Thai Journal of Public Health

Effects of a Program Applying the Transtheoretical Model on Diet and Exercise Behaviors among Hospital Personnel with Metabolic Syndrome

Suphanan Pimpru — 2026-07-01

Background: Metabolic syndrome is a major public health concern associated with increased risks of type 2 diabetes mellitus and cardiovascular disease. Hospital personnel may be particularly vulnerable due to occupational demands, shift work, and limited opportunities for self-care. Objective: To evaluate the effects of a stage-tailored intervention based on the Transtheoretical Model on awareness of metabolic syndrome prevention, dietary behavior, physical activity, body weight, and waist circumference among hospital personnel with metabolic syndrome. Methods: A quasi-experimental two-group pretest–posttest design with cluster allocation was conducted among 64 hospital personnel in a private hospital in Thailand. Four departmental clusters were first identified, and cluster-level simple random allocation was used to assign two clusters to the intervention group and two clusters to the comparison group. Simple random sampling was then used to select participants until the required sample size of 32 participants per group was achieved. The intervention group received a five-week stage-tailored intervention followed by a three-week follow-up period, while the comparison group received routine health information. Data were analyzed using repeated measures ANOVA, paired t-tests, and independent t-tests (p < .05). Results: The intervention group demonstrated significant improvements in awareness of metabolic syndrome prevention and physical activity over time (p < .05). Waist circumference also showed a significant within-group reduction in the intervention group. However, no significant group-by-time interaction effects were observed for behavioral or anthropometric outcomes, and no significant between-group differences were found in body weight or waist circumference. Conclusion: A stage-tailored intervention based on the Transtheoretical Model resulted in partial improvements in awareness and selected health outcomes, particularly physical activity and waist circumference within the intervention group. These findings suggest potential benefits of readiness-based behavioral strategies in workplace health promotion; however, stronger evidence from larger and longer-term studies is needed to confirm between-group effectiveness.

Perceived Influencers of Self-management among Chinese Older Adults at Risk for Stroke: A qualitative study

Min Gao — 2026-06-30

Background: Similar to other part of the world, Stroke is a major global health issue in China due to rapid population ageing and the increasing prevalence of non-communicable diseases. Effective self-management is considered as essential for stroke prevention among high-risk older adults. However, evidence on the barriers and facilitators influencing self-management of Chinese older adults to prevent stroke were limited. Objective: This qualitative study aimed to explore multilevel perceived barriers and facilitators of self-management among Chinese community-dwelling older adults at risk of stroke. Methods: Purposive sampling was employed to select participants from a community health center in Xinxiang City. Data saturation was reached with a final number of 18 older adults at high-risk for Stroke, 8 family caregivers, and 11 health care professionals. Data were collected by a researcher using a semi-structured interview and a focus group guideline. Themes and sub-themes were extracted by using Braun and Clarke’s six-phase thematic analysis. Results: Three interconnected perceived influencers of stroke prevention self-management were identified across individual, family, and community-level factors. Individual barriers included limited health literacy, complex risk management, functional decline, financial constraints, and fatalistic beliefs; while self-efficacy and supportive environments facilitated self-management engagement. Family barriers involved fragmented caregiving roles and caregiver burden, whereas family support enhanced self-management. Community barriers included fragmented health services, limited accessibility, and heavy workloads; while integrated care, peer support, and tailored health education promoted self-management engagement. Conclusion: Strengthening multilevel strategies, professional competency, and integrated community health service can enhance sustainable self-management to prevent stroke among high-risk Chinese older adults for strengthening primary stroke prevention within community-based primary health care (CB-PHC) systems.

The Effects of the V-Card Program on Healthy Food Consumption among School Children in Thailand

Isiporn Masook — 2026-07-01

Background: Childhood obesity represents a significant and escalating public health challenge worldwide, with a particularly profound and sustained impact on low- and middle-income countries, especially in urban areas ⁽¹⁾. The rising prevalence of overweight and obesity among children leads to a cascade of adverse physical and psychological consequences. Objective: This quasi-experimental study aims to evaluate the effectiveness of the V-Card Program, developed based on self-regulation theory, in promoting healthy food consumption behaviors among Grade 5 students in Chanthaburi Province, Thailand. Methods: Thirty-five students in the intervention group participated in five intervention activities under the V Card intervention, while 35 students in the comparison group continued with the standard school curriculum. Data were collected on nutritional knowledge, attitudes, and food consumption behaviors, using a pretest-posttest design. Results: The results showed that, the post-intervention scores in the experimental group were significantly higher than those in the comparison group. (p < 0.001). Conclusion: The findings indicate that the V Card Program is an effective and feasible approach for improving nutritional knowledge, attitudes, and healthy dietary behaviors in the short term. Therefore, it is recommended that schools and public health authorities scale up the implementation of this program. Additionally, policymakers should consider integrating interactive, learner-centered tools such as the V Card and board games into national curricula to promote long-term and sustainable health behavior change from early childhood.

