0% of the patients, with bradycardia (heart rate <50 bpm) being the most common (15.3%). Surgical drain placement was performed in 20.1%. Patients were categorized into two groups based on recovery time: those with early recovery (hospital stay ≤3 days) and those with delayed recovery (hospital stay >3 days), accounting for 68.1% and 31.9% of the patients, respectively. Factors significantly associated with delayed recovery, identified through both univariate analysis and binary logistic regression, included: 1) emergency surgery (Adjusted OR [95% CI]: -6.17 [-9.24 to -3.09], p < .001), 2) surgical drain placement (Adjusted OR [95% CI]: -1.99 [-3.46 to -0.51], p = .008), 3) platelet count <150 × 10³/mm³ (Adjusted OR [95% CI]: -3.19 [-5.26 to -1.13], p = .002), 4) use of oral analgesics (Adjusted OR [95% CI]: -1.34 [-2.36 to -0.32], p = .010), and 5) presence of postoperative complications (Adjusted OR [95% CI]: -1.81 [-2.82 to -0.80], p < .001).

Recommendation Older people with gallbladder-related conditions should be proactively managed to prevent emergency surgery, including scheduling elective surgery before the onset of severe symptoms. Prior to laparoscopic cholecystectomy, platelet levels should be assessed and any thrombocytopenia addressed. Postoperatively, if a surgical drain is placed and oral analgesics are administered, a comprehensive care plan should be implemented. This plan should include pain management, assistance with sitting and mobilization, and appropriate measures to prevent postoperative complications. Such interventions are essential to promote early recovery in older patients.

Effects of the Nurse Competency Improvement Program in Caring for Pediatric Patients with Cardiac Arrhythmia on Knowledge, Attitude, and Caring Skills for the Pediatric Patients with Cardiac Arrhythmia

Onchira Theannamngian — 2025-09-23

Introduction Cardiac arrhythmia in pediatric patients is a medical emergency that can be life-threatening, particularly among children with congenital heart disease. Nurses who care for pediatric patients with this condition need specialized competencies to help reduce complications and mortality rates. Currently, Thailand Nursing and Midwifery Council is no established framework outlining the specific nursing competencies required for managing pediatric arrhythmias. Moreover, despite having received advanced pediatric life support training, many nurses still lack the necessary skills to effectively care for children experiencing arrhythmic episodes. Therefore, the development of an educational program aimed at enhancing nurses’ competencies in managing pediatric arrhythmias represents a critical strategy to improve the quality of care for this vulnerable patient population.

Nurses who care for pediatric patients with this condition need specialized competencies to help reduce complications and mortality. Currently, it is found that there are no specialized nursing competency requirements to care for pediatric patients with arrhythmias. It was found that nurses have limited skills in caring for pediatric patients when arrhythmias occur, even though they have been trained in pediatric advanced life support. Therefore, the development of teaching programs to improve nurses’ competency in caring for children with arrhythmias is one of the approaches to promote the competence of nurses in caring for this group of patients.

Objective To investigate the effects of the nurse competency improvement program in caring for pediatric patients with cardiac arrhythmias by comparing the knowledge, skills, and attitudes of nurses towards caring for children with arrhythmias between before and after participating in the program.

Design This study employed a quasi-experimental, one-group pretest-posttest design, applying the coaching framework proposed by Helfer and Willson into the instructional process of a competency development program for nurses caring for pediatric patients with cardiac arrhythmias. The coaching process consisted of four key stages: 1) establishing rapport and providing information, 2) skill development through instruction and hands-on practice, 3) skill reinforcement through review, and 4) follow-up and evaluation. The program aimed to enhance nurses’ competencies in managing pediatric arrhythmias, including nine core competencies: 1) performing 12-lead electrocardiograms, 2) interpreting ECG results, 3) nursing care for pediatric patients with bradyarrhythmias, 4) nursing care for pediatric patients with tachyarrhythmias, 5) administration of anti-arrhythmic medications, 6) performing vagal maneuvers, 7) caring for patients undergoing cardioversion or defibrillation, 8) managing patients with temporary pacemakers, and 9) providing care for pediatric patients experiencing cardiac arrest. Learning outcomes were assessed based on Bloom’s taxonomy, including cognitive, affective, and psychomotor domains, resulting in improved knowledge, clinical skills, and attitudes toward nursing care for pediatric patients with cardiac arrhythmias.

