Journal of Health Science of Thailand

Editor's note

2026-02-27T09:34:35+07:00

Introduction

2026-02-27T09:15:21+07:00

cover

2026-02-27T09:06:50+07:00

Editorial

2026-02-27T09:19:39+07:00

Content

2026-02-27T09:12:23+07:00

Insulin resistance in type 1 diabetes

2024-01-29T13:55:10+07:00

During recent years, the condition whereby insulin resistance and type 1 diabetes combine, namely Double Diabetes, has become more widely recognised by scientific communities, in line with the increasing prevalence of obesity among populations with type 1 diabetes. Ample evidence shows that insulin resistance plays an important role in the increased risk of vascular complications, independent of glycaemic control. Given the increased prevalence of individuals with features of double diabetes, pragmatic diagnostic criteria are paramount. In this review, we discuss the potential role of estimated glucose disposal rate as an assessment of insulin resistance for individuals with type 1 diabetes. We also discuss the challenges of managing insulin resistance given that factors including peripheral insulin administration and fear of hypoglycaemic impede weight management in this group. Non-insulin therapy such as sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists may also have an additional role in improving insulin resistance but more studies on this topic are required before drawing any robust conclusion.

Full Issue

2026-02-27T09:00:01+07:00

The Relationship Between Social Support and Blood Pressure Control Behaviors among Pregnancy Induced Hypertension

2025-08-06T10:55:46+07:00

Nursing care of pregnancy-induced hypertension is an important matter that nurses and family members must work together to care for. This study aimed to examine the relationship between social support, personal factors and blood pressure control behaviors among pregnancy-induced hypertension at the antenatal clinic of Mahasarakham Hospital. The sample consisted of 98 participants. Data were collected using a social support questionnaire and a blood pressure control behavior questionnaire for pregnant women with pregnancy-induced hypertension, with Cronbach’s alpha coefficients of 0.87 and 0.85, respectively. The data were analyzed using frequency, percentage, mean, standard deviation, and Pearson’s correlation coefficient. The results indicated that overall social support was at a good level (mean=3.66, SD=0.68), while blood pressure control behaviors among pregnant women with pregnancyinduced hypertension were moderate (mean=2.28, SD=0.24). Blood pressure control behavior in pregnancy-induced hypertension was significantly positively associated with social support and education level (p<0.05). This shows that receiving support from family members and high-level education allows pregnancy-induced hypertension to have appropriate eating behaviors for the disease, exercise to maintain good health, and take medication to prevent complications. Therefore, prenatal clinic nurses should organize activities that are consistent or can be developed in various areas in order to encourage pregnant women to have appropriate behaviors in all aspects.

Proportion of the First Antenatal Care within 12 Weeks of Pregnancy and Associated Factors in Wichian Buri Hospital

2025-09-16T13:18:10+07:00

The first antenatal care (ANC) visit within the first 12 weeks of pregnancy plays a critical role in preventing maternal and neonatal complications. In fiscal year 2020, only 37.5% of pregnant women received ANC within 12 weeks at Wichian Buri Hospital, Phetchabun Province. This study aimed to assess the proportion of early ANC and identify associated factors. Retrospective analytical study was conducted among 390 postpartum women gave birth and had a history of antenatal care at Wichian Buri Hospital in the fiscal year 2021. Data were collected using a clinical record extraction form and analyzed using a statistical program. The results show that 64.4% of pregnant women received first ANC within 12 weeks. Factors that were significantly associated at the 0.05 level were age 18–25 years, educational level, number of pregnancies, knowledge of ANC, no history of miscarriage, and family support in emotional, practical, and informational aspects. Factors that were not significantly associated were a history of abnormal delivery, chronic illness, occupation, travel distance from home to hospital, and health service scheme. These findings highlight the importance of personal factors and family support for early ANC attendance, suggesting the need for targeted promotion at the primary care level.

