Journal of Health Science of Thailand

Assessment and Comparison the Environmental Pollution Status of Heavy Metals from Landfills of Sa Kaeo and Trat province in Special Economic Zones (SEZ) of Thailand Eastern Region

Narongsak Tongthammachart — 2024-06-30

The purpose of this research was to study the environment surrounding the sanitary landfill according to the environmental quality index and to assess the status of environmental pollution affected by landfills in the eastern border provinces: 3 places in Sa Kaeo provinces and 2 places in Trat provinces in the Public Region 6. The environmental indexes on heavy metal for surface water resources soil pollution and air pollution, and environmental samples were taken for laboratory analysis and field measurements. The results showed that the environmental quality index for surface water quality and the soil pollution index around the 5 landfill sites regarding arsenic (As) cadmium (Cd) chromium (Cr) lead (Pb) and manganese (Mn) passed all criteria in environmental status score of surface water resources and soil pollution with the score of 1 which was considered as perfect natural state. However, the level of sulfur dioxide (SO2 ) was high; while carbon monoxide (CO), methane (CH4 ), all passed the criteria. In addition, the environmental score of air quality was 0.75 which was classified as a warning condition. The suggestion obtained from this research are that there must be the measures for air pollution surveillance and monitoring for soil pollution and surrounding landfills which need to be concurrently continued for environmental quality in both aspects; and measures should be established to screen for heavy metal waste by focusing on campaign for public and private sectors to separate waste containing chemicals and hazardous substances.

The Study of Socioeconomic Determinants That Determine Non-communicable Diseases for the Quality of Life Indicators of Health-Related Thai Social Situation among the People

Rakkhwan Sarawasee — 2024-06-30

Non-communicable diseases (NCDs) are public health problems that impact on economic and social burden and also affect to loss of disability adjusted life years of the Thai people. The objectives of this study were to (1) identify socioeconomic determinants related and influenced to chronic noncommunicable diseases (NCDs) for the quality of life indicators and (2) construct the prediction equation to calculate probability of the determinants that would have the likelihood of influencing NCDs occurrence and severity. Altogether 385 sets of provincial level data were collected from the various organization published sources. They were secondary data in the fiscal years 2014 - 2018. The data were analyzed with multinomial logistic regression model. It was found that the determinants relating to and influencing NCDs (hypertension, diabetes and heart diseases) were number of academic years, per capital income, depression diseases and the health promotion budget. Other outcomes of the study were the NCDs prediction equations with an overall prognostic accuracy of 80.28%. The model of improving quality of life for the people was to raise the level of per capita income, enhance health promotion for the NCDs prevention at the local level corresponding with providing education including health literacy and surveillance for patients with depression. Thus, the NCDs equation prediction to calculate probability of NCDs should be used for the planning, health promotion and prevention of the NCDs that would occur in the future.

Effectiveness of a Health Promotion Program on Reducing Sugar-Sweetened Beverage Consumption among Health Village Volunteers in Tak Province

Waraporn Pimpasorn — 2024-06-30

This study was a quasi-experimental research with the objective to assess the effectiveness of a health promotion program on reducing sugar-sweetened beverage consumption among health village volunteers in Tak province. The samples consisted of 70 health village volunteers in Tak province selected through purposively sampling method; and were divided into 35 individual in the experiment group and 35 in the controlled group. The experiment group was provided with a health promotion program on reducing sugar-sweetened beverage consumption based on the Theory of Planned Behavior while the control group provided with regular health promotion services. Data were collected using six questionnaires, with content validity assessed using the index of congruence (IOC) ranging between 0.67 and 1.00. The reliability of the questionnaires was measured by Cronbach’s alpha coefficient of which the outcome for attitudes towards reducing sugar-sweetened beverage consumption, subjective norms, perceived behavioral control, intentions, and behavior of sugar-sweetened beverage consumption was 0.80, 0.79, 0.85, 0.86, and 0.88 respectively. Descriptive statistics including percentages, means, and standard deviations were used for data analysis. The effectiveness program of the between groups was tested using independent t-test and those within group was tested using paired t-test statistics. The study revealed that after the program ended, mean scores of attitudes towards reducing sugar-sweetened beverage consumption, subjective norm, perceive behavioral control and intention to reduce sugar-sweetened beverages consumption were greater than before intervention and the control group. After the intervention, mean score of the behavior of sugar-sweetened beverage consumption and body mass index (BMI) in the experimental group was significantly less than mean scores before the program and those of the control group (p<0.05). Consequently, the health promotion program effectively encouraged village health volunteers to reduce their consumption of sugar-sweetened beverages. Therefore, thsi approach should be widely implemented to reduce the consumption of sugar-sweetened beverages among health village volunteers, aiming to prevent non-communicable diseases (NCDs) and serve as a model for healthy behaviors at community level.