Methodology The study participants consisted of 12 newly graduated nurses working in the pediatric cardiology unit at a tertiary-level hospital in Bangkok. Participants were purposively selected based on the following inclusion criteria: 1) holding a Bachelor of Nursing Science degree in Nursing and Midwifery, 2) having 1–5 years of clinical nursing experience, 3) being proficient in computer use and owning a smartphone capable of using the LINE application, and 4) voluntarily agreeing to participate in the program. The sample size was determined using power analysis via the G*Power software. The research instruments were divided into two components: 1) the competency development program for nurses caring for pediatric patients with cardiac arrhythmias, which included theoretical and practical teaching plans, a training manual, Powerpoint presentations, instructional videos, LINE application content, medical equipment and medications, and pediatric advanced life support trainer with arrhythmia simulation, and 2) data collection tools, consisting of a demographic information questionnaire, a knowledge assessment tool for pediatric arrhythmia care, a skill assessments in caring for pediatric patients with arrhythmias, and a questionnaire assessing nurses’ attitudes toward developing competencies in pediatric arrhythmia care. Data collection was conducted from June to July 2024 and analyzed using descriptive statistics and Paired t-tests.

Results The majority of participants had prior experience in caring for pediatric patients with cardiac arrhythmias (75%). Additionally, 91.7% reported that their workplace provided opportunities to care for such patients. Half of the participants (50%) had received training on electrocardiogram (ECG) interpretation at least once, and an equal proportion had undergone training specifically focused on ECG interpretation in pediatric patients. Furthermore, 58.3% had received training in pediatric arrhythmia care, while 91.7% had completed advanced pediatric life support training. Analysis of the overall knowledge revealed that knowledge after the program (M = 66.75, SD = 14.81) was higher than before the program (M = 25.75, SD = 10.81; t = 11.660, p < .001). Similarly, the mean skill in pediatric arrhythmia care after the program (M = 55.67, SD = 5.16) was significantly higher than before the program (M = 6.25, SD = 3.70; t = 33.754, p < .001). However, the mean attitude before (M = 25.83, SD = 2.44) and after the program (M = 26.08, SD = 4.64) were not statistically different (t = .248, p = .405).

Recommendation Healthcare institutions responsible for the care of pediatric patients with cardiac arrhythmia can consider adopting this program as part of nurse training initiatives. The program has the potential to enhance nurses’ competencies, particularly knowledge and skills related to the care of children with arrhythmias. Future studies should employ an experimental research design to validate the findings and assess long-term outcomes.

Effects of a Simulation-Based Learning Program on Nursing Students’ Knowledge, Self-confidence, and Clinical Performance in Caring for Pregnant Women with Complications

Sunetr Boobpamala — 2025-09-24

Introduction Caring for pregnant women experiencing complications including preterm labor, gestational hypertension, gestational diabetes, fetal distress, umbilical cord prolapse, retained placenta, shoulder dystocia, and postpartum hemorrhage is a significant challenge for nursing students. Clinical practice in labor rooms remains limited due to students’ stress, anxiety, limited knowledge and skills, and a declining number of childbirth cases. Simulation-based learning, grounded in Kolb’s experiential learning cycle theory, has been adopted to prepare nursing students by enhancing their knowledge, self-confidence, and clinical performance in managing obstetric complications. However, no studies comparing the effectiveness of such programs between students who engage in immediate clinical practice following simulation-based training and those who begin clinical practice one month after completing the program.

Objectives This study aimed to: 1) compare the mean knowledge in nursing care of pregnant women with complications before and after participating in the program between the experimental and comparison groups, 2) compare the mean confidence in providing nursing care for pregnant women with complications before and after participating in the program between the experimental and comparison groups, and 3) compare the mean knowledge, self-confidence, and clinical performance in nursing care of pregnant women with complications between the experimental group, who practiced immediately after the program, and the comparison group, who practiced one month after participating in the program

Design This study is quasi-experimental research with a two-group, pretest-posttest design.