Study of Incidence of Hypoglycemia after Diabetes Remission Policy in Thailand

2026-02-01T10:44:31+07:00

Hypoglycemia is a common and serious complication in diabetic patients undergoing intensive glycemic control. Inappropriate dose reduction or discontinuation of medications relative to lifestyle modifications during diabetes remission management can lead to hypoglycemic events. This study was conducted among diabetic patients at Ban Ta Khun Hospital who were enrolled in the diabetes remission program. Secondary data were collected from the hospital database for all patients in the remission clinic from January 2019 to October 2024, totaling 172 participants. A retrospective cohort study was employed to determine the incidence of hypoglycemia and identify associated risk factors. The results showed an incidence of hypoglycemia in 14 patients (8.1%), totaling 22 events (12.8 events per 100 person-years). Univariate analysis revealed that obesity (BMI ≥30.0 kg/m2) and the use of insulin and/or insulin secretagogues during the service period were significantly associated with an increased risk of hypoglycemia, with risk ratios (RR) of 1.28 (95%CI 1.01 – 1.64; p<0.05) and 2.52 (95%CI 1.13 – 7.19; p<0.05), respectively. Furthermore, multivariate logistic regression analysis confirmed that obesity and the use of diabetic medications were significant independent risk factors, with adjusted odds ratios (aOR) of 6.60 (95%CI 1.49 – 29.16; p<0.05) and 30.71 (95%CI 5.40 – 174.72; p<0.05), respectively. The incidence of hypoglycemia among patients in the diabetes remission program is relatively low compared to conventional intensive glycemic control. Nevertheless, it is recommended to strictly follow de-prescribing guidelines for the medication groups, exercise caution regarding overly restrictive diets in obese patients, and consider appropriate physical activity levels particularly for those still in the workforce to prevent hypoglycemic episodes.

Preventing Road Accidents Caused by MotorcyclesThrough the Community Participation process: a Case Study of Na Bon subdistrict, Na Bon District, Nakhon Si Thammarat Province

2024-05-19T00:06:21+07:00

This action research aimed to develop a community-participatory model for managing motorcyclerelated road accidents in Nabon District, Nakhon Si Thammarat Province. Data were collected using a mixed-methods approach, combining both quantitative and qualitative techniques. The core development group consisted of 106 members, including representatives from governmental agencies and civil society partners. The quantitative research tools included questionnaires assessing knowledge, attitudes, and behaviors regarding motorcycle riding. The qualitative research tools comprised semi-structured interview guides. In addition, five specific instruments were used to guide the development of a motorcycle accident prevention model through community participation, enabling the effective functioning of the Road Safety Directing Center (RSDC). The model development followed four phases: planning, implementation, monitoring, and evaluation. The data analysis revealed that the majority of participants demonstrated moderate levels of knowledge, attitudes, and safe motorcycle riding behaviors. The implementation of the community-participatory model for road accident management emphasized a shared understanding of the problem, with problem-analysis forums playing a crucial role in fostering collaboration and engaging stakeholders in joint problem-solving. The model enabled interventions in four key areas: driver behavior, vehicles, road infrastructure, and environmental and social factors. Successful implementation required stakeholder participation at every stage of the process — from problem analysis and planning to implementation and evaluation — ensuring an integrated and collaborative approach to road safety management.

Effectiveness of Program literacy for Comprehensive Sexuality Education and life Skill for Comprehensive Sexuality Education, life Skill, Pregnancy Prevention Behaviors and Pregnancy Prevention Intentions of High School Students in PrachuapKhiriKhan Province

2025-07-24T10:07:40+07:00

This research is a quasi-experimental research (two-groups pretest and posttest design). The objective was to study the effectiveness of program literacy for comprehensive sexuality education and life skills, as well as pregnancy prevention behaviors and intentions, among high school students in Prachuap Khiri Khan Province. The sample group consisted of male and female students in Grade 8 under the Secondary Educational Service Area Office, PrachuapKhiriKhan. The samples were of 40 grade 8 students from School 1 (experimental group) and School 2 (control group), 40 each. The instrument used was a program literacy for comprehensive sexuality education and life skill for pregnancy prevention consisting of 8 activities, 3 hours each, separated by 1 week, and questionnaires consist of 5 sections: (1) general information, (2) comprehensive sexuality sducation, (3) life skills, (4) pregnancy prevention behaviors, and (5) pregnancy prevention intentions. With a concordance index between 0.80-1.00 and a reliability of section 2=0.95, section 3=0.96, section 4=0.96, and section 5=0.92. Statistics used include frequency, percentage, mean, standard deviation, and paired t-test and independent t-test. As for the results, after the experiment, literacy for comprehensive sexuality education, life skills, and intentions to prevent pregnancy were significantly higher in the experimental group than the control group (p<0.05), and after the experiment, they were significantly higher than before the experiment (p<0.05), and there was less risky sexual behavior in the experimental group (p<0.05). The program literacy for comprehensive sexuality education and life skill for comprehensive sexuality education, life skill, pregnancy prevention behaviors, and pregnancy prevention intentions. Public health officials and teachers can work with students to prevent and solve the problem of pregnancy in school.

