Development of Primary Health Care Service Standards for Sub-district Health Promoting Hospitals under Local Administrative Organizations: A Participatory Action Research in Khon Kaen Province

Abstract

This research aimed to analyze the situation, develop, pilot, and evaluate the appropriateness of primary health care system standards for Sub-district Health Promoting Hospitals (SHPHs) under Provincial Administrative Organizations (PAOs). The study employed participatory action research within the Health System Building Blocks Plus One conceptual framework, conducted across three SHPHs under Khon Kaen PAO, representing large, medium, and small service units. Qualitative data were collected from 65 purposively selected informants, while quantitative data were obtained from 139 participants whose sample size was determined using G*Power software for paired t-test analysis and selected through systematic random sampling. Research instruments included focus group discussions, in-depth interviews, participant observation, and questionnaires. Qualitative data were analyzed using inductive content analysis with triangulation, while quantitative data were analyzed using descriptive statistics and paired t-test. The findings revealed that all SHPHs were able to operate in accordance with the primary health care system components; however, limitations were identified in information systems, data linkage, coordination, and quality supervision. The developed standards comprised 7 components, 9 indicators, and 31 assessment items. Following the pilot implementation, community health literacy and service satisfaction increased at statistically significant levels (p = 0.004 and p = 0.025, respectively). The developed standards were evaluated as highly appropriate (Mean = 4.46, SD = 0.52). In conclusion, the developed standards are appropriate and have potential to serve as a framework for primary health care system development within the context of decentralization.