Methodology The participants consisted of 120 fourth-year nursing students enrolled in Maternal–Newborn Nursing and Midwifery II at the Faculty of Nursing in a University. Participants were randomly selected and then assigned into two groups via matching on Grade Point Average and gender, and then randomly assigned the 2 groups into experimental and comparison groups. All participants underwent a simulation-based learning program. The experimental group proceeded to clinical practice in the labor room immediately after the program, while the comparison group began clinical practice one month later. The study duration was three months. Research instruments included a simulation-based learning program and a five-part questionnaire: 1) demographic data, 2) knowledge in caring for pregnant women with complications, 3) self-confidence in caring for pregnant women with complications, 4) clinical performance in caring for pregnant women with complications, and 5) structured interview guidelines. Content validity was assessed by three experts, yielding a scale content validity index of .80 for the program, .89 for knowledge, .80 for self-confidence, and .95 for clinical performance scales. Reliability testing was conducted in 30 nursing students who were not study participants, revealing Cronbach’s alpha coefficients of .93 for self-confidence and .94 for clinical performance. Reliability of the knowledge scale was assessed using KR-20, yielding a coefficient of .72. Data were analyzed using descriptive statistics, Fisher’s exact test, Independent t-test, and Paired t-test, with a significance level set at .05.

Results The mean age of participants in the experimental group was 22.25 years (SD = 2.03), while that of the comparison group was 22.27 years (SD = 1.61). There were no significant differences between the two groups in terms of gender, age, grade point average, monthly expenses, or underlying health conditions (p = 1.000, .960, .902, .419, 1.000, respectively). Before participating in the program, the mean knowledge of the experimental group (M = 19.450, SD = 4.086) and the comparison group (M = 19.567, SD = 4.634) did not differ significantly (p = .884). Similarly, self-confidence in caring for pregnant women with complications was not significantly different between the experimental group (M = 3.638, SD = 0.448) and the comparison group (M = 3.672, SD = 0.448) (p = .684). After participating in the program, both groups demonstrated significantly higher in knowledge and self-confidence. The experimental group showed increased knowledge (M = 30.950, SD = 4.869) and confidence (M = 4.248, SD = 0.459) (p < .001), as did the comparison group, with higher knowledge (M = 32.300, SD = 3.514) and self-confidence (M = 4.160, SD = 0.509) (p < .001). However, no statistically significant differences were found between the two groups in terms of knowledge and self-confidence after the program (p = .084, .329). When comparing clinical performance in caring for pregnant women with complications, the experimental group demonstrated significantly higher performance (M = 3.513, SD = 0.359) than the comparison group (M = 3.080, SD = 0.510) (p < .001).

Recommendation The simulation- based program designed to enhance nursing students’ readiness for caring for pregnant women with complications through simulated scenarios is effective in improving their knowledge, self-confidence, and clinical performance. Immediate clinical placement following completion of the program contributed to favorable outcomes in clinical performance.

Learning Needs and Barriers to Accessing Sexual Health Services among Adolescents: A Descriptive Qualitative Study

Sitanan Srijaiwong — 2025-09-24

Introduction Adolescent sexual health during the transitional phase from childhood to adulthood represents a critical issue requiring heightened attention particularly in an era marked by rapid information exchange and prevailing societal attitudes that remain resistant to comprehensive sex education. Despite ongoing efforts to promote sexual education and expand youth-friendly health services, access remains constrained by a constellation of factors at the personal, family, school, and health services system levels. These challenges are especially pronounced within the cultural context of Northern Thailand, where traditional values continue to shape perceptions and practices surrounding sexuality. Understanding adolescents’ learning needs and the barriers they face in accessing services through the perspectives of multiple stakeholders is essential for designing interventions appropriately.

Objectives This study aimed to 1) describe perceptions regarding the learning needs, barriers, and access to sexual health services among adolescents of reproductive age within Health Region 2, 2) explore perceptions of sexual communication with children and adolescents, as perceived by students, teachers, and parents, and 3) study perceptions and proposed strategies for developing youth-friendly sexual health services, based on perceptions of students and public health personnel.