The effects of “Treadmill training program” compared to “Endurance and strengthening exercise program” on walking and balance in the elderly

2025-06-17T17:05:38+07:00

There is inceasing number of elderly people in Thailand, and more than three million of elderly people fall every year. Poor balance or weakness of leg muscles can cause risk of fall and falling can cause bbone fracture, bedridden patient, or death. Then falling problem have to be solved. The objective of this research was to find out the effect of treadmill training program compared to the effect of endurance and strengthening exercise program on walking and balance in the elderly. There were 52 elders at risk of fall were randomly divided into 2 equal groups. Group 1 (n=26) received “treadmill training program” with body weight supported, while group 2 (n=26) received “endurance and strengthening exercise program”. The elders of both groups had to perform exercise 2 times a week for 6 weeks. During the training period, the level of difficulty was gradually increased. All participants were assessed through balance by timed up and go test (TUGT), five times sit to stand test (FTSST) before and after the six-week intervention period. The data were analyzed quantitatively using Wilcoxon signed rank statistics and the Mann-Whitney U test. It was found that both groups had significantly improved in TUGT and FTSST after finished the program, with p<0.01 for all variables. Comparing the 2 groups there was no significant difference in TUGT and FTSST (p>0.01). The treadmill training program and the endurance and strengthening exercise program were able to improve muscle power, balance and stability and reduce risof falling. Both programs were suitable options for rehabilitation of walking and balance of the elderly to promote the good quality of life.

Development of an Integrated District-Level Management Model to Enhance Health and Social Security for Vulnerable Groups in Saraburi Province

2026-02-22T09:37:12+07:00

This mixed-methods study was conducted to develop and test an integrated district-level management model to strengthen health and social security for vulnerable populations in Saraburi Province. Conducted over 12 months, the research comprised three phases: (1) assessing current implementation and management mechanisms for improving the quality of life of vulnerable groups; (2) developing the integrated management model; and (3) testing the model’s effectiveness. Participants included district health board members, experts, and members of vulnerable population groups. Data were collected using questionnaires, in-depth interviews, evaluation forms, observation records, a model operational manual, and focus group discussions. Data analysis involved descriptive and inferential statistics, along with content analysis. The results revealed that the overall implementation of quality-of-life development was at a high level, while the management mechanisms were at a moderate level. Key limitations included insufficient intersectoral integration, inadequate resources, and fragmented information systems. Promising opportunities for improvement were leadership commitment and strong community–local government networks. The developed D-SAFE Model consisted of five steps: Diagnostic Assessment (D), Stakeholder Synergy (S), Action Planning (A), Field Implementation (F),and Evaluation and Enhancement (E). The model demonstrated high appropriateness in both content and structure. Post implementation evaluation showed high mean scores for perceived usefulness (4.40) and feasibility (4.35) on a 5-point scale. While perceived benefits did not differ between urban and rural areas, a statistically significant difference in feasibility was found (p<0.05), with higher feasibility reported in urban contexts. Key success factors included policy support, cross-sectoral collaboration, personnel readiness, and an accessible information system. In conclusion, the D-SAFE Model proved to be a applicable framework for strengthening the health and social security of vulnerable populations at the district level in Saraburi Province.

A Study of Model Development of Database Management for Public Health Emergency: a Case Study of Flooding Situation

2023-05-19T11:23:27+07:00

This study was aimed to investigate a model of national database management system for flooding events using in three purposive sampling-provinces in southern of the country. Qualitative analysis was conducted. Chomphon, Surattani, and Nakhon Si Thammarat prrovinces were selected. Public health officers from these provinces were interviewed with structed questionnaires and focus group discussion were also conducted. The results were collected from the answers of questionnaire of 60 samples. The results found that there were four groups of information for national database management of flood of Public Health Emergency Operation Center (PHEOC) which were physical, populations, social, and management. The data in the past five years covered information of appointment points, evacuation points, evacuation routes, and risk areas or risk points. The administer was the Division of Public Health Emergency Management. The key persons from public health offices/hospitals were appointed to record/report required information of floods in this database system. Further study should take the result from this study to apply for the investigation of other types of disaster database management.

