Development of a Health System for the Management of Colorectal Cancer in Sakaeo Province
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Abstract
BACKGROUND: Colorectal cancer is the third most common form of cancer in Sakaeo Province, Thailand. However, most patients fail to seek treatment until the advanced stages, leading to increased morbidity and mortality rates. Key challenges include shortages of FIT kits, long waits for colonoscopy, poor follow-up, and low awareness.
OBJECTIVE: To develop a colorectal cancer management system in Sakaeo Province aimed at improving service efficiency, comparing knowledge, perception, and behavior before and after intervention, and assessing the coverage of screening and diagnostic services.
METHODS: This participatory action research (PAR) employed a mixed-methods approach based on the Health Belief Model (HBM). The research was conducted in five phases comprising problem identification, system development, implementation, evaluation, and lesson learned. Participants included 45 stakeholders and 400 at-risk individuals aged between 50–70 years, selected through stratified random sampling. Data were collected via pre and post intervention questionnaires, in-depth interviews, and a focus group. Quantitative data were analyzed using a paired samples t-test, while qualitative data were analyzed through content analysis.
RESULTS: The developed system significantly improved knowledge scores (from 7.88 to 11.10), perception scores (from 51.4 to 57.3), and behavior scores (from 23.4 to 24.1), all with statistical significance (p<0.0001). Screening coverage via FIT increased from 65.42% to 80.33%, while colonoscopy coverage rose from 65.31% to 71.29%.
CONCLUSIONS: The development of a Health System for the Management of Colorectal Cancer in Sakaeo Province effectively enhanced knowledge, perception, and health-seeking behavior. It also increased screening and diagnostic coverage. These improvements are expected to facilitate early cancer detection, timely treatment, and better health outcomes. Key success factors included annual planning, proactive community health worker engagement, and multi-channel communication. Long-term follow-up is recommended along with continued collaboration with the Provincial Service Plan Committee, Cancer Division.
Thaiclinicaltrials.org number, TCTR20250811006
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