Design This study employs a descriptive qualitative research design, grounded in the constructivist/ interpretivist paradigms, to explore the perceptions and perspectives of multiple stakeholders regarding adolescent sexual health. The researchers applies a health service development framework including 3 components: 1) learning needs, 2) barriers to service access, and 3) stakeholder experiences and perceptions. Additionally, the study employs the concepts of positive sexual health approach and youth-friendly services as theoretical foundations.

Methodology This study was conducted within Health Region 2, including five provinces: Phitsanulok, Phetchabun, Tak, Sukhothai, and Uttaradit, between September 2022 and June 2023. Informants were selected through purposive sampling and snowball sampling techniques, resulting in a total of 100 informants. These included 50 students in late primary and early secondary education (aged 9–15 years), 20 parents, 15 teachers, and 15 public health personnel. Instruments for data collection comprised semi-structured interview guides, focus group discussion protocols, non-participatory observation forms, and personal information recording sheets. The data were gathered through 50 in-depth interviews, 8 focus group discussions, and non-participatory observations conducted at 15 sites. Content analysis was conducted following the approach outlined by Elo and Kyngäs, utilizing NVivo 12 software. Trustworthiness was ensured through member checking, triangulation across data sources, researchers, and methods, and researcher reflexivity.

Results The data analysis revealed three major themes aligned with the study’s objectives. First, Learning Needs: Students’ learning needs regarding sexual health were categorized into five sub-themes: 1) physical changes and self-care, 2) relationship and communication skills, 3) sexual protection and safety, 4) safe technology and online media use, and 5) sexual diversity and acceptance. Among students who had previously accessed health services, four areas for service improvement were identified: enhancing service delivery processes, developing modern educational media, expanding online platforms, and providing training for service providers. Barriers to accessing information and services consisted of four main categories: attitude and belief-related barriers (3 subcategories), barriers to accessing accurate information (4 subcategories), health system-related barriers (5 subcategories), and family and school-related barriers (3 subcategories). Second, Perceptions of Sexual Communication: Students perceived that parents and teachers lacked confidence in discussing sexual topics. Teachers reported feeling unprepared and lacking communication skills, while parents expressed concerns that such discussions might stimulate curiosity and acknowledged their own limited access to up-to-date knowledge. Third, Perceptions of Current Services and Recommendations for Youth-Friendly Development: Students perceived existing services as unfriendly and judgmental. Public health personnel reported constraints in time and specialized skills. Recommendations for developing youth-friendly services, as identified across stakeholder groups, included four key areas: 1) improving service environments and processes, 2) enhancing personnel capacity, 3) integrating innovation and technology, and 4) fostering networks and collaborative partnerships.

Recommendation Based on the findings, five key recommendations are proposed: 1) Develop an integrated sex education curriculum that incorporates content on evaluating online information and understanding sexual diversity, 2) Establish concrete youth-friendly sexual health services, including dedicated youth clinics, digital counseling applications, and flexible service hours, 3) Create cross-sectoral coordination mechanisms, such as district-level youth sexual health committees and digital referral systems, 4) Enhance parental capacity for sexual communication through tiered communication training programs and peer support groups, and 5) Foster sustainable community engagement by establishing community learning centers and networks of local leaders. This research contributes new knowledge on the diverse and emerging needs of adolescents in the digital era and serves as a foundational resource for policy development and practice that genuinely responds to the lived realities of the target population.

Factors Affecting Intention to Use E-Cigarette Among Female Secondary School Students

Phimsuphak Aumphimai — 2025-09-24

Introduction Although the use of electronic cigarettes, (e-cigarette) is prohibited by law in Thailand, their prevalence has been increasing among students, particularly in female adolescents. Most existing research has focused on people aged 15 years and older, while studies specifically targeting early adolescent females remain limited. Furthermore, there is a lack of research grounded in clear theoretical frameworks. Intentions to use electronic cigarettes are a critical predictor of actual behavior and therefore represent an essential factor for surveillance and early prevention efforts targeting e-cigarette use among young females.

Objective This study aims to describe the intention to use electronic cigarettes among female lower secondary school students, as well as the factors influencing such intentions. These factors include prior experience with conventional cigarette smoking and substance use, current cigarette smoking behavior, perceived self-efficacy in resisting e-cigarette use, knowledge about electronic cigarettes, attitudes toward e-cigarette use, peer and parental use of conventional or electronic cigarettes, and access to media.