Multifactorial Fall Prevention Intervention with Tai Chi on Physical Function in Urban Community-Dwelling Older Adults with Fall History

Siriwan Khruesanit — 2026-06-30

Background: Falls among older adults are a significant public health concern associated with reduced lower extremity muscle strength and balance. Objective: This study aimed to evaluate the effectiveness of a multifactorial fall prevention intervention with Tai Chi on lower extremity muscle strength and balance among community-dwelling older adults with a fall history in Bangkok, Thailand. Methods: A quasi-experimental, two-group pretest–posttest design was employed (n = 60; experimental = 30, comparison = 30). The experimental group received an 8-week program incorporating fall prevention education and fall risk assessment, Tai Chi training, scenario-based risk management, home hazard assessment, digital reinforcement via LINE Official Account, and family-engaged home visits. The comparison group received usual care and a fall prevention manual. Results: Post-intervention, the experimental group demonstrated a statistically significant improvement in lower extremity muscle strength compared with the comparison group. The mean Five Times Sit-to-Stand Test (FTSST) completion time decreased from 11.64 ± 2.07 seconds to 9.63 ± 1.53 seconds in the experimental group, whereas only a minimal change was observed in the comparison group (15.08 ± 3.40 seconds to 15.74 ± 3.75 seconds). ANCOVA-adjusted means confirmed a significant between-group difference in lower extremity function, with the experimental group demonstrating a shorter FTSST completion time than the comparison group (11.04 vs. 14.20 seconds; F (1,57) = 36.33, p < .001, partial η² = .389). Dynamic balance also improved significantly in the experimental group compared with the comparison group. Dynamic balance improved significantly following the intervention. The mean Timed Up and Go (TUG) test time decreased from 10.45 ± 1.86 to 8.75 ± 1.55 seconds in the experimental group, compared with a marginal reduction from 14.13 ± 3.95 to 13.93 ± 4.08 seconds in the comparison group. ANCOVA-adjusted mean TUG times demonstrated a significant between-group difference, favoring the experimental group (10.34 vs. 12.34 seconds; F(1,57) = 17.53, p < .001, partial η² = .235). Static balance also showed significant improvement. Within the experimental group, Wilcoxon signed-rank test results indicated a significant increase in static balance performance (pre-intervention: median = 40.00 s, IQR = 7.75; post-intervention: median = 40.00 s, IQR = 0.00; Z = -2.437, p = .015). Furthermore, post-intervention static balance was significantly better in the experimental group than in the comparison group, as demonstrated by the Mann–Whitney U test (Z = -2.762, p = .006). Conclusion: This multifactorial program incorporating Tai Chi significantly improved lower extremity muscle strength and balance, providing a feasible, low-cost model to improve physical function and reduce fall risk among community-dwelling older adults.

Peer, Parental, and Educational Influences on Sexual and Reproductive Health Literacy Among Young Adults

Shihua Zhang — 2026-07-01

Background: Sexual and reproductive health literacy (SRHL) is a public health challenge for young adults, who are vulnerable to issues such as unintended pregnancy and STIs. This study aimed to assess SRHL and its predictors. Methods: A cross-sectional study was conducted at a university in Guangzhou, China. The study employed a two-stage cluster sampling design. In Stage 1, five faculties were randomly selected from twenty using simple random sampling. In Stage 2, within each selected faculty, classes were selected using probability-proportional-to-size (PPS) sampling. A Totally of 557 participants aged 18 – 24 years who were currently in a romantic relationship were enrolled from five faculties. SRHL was measured using the 12-item Sexual and Reproductive Health Literacy questionnaire (SRHL-12Q). Data were analyzed using Pearson correlation and linear regression analysis. Results: Among 557 participants in relationships (mean age 20.52 ± 1.38 years; 50.3% male), most reported poor levels of peer influence (47.6%), parental communication (49.4%), and SRH education (45.1%). Regarding SRHL, 35.0% had low, 43.4% moderate, and 21.5% high literacy. Multiple linear regression (adjusted R² = 0.601) identified peer influence (β = 0.329, p < 0.001) and SRH education and services (β = 0.454, p < 0.001) as significant predictors of SRHL. Parental communication was not a significant predictor (β = 0.051, p = 0.281). Conclusion: One-third of university students in relationships demonstrated inadequate SRHL, highlighting an urgent public health concern. Peer-led SRH education and enhanced university-based SRH services are recommended as evidence-based intervention targets. Parent–child communication regarding SRH should be initiated earlier, prior to the transition to young adulthood, as it was not a significant predictor in this university-age sample.

Why Blood Pressure Remains Uncontrolled Among Working Adults in Thailand: A Qualitative Study

Romthanika Faimuenwai — 2026-06-30

Background: Uncontrolled hypertension remains a major public health concern and a leading risk factor for stroke and other cardiovascular diseases. Despite effective treatments, blood pressure control among working adults remains suboptimal, particularly at the community level. Working adults often face challenges related to occupational demands, family responsibilities, and limited access to continuous care, which may hinder adherence to hypertension management and stroke prevention behaviors. Understanding these barriers may help guide interventions that are more appropriate for community settings. Objective: This qualitative descriptive study aimed to explore barriers to blood pressure control among working adults with uncontrolled hypertension receiving care at sub-district health promoting hospitals in Pathum Thani Province, Thailand, guided by the Ecological Model. Methods: Data were collected from 39 working adults with uncontrolled hypertension and 5 community health nurses through focus group discussions and semi-structured interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic analysis. Results: Three main themes emerged across ecological levels. Individual-level barriers included knowledge gaps and low awareness, inconsistent medication adherence, and work–life imbalance. Family-level barriers involved caregiving responsibilities, financial and family obligations. Healthcare system and social-level barriers included workforce constraints, lack of social support and traditional education limitations. Conclusion: Improving health literacy, strengthening family support, and increasing access to flexible healthcare services may help working adults better manage their blood pressure.