Effect of Self-Management Program with Group Process Learning on Health Behavior and Blood Pressure Level among New Hypertension Patient in Thung Yai Hospital, Nakhon Si Thammarat Province

Thitiya Athikamanon — 2024-06-30

New cases of hypertension increase every year, with a continuous upward trend. The main causes is related to unhealthy behaviors: consuming sweet foods, oily, and salty tastes, irregular exercise, and continuous medication non-adherence. The aim of this quasi-experimental research was to investigate the effects of a self-management program combined with group process-based learning on health behavior and blood pressure levels in newly diagnosed hypertension patients. The study was conducted at Thung Yai hospital, Nakhon Si Thammarat province, with a total of 82 participants who were divided into experimental and control groups, each consisting of 41 individuals. The intervention was carried out for 6 weeks, during which the experimental group received the self-management program combined with group process-based learning, while the control group received regular hospital services. Data were analyzed using inferential and descriptive statistics. The results revealed statistically significant differences (p<0.05) in all three aspects of health behaviors (diet, exercise, and medication adherence) and systolic blood pressure levels between the experimental and control groups. However, there was no statistically significant difference (p>0.05) in diastolic blood pressure levels between the two groups. Therefore, public health personnel should implement self-management programs combined with group process-based learning to promote proper self-management skills regarding health behaviors among newly diagnosed hypertension persons. This intervention could lead to better blood pressure control and prevention of subsequent complications.

Lessons Learned on the Public Health Emerging Management of COVID-19, Khon Kaen Province

Mingkhuan Phuhongtong — 2024-06-30

This qualitative research aimed to identify lessons learnt on public health emerging management of COVID-19, Khon Kaen Province. The purposive samples were (1) policymakers, (2) diseases prevention and control practitioners, (3) individuals involved in managing COVID-19 situations, and (4) community-level personnel who were community leaders and public health volunteers. The data were collected through interviews and group discussions. The findings revealed that Khon Kaen province preparation for the COVID-19 situation utilized the Incident Command System: ICS that followed the 2P2R principles: Prevention, Preparedness, Response, and Recovery. Such principlee were driven by the provincial Communicable Disease Committee established under the 2015 Communicable Diseases Act. Additionally, an emergency operation center (EOC) was set up to coordinate and manage the public health emergency. The centre was established based on the 3S principle: Staffs, Stuffs, and Systems. Emergency response guidelines was developed under six necessary measures (6 C) as follows: (1) screening and monitoring of patients at medical infirmary and communities (capture), (2) case management and infection control, (3) contact tracing, (4) communication of risk factors, (5) community intervention and law enforcement, (6) coordinating and joint information centre results from appropriate preparation and control of COVID‐19 impact from all three levels (individual, community, and provincial) which were the key success factors within the health system for managing the public health emergency dealing with the epidemic of COVID-19 in Khon Kaen province.