Design This study employed a cross-sectional correlational design, guided by the Triadic Influence Theory developed by Flay and Petraitis. This theoretical framework was selected for its comprehensive approach to explaining adolescent behavior, including intrapersonal, interpersonal, and socio-environmental factors. Each group of influence contributes to varying degrees of engagement in e-cigarette use, ranging from minimal to substantial. These factors also shape the intention to experiment with or initiate e-cigarette use, thereby serving as predictors of future behavior of e-cigarette use among adolescents.

Methodology The participants consisted of 193 female students enrolled in Grade 7 at state-supervised educational institutions. They were selected through multistage random sampling. The inclusion criteria were: 1) Thai nationality, 2) aged between 13 and 15 years, and 3) parental and/or school administrator consent, along with the students’ willingness to participate in the study. The sample size was calculated using a formula based on survey designed to estimate proportions according to the parameters of the Parell method. Data were collected using structured questionnaires including demographic information, smoking and substance use behaviors, peer and family use of conventional or electronic cigarettes, knowledge about e-cigarettes, perceived self-efficacy in resisting e-cigarette use, attitudes toward e-cigarettes, media access, and intention to use e-cigarettes. Reliability testing of the instruments yielded Cronbach’s alpha coefficients of .86 for the self-efficacy scale, .90 for the attitude scale, .80 for the media access scale, and .95 for the intention to use e-cigarette scale. The Kuder-Richardson 20 (KR-20) coefficient of the knowledge questionnaire was .83. Data were analyzed using descriptive statistics, including frequency distribution, percentage, mean, and standard deviation, and inferential statistics, specifically Binary Logistic Regression analysis.

Results The participants had a mean age of 13 years (SD = 0.279). The majority had a grade point average (GPA) of 3.00 or higher (94.3%), lived with both parents (66.3%), received a daily allowance of 100–199 Thai Baht (62.2%), and had parents who cohabited (67.9%). Notably, 29.5% of the participants reported an intention to use electronic cigarettes. Statistically significant factors influencing the intention to use e-cigarettes among female secondary school students included: attitudes toward e-cigarette use (Adjusted Odds Ratio: AOR = 8.81, 95% Confidence Interval: CI = 3.784–20.529), perceived self-efficacy in resisting e-cigarette use (AOR = 3.55, 95% CI = 1.559–8.061), and media access (AOR = 2.65, 95% CI = 1.177–5.948).

Recommendation The findings of this study are beneficial for school administrators, healthcare professionals, and public health personnel involved in developing strategies to prevent the initiation of e-cigarette use among female secondary school students within the school setting by identifying risk factors of intention to use e-cigarette including attitudes toward e-cigarette use, perceived self-efficacy in resisting e-cigarette use, and media access.

Effectiveness of a Self-Management Program through LINE Application in Pregnant Women with Gestational Diabetes Mellitus, Class A1

Papeam Toburan — 2025-09-24

Introduction Gestational diabetes mellitus is a common complication of pregnancy. Appropriate glycemic control can significantly reduce the risk of complications in both the mother and the infant. The implementation of a self-management program via the LINE application facilitates convenient monitoring of health behaviors and blood glucose levels among pregnant women. Moreover, it enables continuous communication with healthcare teams, thereby promoting effective and sustainable self-care.

Objective This study aimed to examine the effects of a self-management program delivered via the LINE application on food consumption behaviors, exercise behaviors, and two-hour postprandial blood glucose levels among pregnant women diagnosed with gestational diabetes mellitus, class A1.

Design This study employed a quasi-experimental with two-group pretest-posttest design to investigate the effects of a self-management program delivered via the LINE application on health behaviors among pregnant women diagnosed with gestational diabetes mellitus, class A1. The program was developed based on Creer’s self-management framework and comprised six key components: 1) Goal Selection: Pregnant women collaborated with healthcare professionals to establish goals for glycemic control and behavioral modification; 2) Information Collection: Participants recorded health-related behaviors, such as dietary intake, exercise, and blood glucose levels, using online forms within the LINE application; 3) Information Processing and Evaluation: This component facilitated awareness of the impact of behaviors on blood glucose levels; 4) Decision-Making: Participants were guided to select appropriate behavioral modification, such as increasing exercise or reducing intake of high-glycemic foods; 5) Action: Pregnant women implemented their individualized plans with ongoing support and feedback from the healthcare team via the LINE application; and 6) Self-Reaction: Participants evaluated their own practices and made necessary adjustments to improve future health behaviors.