Effects of Compassion-Focused Therapy Training Program on Self-Compassion and Mental Health among University Students

Thitaporn Kaewboonchoo — 2026-06-30

Background: There has been a substantial increase in the concern regarding mental health among university students, with an increasing number of evidence that students are experiencing high level of psychological distress including stress, anxiety, and depression. Objective: This quasi-experimental study aimed to examine the effectiveness of the compassion focused therapy (CFT) training program for enhancing self-compassion and mental health among university students. Methods: The intervention sought to improve self-compassion as well as promote mental health using dual-factor model framework of Greenspoon and Saklofske. Undergraduate students from a university in Northern Thailand were recruited and randomly assigned to either experimental group (n = 30) or control group (n = 30). Assessments tools including Self-Compassion Scale (SCS), Flourishing Scale (FS) and Patient Health Questionnaire-9 (PHQ-9) were conducted at baseline, post-intervention, and one-week follow-up. Results: The repeated measures multivariate analysis revealed a significant increase of self-compassion and psychological well-being as well as significant decrease of psychopathology in the experimental group compared to the control group. Conclusion: These findings indicate that CFT training program was effective in improving both positive and negative dimensions of mental health for university students. Integrating compassion-based practices into mental health program may offer sustainable approach to enhance well-being and reducing psychological distress. Future research should examine the long-term effects and broader application in more diverse populations.

Burden of Lower Urinary Tract Symptoms among Nepalese Adults with Type 2 Diabetes Mellitus

Anjan Rijal — 2026-06-30

Background: Lower urinary tract symptoms (LUTS) represents a significant burden in patients with Type 2 Diabetes Mellitus (T2DM). With a wide range of LUTS prevalence, a cross-sectional study aimed to assess the prevalence and burden of LUTS among Nepalese patients with Type 2 Diabetes. Methods: The burden was assessed in terms of quality adjusted life years (QALYs) and QALYs lost. Data were collected from patients with DM who lived in nine districts in Nepal during 2022-2023. Results: Among 480 respondents, more than a half of them were male with mean age of 59.90 ± 12.13 years. The LUTS was more present in Nepalese female (79.9%) than males (75.2%), with no statistical difference between sex (p = 0.27). There was statistically significant difference of Euro Quality of life (EQ-5D) between people who had only DM compared to people with DM and LUTS (p <.001). Using bivariate analysis, there was an association between LUTS and QALYs (p <.001). The QALYs lost was significantly higher in people who had both LUTS and DM. People with DM alone were three times more likely to have perfect health than those with DM and LUTS. Significant positive correlation between age, blood sugar levels, duration of diabetes and LUTS were found; whereas significant negative correlations between health behavior, social support, access to health and LUTS were reported. Conclusion: These findings suggest that diabetic patients should be screened for LUTS. Further, social perceptions and access to care should be managed to reduce the burden of LUTS among older DM patients.

Effects of A Nurse - Led Integrated Care Model for Older Adults with Uncontrolled Chronic Diseases in Bangkok Metropolitan

Penrung Nualchaem — 2026-07-01

Background: Uncontrolled non-communicable disease is a significant challenge for older adults, who have multimorbidity. In Bangkok, older adults with multimorbidity have difficulties in self-management due to fragment health services and continuing care, leading to poor control. Objective: This two-group pretest-posttest quasi-experimental research was conducted to evaluate the effects of a Nurse-led integrated care model for older adults with uncontrolled chronic disease, living in Bangkok. Methods: A total of 60 older participants with uncontrolled chronic disease were recruited from two public health centers and allocated by sites to an intervention group (n=30) or a comparison group (n=30). The intervention group received the 12-week Nurse-led ICM program, consisting of 1) a comprehensive geriatric assessment; 2) health education and skill training; 3) monthly home visits by multidisciplinary team; 4) bi-weekly self-management support by a nurse case manager using self-monitoring application; and 5) two group sharing sessions. While, those in a comparison group received usual care. Results: According to Paired t-test and Independent sample t-test results, the mean score of self-management, functional status, blood sugar, and blood pressure within the intervention group were significantly improved and better than the comparison group (p < 0.001) at week 12^th. Conclusion: Findings suggest that this integrated care model is feasible and effective for older adults with uncontrolled chronic diseases in primary care context. Thus, it could be applied to those older adults with chronic diseases, living in other community in Bangkok. In addition, self-management support competency of public health nursing should be strengthened to promote quality of care and patient outcome.

A Comparative Study of Elderly Healthcare Models between Mainland and Island Areas in Satun Province, Thailand

JITRAVEE CHEYCHOM — 2026-08-26

Background: Satun Province, located along Thailand’s Andaman Sea coast, has a growing elderly population comprising 14.27% of its total residents, distributed across both mainland and island communities. Objective: This study aims to examine elderly healthcare models in contextual differences. Methods: A descriptive cross-sectional study was conducted among 400 older adults in Satun Province, selected via multi-stage sampling. Data were collected using a validated structured questionnaire (CVI = 0.91; Cronbach’s alpha = 0.87). Statistical analyses comprised descriptive and inferential methods. Results: Results revealed no overall difference in healthcare models between the mainland and island elderly populations. However, dimension-specific differences were evident: mainland participants exhibited greater self-reliance in healthcare, whereas island residents demonstrated stronger mutual reliance facilitated by community and primary healthcare networks (p < 0.001). Reliance on professional healthcare services did not differ significantly between the two groups. Conclusion: These findings underscore the necessity of context-specific healthcare models for aging populations. Interventions should focus on strengthening self-care among the mainland elderly and enhancing community-based mutual care in island areas. Furthermore, improving the accessibility and responsiveness of formal health services across both settings will support healthy aging outcomes.