Effectiveness of applying Protection Motivation Theory in Promoting the Behaviors of upper limb movement in stroke patients

2025-07-25T16:29:54+07:00

This randomized controlled trial aimed to study the effectiveness of a program applying the Protection Motivation Theory to promote upper limb movement behaviors in stroke patients. A total of 46 participants were selected through simple random sampling and divided into two groups, with 23 participants in each group. The control group received occupational therapy rehabilitation, while the experimental group received the same therapy along with the program applying the Protection Motivation Theory to promote upper limb movement behaviors. The intervention lasted four weeks. Pre- and post-intervention assessments were conducted using three tools: (1) a scale measuring upper limb movement behaviors in stroke patients based on the Protection Motivation Theory, (2) a basic stroke knowledge test for patients, and (3) the Fugl-Meyer Assessment of Physical Performance (upper extremity motor). Post-intervention comparisons using the Mann–Whitney U test showed that the experimental group had significantly higher median scores in upper extremity movement behavior than the control group (4.08 versus 3.52), p<0.05. Similarly, the experimental group demonstrated significantly higher median scores in strokerelated knowledge compared with the control group (19 versus 16), p<0.05. For upper extremity motor control ability, no significant difference between the 2 groups was observed (p>0.05). In conclusion, the program applying the Protection Motivation Theory was effective in enhancing upper limb movement behaviors in stroke patients. This integration of rehabilitation medicine and health psychology knowledge leads to sustainable and consistent health care behaviors in stroke patients.

A Community Health and Healthcare Service System for Stroke Patients: Development and Effectiveness Evaluation

2025-07-16T11:51:19+07:00

The objective of this study was to develop and evaluate the effectiveness of the community health system to health care service system for stroke patients. The participatory action research was used to develop the model. Four provinces were selected: Chiang Rai, Nong Bua Lamphu, Samut Prakan, and Trang. The process consisted of 4 phases: (1) planning and development, (2) action period, (3) monitoring, and (4) effectiveness evaluation. The planning phase utilized mixed methods (quantitative surveys and qualitative focus groups) alongside brainstorming sessions with stakeholders at the community and health service system levels. The effectiveness evaluation was used to compare stroke knowledge achievement before and after the implementation. The samples were 1,134 elderly people aged 60 years and over. Data collected by a survey with questionnaires. The quantitative data were analyzed using descriptive statistics and paired t-test samples. Access to emergency medical services and results of hospital services by analyzing secondary data. The results of the study found that the community developed selfmanagement measures for promotion, prevention, risk control, emergency management, and follow-up. For the health service system, service systems both outside and inside the hospital were developed via a fast track for stroke patients. The elderly’s knowledge of stroke test scores were higher than the pretest at the significance level of 0.05 (Max score 12; pre/post: Chiang Rai 5.8/7.2, Nong Bua Lamphu 8.7/9.5, Samut Prakan 8.4/11.5, and Trang 8.0/10.4). Regarding access to the emergency medical service, it was found that stroke patients who came with the emergency medical service were 15.3%, 35.28%, 17.1%, and 52.1% in Chiang Rai, Nong Bua Lamphu, Samut Prakan, and Trang, respectively. The proportion of ischemic stroke patients arriving within the 4.5-hour window was 29.1%, 44.0%, 42.5%, and 52.6%, respectively (exceeding the 25% target). The rate of recombinant tissue plasminogen activator (rt-PA) administration within 1 hour was 87.7%, 60.0%, 81.9%, and 93.3% (exceeding the ≥60% target). Stroke mortality rates were 6.7%, 5.3%, 13.2%, and 4.9% (below the <7% target, except Samut Prakan). The findings of this study can be used as a guideline for promoting stroke patient care by utilizing a mechanism that seamlessly links the community health system with the health service system.