Methodology The study sample consisted of 52 pregnant women diagnosed with gestational diabetes mellitus, class A1, recruited between March and July 2024. Participants were purposively selected from an antenatal clinic at a hospital located in northeastern Thailand and were assigned to either the control group (n = 26) or the experimental group (n = 26). The control group received standard care, while the experimental group received standard care and a self-management program delivered via the LINE application over a period of seven weeks. The program was validated for content by five experts, yielding a content validity index of 1.00. Data were collected using a personal information questionnaire, a food consumption behavior questionnaire with reliability revealing Cronbach’s alpha coefficient of .71, an exercise behavior questionnaire reporting Cronbach’s alpha coefficient of .95, and a two-hour postprandial blood glucose recording form. Data were collected in weeks 1, 3, 5, and 7. Data analysis included descriptive statistics, Independent t-test, Paired t-test, and Chi-square test.

Results The experimental and control groups had mean ages of 29.26 years (SD = 5.95) and 28.57 years (SD = 6.16), respectively. There were no statistically significant differences in demographic characteristics. After participating in the program, the experimental group had a significantly higher mean score for food consumption behaviors (M = 41.92, SD = 3.68) compared to before the program (M = 36.34, SD = 4.48) and the control group (M = 37.46, SD = 5.21), with statistical significance (t = -6.395, 3.568, p < .001). Similarly, the mean score for exercise behavior in the experimental group (M = 36.88, SD = 8.29) was significantly higher than before the program (M = 29.76, SD = 10.93) and the control group (M = 28.26, SD = 8.44) (t = -4.135, 3.712, p < .001) Furthermore, the proportion of participants in the experimental group who had normal two-hour postprandial blood glucose levels (< 120 mg/dL) was significantly higher than that of the control group in weeks 3 and 5 (χ² = 4.282, p = .039; χ² = 9.028, p = .003). However, by week 7, there was no statistically significant difference between the two groups in the proportion of participants with normal blood glucose levels (χ² = 3.519, p = .061).

Recommendation Nurses and healthcare professionals can apply a self-management program via the LINE application to promote food consumption behavioral control, exercise, and glycemic control among pregnant women diagnosed with gestational diabetes mellitus, Class A1. This approach facilitates continuous monitoring of health behaviors, particularly through health alerts, the use of online manuals, and real-time feedback mechanisms.

Effectiveness of a Family Self-management Enhancement Program for Suspected Diabetic Patients in Chaiyaphum Province

Somkid Chotnawakun — 2025-09-26

Introduction Diabetes is a major global public health problem, with a continuously rising incidence of newly diagnosed cases. Effective prevention and control of diabetes have therefore become critical public health goals. Previous studies have shown that self-management, when combined with family support, is associated with improved health behaviors among both patients diagnosed with diabetes and those at risk. This is particularly evident in behavioral modifications related to dietary control, physical activity, and stress management, which contribute to reductions in body mass index and better glycemic control. Patients suspected of having diabetes represent a group undergoing diagnostic evaluation, with outcomes potentially confirming either a diagnosis of diabetes or identifying them as at-risk. Enhancing self-management practices during this transitional phase, supported by family participation, may facilitate positive behavioral changes, reduce the likelihood of progression to diabetes, and support disease control in those who are subsequently diagnosed.

Objective To examine the effects of a family self-management enhancement program on knowledge of diabetes prevention, family support, self-management behaviors for diabetes prevention, body mass index, and blood glucose levels in patients suspected of having diabetes mellitus.

Design This study employed a quasi-experimental design with two-group pre- and post-tests. It applied the self-management framework of Ryan and Sawin, which integrates both contextual and process dimensions. The contextual dimension involved assessing current health behaviors, risk factors, and the family’s potential to provide support. The process dimension included activities aimed at enhancing knowledge and self-management skills related to diet, physical activity, and stress management, all facilitated through family support. Monitoring and evaluation mechanisms were incorporated to ensure short-term outcomes, specifically behavioral changes in food consumption, exercise, and stress management. These changes are expected to lead to long-term outcomes, including reductions in body mass index and blood glucose levels, thereby decreasing the risk of developing diabetes.