The Effect of Three Generation Family Caring Program through Community Participation on Quality of Life, Family Functioning and Caregiving Knowledge among Elderly

Maturada Bunjongkarn — 2026-08-27

Background: The transition to an aging society necessitates sustainable care models as aging is commonly associated with physiological decline and increased susceptibility to chronic conditions. Objective: This study evaluated the effectiveness of a Three Generation Engagement to Three Generation Family Caring for Elderly Program, developed through Participatory Action Research (PAR) to enhance elderly well-being through community engagement. Methods: Utilizing a quasi-experimental design, the study involved 30 elderly participants and 30 family members in Koh Pherd Subdistrict, Chanthaburi Province. Outcomes, including Quality of Life (WHOQOL-OLD), Family Functioning (CFI), and Caregiving Knowledge, were assessed at three-time points: pre-intervention, immediate post-intervention, and a six-month follow-up. Data were analyzed using Multivariate Repeated Measures and One-way ANOVA. Results: Significant long-term improvements were observed across all variables at the six-month follow-up compared to baseline. Statistical analysis revealed a significant impact on Quality of Life (F = 4113.32, p < .001), Family Functioning (F = 7699.02, p < .001), and General Knowledge of Care (F = 2660.45, p < .001). Although immediate post-intervention changes were minimal, the sustained engagement of three generations led to substantial gains over time. Conclusion: The three generation engagement model effectively strengthens family bonds and improves elderly quality of life. Public health policies should prioritize scaling this community-participatory model to foster sustainable, home-based long-term care for the elderly in aging societies.

Development of the “BUU True Friend” Mobile Application: Feasibility and Usability Study for Chronic Psychiatric Rehabilitation

Pornpun Sudjai — 2026-08-27

Background: Currently, promoting psychiatric rehabilitation through the integration of technology is of great importance to support the daily lives of chronically psychiatrically ill individuals living in the community. Objective: This research and development (R&D) study aimed to design and develop a prototype health application for promoting psychiatric rehabilitation among individuals with chronic mental illness in the community. Methods: The target population consisted of 40 individuals with chronic psychiatric conditions attending outpatient services at the Psychiatric Clinic, Queen Savang Vadhana Memorial Hospital, Sriracha District, Chon Buri Province, in July 2025. The research was divided into two phases: 1) application development phase according to the ADDIE Model process; and 2) feasibility and usability testing. Following a 14-day trial on participants’ smartphones, usability and feasibility evaluations were formally completed by both the study participants (patients) and psychiatric clinic nurses to ensure multi-stakeholder feedback. Data collection tools included a personal information questionnaire, a Living Skills Assessment for Psychiatric Rehabilitation, an mHealth App Usability Questionnaire, and Guidelines for evaluating mHealth usability. Data were then analyzed using descriptive statistics, including frequencies, percentages, means, and standard deviations, as well as inferential statistics with the Wilcoxon signed-rank test. Results: The findings revealed that the “BUU True Friend” application was rated highly for application quality by expert evaluators. Application users reported high satisfaction with the application's overall usability. While no statistically significant difference was found in psychiatric rehabilitation skills likely due to the limited 14-day trial, the 100% user retention rate and high satisfaction scores demonstrate the application’s strong feasibility and usability. Conclusion: These findings indicate that the “BUU True Friend” application is a viable prototype for promoting psychiatric rehabilitation among individuals with chronic mental illness in community settings.

Preliminary Efficacy of an Integrated Cognitive and Self-Management Training Program in Hemodialysis Patients

Busayarat Loysak — 2026-08-27

Background: Hemodialysis (HD) serves as the primary mode of renal replacement therapy for the majority of these patients, yet it simultaneously introduces significant physiological and psychological stressors ⁽^1,2). Objectives: This pilot randomized controlled study aimed to examine the feasibility and preliminary efficacy of an Integrated Cognitive and Self-Management Training (ICST) program to improve cognitive function and self-management behaviors among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). Methods: ESKD patients who met the inclusion criteria (n = 20) were randomly assigned to either the experimental group (n = 10) or control group (n = 10). The experimental group received usual care plus the ICST program, comprising 16 sessions (60 minutes each, twice weekly) delivered over 8 weeks during the one-hour pre-dialysis waiting period. Cognitive function and self-management behaviors were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) and the Self-Management Behavior Questionnaire (SMBQ) at baseline and post-intervention (Week 8). Qualitative feedback on program acceptability was also collected from experimental-group participants through brief open-ended questionnaire items conducted by the research assistant at the final session. Demographic data were summarized using descriptive statistics. Between-group differences were assessed using independent-samples t-tests, while within-group pre–post changes in the intervention group were examined using paired-samples t-tests. Results: The ICST program demonstrated excellent feasibility with a 100% participant retention and attendance rate, and zero adverse events. At post-intervention, the experimental group achieved significantly higher scores than the control group in both cognitive function (26.20 0.63 vs. 25.10 0.57; t = 4.09, p < .001, 95% CI [0.54, 1.67], Cohen's d = 1.83) and self-management behaviors (173.00 10.38 vs. 136.60 26.38; t = 4.06, p < .001, 95% CI [17.56, 55.24], Cohen's d = 1.82). Within-group analysis (experimental group only, n=10) confirmed significant pre- to post-intervention improvements in cognitive function (t₉ = 6.71, p < .001) and self-management behaviors (t₉ = 7.11, p < .001). Qualitative feedback confirmed high acceptability; participants described the program as "clear, practical, and easy to complete." Conclusions: The ICST program was feasible, highly acceptable, and demonstrated large preliminary effects on both cognitive function and self-management behaviors for HD patients. These findings warrant larger-scale randomized controlled trials with longer follow-up periods to confirm long-term clinical benefits and further studies exploring the feasibility of broader clinical implementation across hemodialysis settings.

Analysis of Organizational Safety Resilience in Indonesia’s Oil and Gas Industry

Narwoko S — 2026-08-27

Background: Severe accidents in Indonesia's oil and gas industry resulting in fatality and property damage still show an upward trend. Organizational safety resilience approach is required to improve the industry's ability to mitigate such accidents, learning from it and anticipating future threats. Objective: The study performed analysis of organizational safety resilience qualities (respond, learn, anticipate and monitor) at oil and gas sector in Indonesia. Methods: A cross-sectional design of mixed method quantitative and qualitative research was conducted through survey approach using questionnaire followed with interview of employee representatives. Results: The result reveals that all qualities have achieved high score of more than three in scale of four with ability to respond has the highest level (3.53) while ability to learn has the lowest one (3.23). However, there are variables in each quality with low score such as access to HSE performance statistic (3.07) and information dissemination (3.15). Priority conflict of safety and production as well as impression that safety is an administrative exercise rather than critical aspect to ensure safe operation are still imminent concern. Conclusion: Continuous improvement on lower score variables along with ability to learn and anticipate will help in boosting the resilience level. Future longitudinal study is recommended to explore resilience level variation over longer time frame which will be critical for enhancing resilience quality in the industry.