Result of Enhancing caregiver skills empowerment for intermediate stroke patients in Acupuncture Department at Debaratana Nakhon Ratchasima Hospital

2025-07-16T16:41:02+07:00

The objective of this action research was to study the results of skill development of caregivers of intermediate stroke patients who received acupuncture treatment. The mixed-method research was used to select 30 purposive samples of intermediate stroke patients and 30 caregivers. The first phase was a quantitative cross-sectional study. Data were collected by interviews and retrospective chart review method. The results were analyzed and presented using the numbers, percentages, means, and standard deviations. The factors associated the rehabilitation of intermediate stroke patients was identified using the Chi square test. The results showed that factors associated with increase Barthel Index for Activities of Daily Living (ADLs Barthel Index) were patients who received acupuncture treatment within 7 and 14 days after illness and patients who did not have a nasogastric tube. In the second phase, caregivers were trained using empowerment teaching and group discussions with a patient care manual. Comparison of caregiver’s skill scores before and after development using Wilcoxon Signed Ranks Test found that the scores increased significantly. Average score before skill training: 53 points, Average score after skill training: 55.50 points (Z=-2.235, p<0.05). Comparison of the difference between the Barthel Index for Activities of Daily Living (ADLs Barthel Index) of the patients when the study began, 1month, 2months and 3months using One way repeated measures ANOVA found the Barthel Index for Activities of Daily Living (ADLs Barthel Index) of the patients increased significantly (F=82.99, p<0.05). Focus group discussions revealed that caregivers were afraid and anxious about caring for patients with nasogastric tubes. Therefore, a nursing practice guideline on safe swallowing training was developed to enable patients to swallow independently without nasogastric tubes, which affects the patient’s level of daily routine. Recommendations for future studies include studying the results of using the developed nursing practice guideline and applying empowerment teaching to patients with other chronic diseases.

Factors related to Mental Health Status among Public Health Employees under Covid-19 Era: Cross-Sectional Survey Research

2023-09-29T22:15:59+07:00

The objective of this research was to study a relationship which affected to mental health status among public health employees in the COVID-19 era. A cross-sectional survey research was used by the stratified random sampling. Altogethe 300 participants were selected among public health employees at the central, the northern, and the eastern region of Thailand. Independent variables consisted of public health referral system for person with disabilities, public health policy, welfare, and work condition. Dependent variable was mental health status which it composed of unhappiness, anxiety, social impairment, and hypochondriasis. General data contained of sex, age, married status, educational level, and occupational status. Data of this research were analyzed by number, percentages, mean, standard deviation, minimum, maximum, and Pearson’s product moment correlation coefficient statistics at p-value less than 0.05. The results from the study found that public health referral system for person with disabilities, public health policy, welfare, and work condition had a positive relationship with mental health status (p<0.05). It was found that public health referral system for person with disabilities had the most positive relationship with mental health status. Mental health status among public health employees in the COVID-19 era was found to be at risk of poor mental health status. Thus, mental health surveillance conducted. Hence, the future study should cover path analysis, structural equation modeling, and qualitative research.

Analysis of medical costs for injuries and hip fractures resulting from falls in the elderly

2024-11-05T10:48:45+07:00

This retrospective descriptive study aimed to analyze the medical costs of injuries and hip fracture associated with falls in elderly aged 60 and over, covered by the National Health Security Fund, based on the secondary data from the National Health Security Office regarding the cost of medical covering claim related with falls from January to December 2022. Data were analyzed using mean, percentage, standard deviation and ratios. The study illustrated that the medical costs of elderly falls were claimed by 41,245 cases in total, average age 74.29±9.17 years (females 61.60% and males 38.40% with 1,300 of out-patients and 39,945 of in-patients). In addition, 11,393 injuries associated with falls and a broken hip (27.62% of total: female 75.99% and male 24.01%) claimed the medical cost of elderly fall treatment 618,331,228 THB (54,273 THB per case and the admission period 9.25 days on average) while the total cost of medical covering claim was 1,477,563,683 THB (35,824 THB per case and the admission period 6.06 days on average). As the result, the elderly fall prevention is a crucial concern - especially the elderly falling on flat surface according to slippery, and slip or trip. Thus, the prevention will reduce falls, injury severity, medical costs, hospitalization, disability and mortality rate as well as the increase in the quality of life in the elderly.