Methodology The study sample consisted of 70 patients suspected of having diabetes in Chaiyaphum Province. Participants were selected through simple random sampling according to inclusion and exclusion criteria, and were assigned equally to the experimental and control groups (35 participants per group). The sample size was determined using G*Power software, with an effect size of 0.80 derived from a previous study and a power of .90. Researchers designated specific community areas for the experimental and control groups, followed by random sampling within each area.

The research instruments, developed by the researchers, comprised two main components: 1) an 8-week family self-management enhancement program, which included five workshop sessions, two of which (sessions 2 and 4) involved family participation. The program also incorporated exercise training using music-based stick dancing and weekly follow-up via the LINE application by family members throughout the intervention period; and 2) data collection tools divided into five sections: (1) general information, (2) knowledge on diabetes prevention, (3) family support, (4) self-management behaviors for diabetes prevention, and (5) clinical assessments including weight, height, and fingertip blood glucose levels. The content validity index (CVI) for both the program and each questionnaire was equally 1.00. Reliability testing yielded a KR-20 coefficient of .82 for the diabetes prevention knowledge questionnaire, and Cronbach’s alpha coefficients of .86 and .89 for the family support and self-management behavior questionnaires, respectively. Data collection was conducted from December 2024 to February 2025. Descriptive statistics, Independent t-tests, and Paired t-tests were used for data analysis.

Results The experimental and control groups did not differ significantly in terms of general and health-related characteristics. The mean age of participants was 57.40 years (SD = 3.35) in the experimental group and 57.94 years (SD = 4.45) in the control group. After participating in the program, the experimental group had significantly higher overall and sub-scale knowledge of diabetes prevention compared to the control group (t = 7.156, p < .001) and to baseline scores (t = -9.367, p < .001). Family support for diabetes prevention was also significantly greater in the experimental group than in the control group (t = 10.957, p < .001) and showed a significant higher from baseline (t = -11.580, p < .001). Similarly, self-management behaviors related to diabetes prevention were significantly higher in the experimental group than in the control group (t = 17.024, p < .001) and improved significantly from the baseline (t = -20.922, p < .001). In terms of clinical outcomes, the experimental group exhibited significantly lower body mass index (BMI) compared to the control group (t = -3.100, p = .003) and the baseline (t = 7.425, p < .001). Blood glucose levels were also significantly lower in the experimental group than in the control group (t = -5.431, p < .001) and showed a significant lower than the baseline (t = -7.395, p < .001).

Recommendation Nurses and multidisciplinary teams involved in the care of patients suspected of having diabetes may adopt the family self-management enhancement program, particularly its components focused on enhancing knowledge and beliefs about diabetes, enhancing self-regulation skills, and promoting family participation in diabetes prevention, for use among target populations with similar contextual characteristics.

Needs of Patients, Family Caregivers, and Nurses in Community-Based Stroke Care

Jureeporn Keskaew — 2025-09-29

Introduction Stroke is a leading cause of mortality among non-communicable diseases. However, research on the need for community-based stroke care remains limited, particularly among key stakeholders such as stroke patients, family caregivers, and nurses working in primary care units (PCUs).

Objective This descriptive qualitative study aimed to describe the care needs of stroke patients, family caregivers and nurses working in primary care units.

Design This study was descriptive qualitative research.

Methodology The study participants included 35 nurses working in primary care units across four provinces in central Thailand, and 25 stroke patients or their family caregivers, selected through purposive sampling. Data were collected using in-depth interviews and focus group discussions guided by semi-structured interview questions. The data were analyzed using content analysis.