Adaptation and Psychometric Validation of Mental Health Literacy and Well-Being Scales among Filipino College Students

Mark Allan C. Mananggit — 2026-08-27

Background: The high prevalence of mental health problems among Filipino college students and the lack of culturally validated assessment tools highlight the need for reliable and valid measurement instruments. Objective: This study culturally adapted and evaluated the psychometric properties of the Mental Health Literacy Scale (MHLS) and the Psychological Well-Being Scale (PWBS) among Filipino college students. Methods: A total of 1828 students were recruited and randomly split into two equal subsamples for exploratory factor analysis (EFA; n= 914) and confirmatory factor analysis (CFA; n =914). The cross-cultural adaptation process involved translation/back-translation, content validation using Lawshe’s content validity ratio (CVR), and comprehensibility assessment. Construct validity, convergent validity, and internal consistency were evaluated. Results: Results demonstrated that a 12-item, 4-factor model of the MHLS exhibited adequate fit (χ²/df = 2.84, RMSEA = 0.046, CFI = 0.99, SRMR = 0.036) and high reliability (Cronbach’s α = 0.82). Similarly, a 12-item, 6-factor version of the PWBS demonstrated good fit (χ²/df = 2.07, RMSEA = 0.035, CFI = 0.98, SRMR = 0.026) and strong internal consistency (α = 0.91). Structural equation modeling revealed that mental health literacy significantly predicted psychological well-being (β = 0.79, p < .001). Conclusion: These validated 12-item scales provide concise, reliable, and culturally appropriate tools for mental health screening and intervention evaluation in Philippine higher education settings.

Unhealthy Snack Consumption and Nutrition Literacy in a School Setting: A Social-Ecological Lens Qualitative Study

Srichai Posri — 2026-08-31

Background: Obesity among school-aged children is a public health concern. Developing context-appropriate school-based prevention requires understanding barriers, facilitators, and stakeholder perspectives on children’s eating behaviors. This study aimed to explore perceived influences on unhealthy snack consumption and nutrition literacy among school-aged children across multiple social-ecological levels and identify stakeholder-suggested components that could inform the development of a future school-based obesity-prevention intervention. Methods: A descriptive qualitative study was conducted in a rural school in Thailand. Data from 35 key informants students, teachers, parents, school lunch cooks, shop vendors, and the school director were collected through focus group discussions, in-depth interviews, and participant observations. Data were analyzed using thematic analysis informed by both NL and the SE lens. Results: Five themes emerged: (1) limited nutrition literacy and misperception of snack food choices; (2) weak family–teacher reinforcement of healthy eating habits; (3) inadequate school policy and learning environment; (4) community and vendor collaboration gaps; and (5) a co-created mutual problem-solving program for obesity prevention. Students chose snacks mainly based on taste, habit, and peer influence and had limited understanding of nutrition and food labels. Support and communication between families and teachers were inconsistent, school nutrition activities were irregular, and nearby vendors commonly sold fried and sugary foods. Conclusions: Preventing obesity among school-aged students requires attention to both individual nutrition literacy and the family, school, and community environments that shape daily food choices. These findings may inform the development of a coordinated, multilevel school-based prevention program integrating nutrition literacy; however, its feasibility and effectiveness require further evaluation.

Agricultural Chemical Exposure Risks and Safety Practices Among Drone Operators in Kanchanaburi Province, Thailand: A Cross-Sectional Descriptive Study

Suwatsa Punneng — 2026-08-31

Background: The use of agricultural drones is expanding rapidly in Thailand, improving pesticide application efficiency and potentially reducing farmers’ direct exposure to agricultural chemicals. However, drone operators may remain exposed during chemical preparation, loading, equipment cleaning, and waste disposal. Objective: This cross-sectional descriptive study assessed operational safety practices, chemical-handling behaviors, and personal protective equipment (PPE) use among agricultural drone operators in Kanchanaburi Province, Methods: Thailand. Forty operators were purposively selected. Data were collected using a researcher-developed questionnaire covering demographic characteristics, drone operation, safety training, chemical-handling practices, and PPE use. Descriptive statistics were used to summarize the data. Associations between safety training and selected safety practices were examined using Fisher’s exact test, while relationships involving ordinal or continuous variables were assessed using Spearman’s rank correlation coefficient. Results: Most participants were male (72.5%), with a mean age of 33.53 years. DJI drones were used by 95.0% of participants, and the mean operating duration was 5.66 hours per day. Although 82.5% had received drone safety training, PPE use remained inconsistent. Long-sleeved shirts and long pants were commonly worn, whereas chemical-resistant gloves, appropriate respiratory protection, and protective aprons were used less consistently. Most operators followed basic pre-spraying procedures; however, 27.5% reported mixing agricultural chemicals without checking chemical compatibility. Post-spraying practices, particularly equipment cleaning and waste disposal, were also inconsistently followed. Conclusions: The findings demonstrate a notable gap between having received safety training and consistently applying comprehensive protective practices. Specifically, deficiencies were identified in PPE use, chemical compatibility checks, and post-spraying waste management. These results support the need for competency-based training focused on chemical preparation, appropriate PPE selection, equipment decontamination, and waste disposal. Future studies should use larger, probability-based samples and direct workplace observations to identify factors influencing safety compliance.