Risk Factors Associated with Short-term Mortality and Complication Rates After Open Heart Surgery in a Regional Hospital Setting

2025-07-16T16:54:55+07:00

This study aimed to investigate the 30-day mortality rate, postoperative complications, and factors associated with short-term mortality among patients undergoing open heart surgery in a regional hospital in Thailand. A retrospective study was conducted using data from 106 patients who underwent open heart surgery at Trang Hospital, Thailand, between July 2022 and June 2024. The primary outcome was the 30-day mortality rate, while secondary outcomes included various postoperative complications and associated risk factors. Logistic regression analysis was employed to identify predictors of mortality. The results showed that six patients died within 30 days after surgery, representing a 30-day mortality rate of 5.7%. The rates of major complications were as follows: arrhythmias 21.7%, pulmonary or bloodstream infections 12.3%, kidney failure requiring dialysis 4.7%, stroke 2.8%, reoperation 2.8%, and deep sternal wound infection 0.9%. Preoperative factors significantly associated with 30-day mortality included older age and lower left ventricular ejection fraction, whereas postoperative predictors were stroke and kidney failure requiring dialysis. Moreover, patients with a predicted 30-day mortality rate greater than 8% according to the EuroSCORE II or GERAADA model had a substantially higher risk of death. In conclusion, the 30-day mortality rate after open heart surgery in this regional hospital remained relatively high compared with national reports. Advanced age, impaired cardiac function, and serious postoperative complications, particularly stroke and renal failure, were key determinants of early mortality. These findings underscore the importance of strengthening perioperative management, optimizing surgical risk assessment, and improving postoperative monitoring systems in regional hospital settings to reduce adverse outcomes.

Relationships Between Perceived Ethical Behaviors of Nurse and Proactive Work Behaviors Among Professional Nurses in Government Hospitals

2025-03-27T10:12:28+07:00

Ethical behavior according to the perception of nurses brings positive results to patients and their families. Having proactive work behavior will reduce the chance of ethical conflicts. It also helps to encourage and support nurses to practice nursing ethically. The purpose of this descriptive study was to explore ethical behavior and proactive work behavior of professional nurses, as well as the relationship between ethical behavior and active work behavior of professional nurses. The samples consisted of 119 nurses working in Government hospitals. Data were collected from September to December 2024. Research instruments included: demographic data questionnaire, perceived ethical behaviors of nurses questionnaire (PEB). and proactive work behavior questionnaire (PWB). The Cronbach’ alpha coefficients of PWB and EBPN were 0.97 and 0.96, respectively. Data were analyzed using descriptive statistics and Spearman’s rank order correlation. The results of the study revealed that out of the all the nurses surveyed, 87.4 percent scored a high level of ethical behaviors, 54.6 percent of the same nurses scored a moderate level of proactive work behavior and perceived ethical behavior of nurses had a positive correlation with proactive work behavior (p<0.05) This relationship can be explained by the universal ethical principle that cognitively ethical behavior makes nurses have a good proactive personality, and the proactive work behavior has a positive impact on the effectiveness of work. The results of this study are important information to promote and support the ethical behavior of nurses that will help nurses to have proactive work behavior in preventing ethical conflicts and providing ethical nursing services.

The Effectiveness of Implementing a New Barcode System in Reducing Errors in Blood Component Dispensing at the Blood Bank of Loei Hospital

2025-07-17T10:35:08+07:00

In the process of blood component transfusion in blood bank of various hospitals, barcode systems have been employed to prevent errors and ensure the safe delivery of blood to patients. Data from the blood bank at Loei Hospital indicate that between 2022 and February 2023, despite using the existing barcode system for blood component transfusion, there was still an error rate of 0.013. The objective of this study was to investigate the error rate in blood component transfusion using a new barcode system. The study method involved enhancing the barcode system by adding an additional barcode verification of blood requisition slips and blood components, which was integrated with the hospital’s Hospital Information System (HIS) and Laboratory Information System (LIS). Data were collected from March 2023 to 2024. The results showed that the error rate in blood and blood component transfusion was 0%. In conclusion, the errors rate in blood component transfusion using the new barcode system at the blood bank of Loei Hospital was 0%. It is recommended that the new barcode system be implemented in other blood banks in hospitals to further reduce errors in blood component transfusion.