Results The majority of stroke patients had been diagnosed with hypertension (80%), and only five patients were in the recovery stage. The average duration of service utilization at the primary care unit was 60 months. The needs of patients and family caregivers included: 1) information regarding warning signs and treatment, 2) social support and care networks, 3) emergency health care services and 4) efficient service delivery and positive communication. Patients and caregivers expressed structural needs related to staffing and infrastructure, including a desire for increased nursing personnel and more spacious service areas with sufficient seating. Process-related needs included educational information on stroke prevention and warning signs, such as dietary guidelines, physical activity, smoking cessation, and symptom monitoring. Additionally, there was a need for emergency care and efficient services and communication for patients requiring long-term care. All nurses were female, with a median of 8 years of experience working in primary care settings. Their expressed needs included: 1) emergency care skills, 2) professional competencies in management and administration, and 3) efficiency of care delivery system.

Recommendation The findings of this study suggest the need for developing a comprehensive care management guideline for stroke patients. Key recommendations include enhancing emergency care competencies among nurses working in primary care settings, improving the efficiency of management systems, strengthening care networks and support mechanisms, and ensuring the provision of medical tools and equipment that align with the needs of patients and caregivers. These measures aim to improve health outcomes and the quality of stroke care within community settings.

Effectiveness of a Virtual Reality-Based Normal Delivery Preparation Program in Nursing Students: A Follow-Up Study

Nareerat Boonnate — 2025-09-29

Introduction Preparation for normal delivery is a critically important skill for nursing students prior to entering clinical practice. Real-world learning environments often present several limitations, including an insufficient number of patients, unpredictable and uncontrollable clinical scenarios, and potential risks to patient safety. These factors pose significant challenges to the development of clinical competencies and may affect students’ confidence in performing procedures. Virtual reality (VR) technology offers a promising solution by providing realistic, controlled, and safe simulation environments. Through VR, students can repeatedly practice clinical skills without posing any risk to actual patients. Moreover, this hands-on learning approach effectively supports the development of professional competencies in a more efficient and engaging manner.

Objectives This study aimed to: 1) examine the outcomes of enhanced preparation for normal delivery beyond the standard criteria on student satisfaction, self-confidence, and clinical skill examination scores in the course “Maternal and Newborn Nursing and Midwifery Practicum 1,” and 2) compare satisfaction with the use of virtual reality technology in simulating normal delivery scenarios, confidence levels, and objective structured clinical examination (OSCE) scores between students who received standard-preparedness and those who received enhanced preparation in the same course.

Design This descriptive research employed a prospective data collection approach, applying Garrison’s self-directed learning framework integrated with a comprehensive review of relevant literature to develop strategies for promoting self-directed learning in virtual environments. This conceptual framework enhances learners’ capabilities across multiple dimensions, including self-management, self-monitoring, and motivation for learning.

Methodology The participants consisted of 198 second-year nursing students enrolled in the Bachelor of Nursing Science Program at Srisavarindhira Thai Red Cross Institute of Nursing. These students were registered in the course “Maternal and Newborn Nursing and Midwifery I” during the second semester of the 2023 academic year, and in the practicum course of the same title during the first semester of the 2024 academic year. As data were collected from the entire eligible population within the specified timeframe, sample size calculation was not required. Data were collected using the following instruments: a personal information questionnaire; a virtual reality-based normal delivery practice assessment form, which demonstrated a content validity index of 1.00; satisfaction, confidence, and VR-based normal delivery simulation evaluation form, with reliability, Cronbach’s alpha coefficient of .92; and a clinical skill examination form for normal delivery. Descriptive statistics and the Mann–Whitney U test were employed for data analysis, with a significance level set at .05.

Results The students in the high-preparedness group, who utilized the VR-based normal labor scenario for self-directed, unlimited practice, achieved higher scores in the Objective Structured Clinical Examination (OSCE) for normal labor clinical skills (M = 26.05, SD = 3.17) compared to those in the Standard-preparedness group (M = 24.73, SD = 3.83), with statistical significance (Z = -2.430, p = .015). However, no statistically significant differences were found between the two groups in terms of satisfaction with the use of VR technology or confidence in performing normal delivery.

Recommendation The findings of this study highlight the potential of virtual reality technology in enhancing experiential learning. Therefore, it is recommended that VR-based media be systematically integrated into instructional processes, particularly in courses aimed at developing practical skills. Such integration can help students become familiar with the technology and utilize it as an effective component of advanced learning. As this study employed a comparative research design, future studies should be designed with more rigorous control of relevant variables, particularly through the use of random sampling or clearly defined group allocation.