Design thinking for fostering 21st-century skills among Thai public health undergraduates: a design-based research approach

Suphawadee Panthumas — 2026-08-31

Background: Design Thinking (DT) has gained increasing recognition in health professions education for its ability to foster key 21st-century skills such as creativity, critical thinking, collaboration, and adaptability. Objective: This study employed a Design-Based Research approach to develop and evaluate a Design Thinking (DT)-driven pedagogical innovation aimed at streamlining curriculum delivery while fostering 21st-century skills among Thai undergraduate public health students. Methods: The intervention was co-constructed with students, faculty, alumni, employers, and community stakeholders (December 2022–May 2023) and assessed using a one-group pretest-posttest design with paired-samples t-tests. A 15-week integrated prototype, implemented among 53 third-year students, restructured conventional lecture-based instruction into a hybrid ecosystem comprising interactive sessions, integrated modules, an autonomous Self-study Café, and field-based projects. Data were collected through self-administered questionnaires and after-action reviews (AARs) with students and instructors. The innovation reduced formal classroom contact hours by 21% without an apparent reduction in learning depth, based on qualitative feedback. Results: Findings revealed significant improvements across all six dimensions of 21st-century skills (p < 0.001, d = 0.91–1.93). Students’ perceptions of teaching-learning management were significantly more positive under the integrated model than the traditional model (p < 0.001), with high overall satisfaction toward the prototype (mean 4.38–4.51). AARs findings indicated that reducing lecture-intensive content facilitated deeper engagement and greater student agency, while also reducing academic anxiety and appearing to strengthen professional identity through authentic problem-solving. Conclusion: Findings align with Cognitive Load Theory, suggesting that reduced extraneous cognitive load facilitated higher-order learning. This DT-driven model constitutes a potentially viable framework for educational reform in health professions education, bridging theoretical knowledge and public health practice. Multi-site, longitudinal research is recommended to examine the model’s scalability and sustained impact.

Association Between Traditional Bullying Victimization and Mental Health among Ethnic Minority In-School Adolescents in Northern Thailand

Thapakorn Ruanjai — 2026-08-31

Background: Traditional bullying victimization is an important public health concern because of its association with adverse mental health outcomes, yet evidence among ethnic minority adolescents in northern Thailand remains limited. Objective: This study aimed to examine the association between traditional bullying victimization and the severity of depression, anxiety, and stress symptoms among ethnic minority adolescents. Methods: A school-based cross-sectional study was conducted among ethnic minority students in grades 10–12 in Chiang Rai Province, Thailand. Traditional bullying victimization was assessed using the Revised Olweus Bully/Victim Questionnaire (R-OBVQ), while mental health symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21). Descriptive statistics and ordinal logistic regression analyses were used to examine the associations between bullying victimization and mental health symptom severity. Results: A total of 450 students participated in the study. Most participants were female (66.0%), with a mean age of 16.80 years (SD = 1.16), and 6.2% were non-Thai nationals. Overall, 91 students (20.2%) were classified as victimized. After adjustment for age, sex, nationality, ethnic group, and alcohol consumption, victimized students had higher odds of being in more severe symptom categories for depression (aOR = 1.73; 95% CI, 1.13–2.66; p = 0.011), anxiety (aOR = 1.97; 95% CI, 1.29–3.01; p = 0.002), and stress (aOR = 2.70; 95% CI, 1.73–4.21; p < 0.001) than non-victimized students. Traditional bullying victimization was associated with greater depression, anxiety, and stress symptom severity among ethnic minority adolescents. Conclusion: These findings support culturally responsive school-based bullying prevention, routine and confidential screening, and clear referral pathways for students requiring further mental health support.

Factors influencing antenatal care completion among married reproductive-age women in peri-urban Yangon, Myanmar

Aye Thi Khaing — 2026-08-31

Background: Antenatal care (ANC) is essential for reducing maternal and perinatal mortality, however, completion of the recommended contact schedule remains inadequate in many peri-urban settings. Objective: This cross-sectional study aimed to assess ANC completion and identify influencing factors among married reproductive-age women in peri-urban Yangon, Myanmar. Methods: Data were collected from January to April 2025 through face-to-face interviews with 408 married women aged 15–49 years who had delivered within the preceding six months. Participants were recruited using multistage cluster sampling from three peri-urban townships with the highest maternal mortality rates. ANC completion was defined as attending eight or more antenatal care contacts with a skilled birth attendant, in accordance with the 2016 WHO recommendations. Multivariable binary logistic regression identified independent predictors. Results: Only 36.8% of women completed the WHO recommended eight ANC contacts. In multivariable logistic regression analysis, adequate family support (AOR = 2.79, 95% CI: 1.37–5.67), higher transportation expenditure per ANC visit (AOR = 2.20, 95% CI: 1.32–3.64), husband's informal sector employment (AOR = 1.85, 95% CI: 1.14–2.98), and access to multiple information sources (AOR = 1.78, 95% CI: 1.01–3.16) were independently associated with ANC completion. Limited availability of healthcare personnel significantly reduced the odds of completion (AOR = 0.48, 95% CI: 0.26–0.90). Conclusion: ANC underutilization in peri-urban Yangon reflects interconnected structural and social barriers. Policy responses should prioritize family engagement programs, financial support for transportation costs, healthcare workforce strengthening, and multi-channel health communication to improve sustained ANC utilization in peri-urban populations.

Health Risk Assessment of PM2.5 Exposure and Respiratory Symptoms among Residents Living Near a Stone Crushing Plant in Chonburi, Thailand

Jetsada Mueangsai — 2026-08-31

Background: Air pollution from industrial activities remains an environmental health concern among communities living near stone crushing plants. Objective: This study aimed to assess non-carcinogenic health risk using Hazard Quotient (HQ) based on PM_2.5exposure and identify factors associated with respiratory symptoms among residents living near a stone crushing plant in Chonburi Province, Thailand. Methods; A cross–sectional study was conducted among 368 residents from seven villages within a 5–km radius. PM_2.5concentrations were measured at two fixed–site air monitoring stations from 25–27 March 2026 using two low–volume air samplers operated continuously for 72 hours and analyzed by the gravimetric method. Results: The mean PM_2.5concentration was 28.06 µg/m³, and mean HQ was 0.96. Respiratory symptoms were reported by 57.9% of participants. Underlying medical conditions (AOR = 3.146, 95% CI: 1.393–7.105, p = 0.006), age <40 years (AOR = 2.065, 95% CI: 1.210–3.523, p = 0.008), opening windows all the time (AOR = 2.642, 95% CI: 1.335–5.229, p = 0.005) or during daytime only (AOR = 1.941, 95% CI: 1.010–3.733, p = 0.047), and low preventive behavior (AOR = 0.254, 95% CI: 0.076–0.843, p = 0.025) were significantly associated with respiratory symptoms. Although 47.3% of participants had HQ values ≥1, HQ was not significantly associated with respiratory symptoms. The HQ estimates were derived from short–term fixed–site PM_2.5 monitoring and should be interpreted as preliminary estimates of community–level exposure. Conclusion: From a public health perspective, strengthening long–term environmental monitoring, respiratory health surveillance, community awareness, and effective dust control measures may help reduce the health impacts of particulate matter exposure. Future studies should incorporate long–term environmental monitoring, exposure assessment, and respiratory health surveillance.

Design thinking in home-visit education among undergraduate public health students in Thailand

Suphawadee Panthumas — 2026-08-31

Background: Community-based home visits are an essential component of public health education, yet traditional approaches may provide limited opportunities for students to develop both technical and transferable skills through authentic community engagement. Integrating design thinking with experiential learning may enhance students’ capacity to apply knowledge, solve problems creatively, and respond to community needs. Objective: This study aimed to evaluate the effectiveness of a design thinking-integrated home-visit module (DTHV module) within a CAR framework on knowledge, attitudes, and skills (KAS) among undergraduate public health students and explore their reflective learning experiences during community-based practice. Methods: Mixed-methods classroom action research (CAR) was conducted from January to May 2023 at Mahidol University, Amnatcharoen Campus, Thailand, the study involved 53 third-year public health students in a 15-hour intervention integrating design thinking with experiential home-visit learning. Statistical analysis revealed significant improvements across all assessed domains (p < 0.001, Cohen’s d = 0.52–1.06), including home-visit knowledge, self-esteem, creative thinking and problem-solving, collaboration and leadership, and information and digital literacy. Results: Mean scores for home care practice and innovation reached 83.01 (SD = 5.65), with 64.2% of participants achieving a good performance level. After action review, student reflections highlighted enhanced empathy, stronger professional identity, greater self-confidence, and improved integration of theory with real-world practice. Innovations developed during the module also received positive acceptance from community stakeholders. Conclusion: Overall, the DTHV module strengthened both hard skills, including home care knowledge and practice, and soft skills such as empathy, collaboration, and professional identity, offering a promising pedagogical approach for community-based public health education; however, findings should be interpreted cautiously given the one-group pre–post design.

Post-stroke care in the community: A qualitative study exploring perspectives of stroke survivors, family caregivers, and nurses in Northeast Thailand

Juthamart Khotchakhote — 2026-08-31

Background: Stroke remains a formidable global health challenge and is recognized as the second-leading cause of death and the primary cause of long-term disability worldwide including Thailand. Objective: This qualitative descriptive study explored the experiences, challenges, and service expectations related to post-stroke care among stroke survivors, family caregivers, and community nurses in Mahasarakham Province, Northeastern Thailand. Methods: A purposive sample of 28 participants—10 stroke survivors, 8 family caregivers, and 10 community nurses—was recruited from primary care units in Kantharawichai District. Data were collected between June and September 2024 through 18 individual in-depth interviews, 2 focus group discussions, and 10 participatory observation sessions. Qualitative data were analyzed using Braun and Clarke's reflexive thematic analysis. Results: Three themes emerged: (1) inadequate knowledge and preparedness, reflecting gaps in rehabilitation skills and barriers to accessing credible information among caregivers; (2) insufficient and overburdened stroke care personnel, reflecting a shortage of specialized professionals and the need for intermediate care (IMC) guideline and monitoring tools for community nurses; and (3) psycho-cultural services, highlighting the role of spiritual beliefs (karma) in coping and the need for professional reassurance through home visits and financial support. Conclusion: The findings suggest a linkage between national IMC policy and its implementation at the community level. Although families demonstrated culturally grounded resilience, the transition to home care was hindered by systemic gaps and financial strain. These context-specific findings suggest that community stroke care may be strengthened through competency development for community nurses, IMC guideline, and culturally congruent care that integrates spiritual and psychosocial support with clinical rehabilitation.

Food Security and Its Determinants among Women Informal Workers in Khulna City Corporation, Bangladesh

Sohana Aktar Urmi — 2026-08-31

Background: Food insecurity among women in informal employment represents a critical yet underexplored public health concern in urban Bangladesh. Objective: This study examined the food security status and its determinants among women informal workers in Khulna City Corporation (KCC), Bangladesh. Methods: A cross-sectional study design was employed, with data collected from 385 women through purposive sampling using structured questionnaires. Food security status was assessed using the Household Dietary Diversity Score (HDDS), with households consuming fewer than five food groups classified as food insecure. Binary logistic regression was employed to identify factors associated with food security status. Results: Findings revealed that 56.36% of respondents were food insecure. Higher educational attainment and greater monthly income were identified as significant positive predictors of food security, while larger family size and the presence of a chronically ill household member significantly reduced the likelihood of food security. Occupational type and daily working hours were additionally significant, with street vendors more likely to be food secure than domestic workers, and women working more than eight hours per day significantly less likely to achieve food security. Age and alternate source of income were not statistically significant predictors. Economic barriers, particularly low and unstable income, high food prices, and irregular employment, were the most frequently reported challenges to food access. Conclusion: These findings highlight the structural vulnerabilities driving food insecurity among women informal workers and underscore the need for targeted interventions, including vocational and literacy-focused education programs, wage protection and income-support schemes for low-earning occupations such as domestic work, and expansion of social safety nets tailored to informal-sector households with dependents or chronically ill members.

Enhancing Gerontological Nurse Practitioner Trainees’ Diagnostic and Health Screening Competencies Through Competency Case-Based Learning (CCBL)

Wilaipun Somboontanont — 2026-08-31

Background: Population aging has increased the demand for nurses with advanced competency in geriatric nursing. Competency Case-Based Learning (CCBL) provides opportunities to connect theoretical knowledge with authentic clinical situations; however, its application to competency-based gerontological nursing education remains insufficiently developed. Objectives: To evaluate the effectiveness of CCBL on gerontological nursing competency and to explore how participants experienced the intervention and perceived its contribution to competency development. Design: A mixed-methods, single-group pretest-posttest study. Methods: The convenience sample within a single clinical training cohort consisted of 8 gerontological nurse practitioner trainees. The intervention consisted of a structured CCBL program (3 days per week for 4 weeks,12 sessions total) developed using the Bloom’s Taxonomy. Nursing competency was assessed before and after the intervention across cognitive, psychomotor, and affective/professional domains. Focus-group discussions and reflective accounts were analyzed thematically. Quantitative and qualitative findings were integrated using a Joint Display Matrix to identify convergence, expansion, and discordance. Results: Eight participants completed the study. Overall competency calculated as the composite mean across four measured domains increased from a baseline median of 2.65 (IQR: 2.34–2.89) to 4.81 (IQR: 4.56–4.86) (Z = -2.521, p = .012, r = .89). Qualitative analysis generated five themes: Baseline Understanding, Expected Competency Outcomes, Instructional Process Expectations, Satisfaction / Perceived Value, and; Barriers & Facilitators. Joint-display integration demonstrated convergence between improved competency and satisfaction scores. Conclusions: CCBL may provide a feasible competency-oriented approach for integrating clinical reasoning, multidimensional health screening, clinical performance, and person-centered gerontological nursing practice. Controlled studies with longitudinal evaluation of CCBL in specialty nursing education are warranted.

Food Literacy among Muslim Older Adults in Narathiwat Province, Thailand

Rohayoo Yuso — 2026-08-31

Background: Food literacy is an important component of healthy ageing. Among Muslim older adults, food-related practices are also influenced by Islamic dietary principles. However, limited information is available on food literacy among Muslim older adults in Thailand. Objective: This study aimed to describe the characteristics and level of food literacy among Muslim older adults in Narathiwat Province, Thailand. Methods: A descriptive cross-sectional study was conducted among 383 Muslim older adults aged 60 years and over who were members of elderly clubs in Narathiwat Province. Data were collected using a structured questionnaire covering sociodemographic characteristics and food literacy indicators. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarize the data. Results: The overall level of food literacy was low (mean = 2.13 ± 0.76). Participants demonstrated high levels of food literacy in refusing unsafe food (3.17 ± 0.68), selecting food according to Islamic dietary principles (halal) (3.15 ± 0.66), choosing halal-certified food vendors (3.02 ± 0.72), and teaching children or family members to consume healthy food (3.02 ± 0.74). In contrast, media and food information literacy had the lowest overall score (1.46 ± 0.68). The lowest individual indicators were searching for food information using technology (1.28 ± 0.54), comparing information from multiple sources before making food decisions (1.29 ± 0.57), and consulting health professionals before changing their diet (1.38 ± 0.67). Conclusions: The results suggest that food literacy promotion should build on existing halal and cultural food practices while strengthening practical nutrition skills and the critical evaluation of food information. Culturally appropriate, community-based, and multichannel approaches involving families, health professionals, and community stakeholders may help support healthy food choices and healthy ageing among Muslim older adults.

Employment and Retention of Retired Nurses in Senior Care Business: A Pre-COVID-19 Scoping Review

Lalita Kaewwilai — 2026-08-26

This review examined employment patterns of retired nurses in senior care settings, analyzing 13 studies selected from 7,445 articles across multiple international databases between 2011-2021. The research revealed a varied approach of post-retirement nursing employment, characterized by diverse and flexible work models including full-time, part-time, and casual positions primarily focused on home and community-based senior care.

Key findings highlighted the multifaceted nature of retired nurses' professional experiences. Strengths included enhanced mental resilience, high job commitment, and lower burnout rates, but face limitations such potential physical and cognitive limitations. Critical competencies identified encompassed geriatrics nursing skills. interpersonal relationships, professional value, work schedule management, continuous self-development, communication skills, and professional independence. Job retention emerged as a complicated process influenced by interpersonal relationships, professional development, work autonomy, and job commitment.

The study found that retirement decisions are complex, involving complicated interactions between individual health conditions, professional relationships, job satisfaction, and organizational environments. Work-life balance was found to depend on personal well-being, meaningful work experiences, supportive workplace cultures, and strong social support networks. Recommendations emphasize the need for adaptive employment models, continuous professional development, and organizational strategies that recognize and maximize the extensive expertise of retired nurses in senior care settings. Future research directions include longitudinal workforce trend analysis, standardized post-retirement employment frameworks, and comprehensive investigations into technological adaptations for retired nurses.