Development of Telemedicine Service Model, Prachuap Khiri Khan Province

Jarurat Pattanathong — 2024-06-30

This study is research and development with the objectives to (1) study the situation and models of telemedicine services in Prachuap Khiri Khan Province during the years 2022-2024, (2) develop service models, and (3) evaluate the developed service models. The tools used for the study were developed from the Technology Acceptance Model theory combined with the six building blocks of health system framework. The study was divided into three phases. In Phase 1, the development began using the quality management cycle, which included work planning, creating work methods, implementation, and performance evaluation. It was found that only 3 out of 8 hospitals had service performance. Phase 2 involved improving the work models using the quality management cycle, carrying out activities based on work promotion measures derived from focus group discussions with stakeholders. These measures included setting departmental and managerial performance targets, awarding outstanding performers, involving executive personnel in listening, solving problems, and regularly monitoring operations, knowledge exchange between model hospitals, empowering visits to all hospitals, and instilling confidence in personnel to see the benefits and understand that telemedicine is not difficult to implement. Phase 3 involved evaluating the developed service model by assessing: (1) volume and access to services, finding that the average number of service instances per month increased by 5.83 times and was applied to more illnesses; (2) the relationship between variables using Spearman Sign rank test, which found that the levels of perceived ease of use, perceived usefulness overall, and perceived benefits of telemedicine in relation to the six building blocks of health system framework had a positive correlation with the intention to use at a confidence level of 0.05. The Biserial correlation was used to test the relationship between staff’s intention to use and their actual usage behavior post-development, showing a positive correlation at a confidence level of 0.05. The Wilcoxon sign ranks test evaluated the levels of perceived benefits, perceived ease of use, and intention to use before and after development, and showed that all variables had significantly increased scores at a confidence level of 0.05. Lastly, patient satisfaction was found to be at a high to highest level. The study concludes that the theoretical framework can explain the behaviors and variables studied, and the developed model used for improving services was effective.

Development of a Risk Communication Model during Public Health Emergencies in Thailand: Major Disease Outbreak Situations

Sumanee Wacharasint — 2024-06-30

This study aimed to explore risk communication management in public health emergencies in Thailand and other countries using the COVID-19 pandemic as a case study; and develop a risk communication model in public health emergencies for the control of major disease outbreaks in Thailand. This quality research and development model was divided into 4 phases including phase 1: synthesis and integration of knowledge composed of documentation review, in-dept interview and group discussion. Key informants were 149 stakeholders from public and private sectors, Phase 2: development of a risk communication management model during Public Health Emergencies in Thailand, Phase 3: testing of the draft model among 9 risk communication senior experts and 200 stakeholders, and Phase 4: improvement of a risk communication model. From this study, we found that emergency risk communication during the COVID-19 pandemic was focused on promoting common understanding between message senders and receivers through preparation of pre-crisis communication using appropriate communication channels such as online social media, meeting with the press and promoting proper public decisions and efficient actions to respond to the occurring threat. We, therefore, proposed a risk communication management in public health emergencies called a CAT-D model which had 4 elements, i.e., (1) Strengthening of Risk Communication at Provincial Level - main activities should include establishment of provincial risk communication unit (formal structure) in provincial health offices and relevant non-health sectors, designation and training of spokespersons, and establishment of a risk communication plan that links properly up to the central level, (2) Active Engagement with stakeholders: to build up relationship with stakeholders in public, private and civil society sectors, (3) Using Technologies, Tools and Innovations for Risk Communication Messages: to include also the infodemic management during the situation, and (4) Establishment of Data Hub for Information Management and Easy Access: to prepare for emergencies which should work closely with the Joint Information Center (JIC) of the Emergency Operations Center (EOC). All elements should be operationalized in all phrased, i.e., (1) preparedness for the crisis, (2) response to the crisis, and mitigation following the crisis.

Mechanisms Development for Driving COVID-19 Pandemics Prevention in Educational Institutions in Thailand

Panadda Junporng — 2024-06-30

This research aimed to study the mechanisms development for driving COVID-19 pandemics prevention in educational institutions in Thailand and evaluate the preparation measures before the start of the semester 1 in the academic year 2022. The samples were purposively selected, including 10 senior executives of the Ministry of Public Health and Ministry of Education. Qualitative data were collected through in-depth interviews based on structured questions. Data were analyzed using content analysis. Quantitative sample group were 36,751 educational institutions that performed self-assessment on their preparation for COVID-19 prevention for semester 1 of academic year 2022 through the Thai Stop COVID Plus system. The data were analyzed by frequencies, percentages and tested of spatial relationships including the use of Local Indicators of Spatial Association (LISA) study. It was found that the development of mechanisms to drive measures to COVID-19 pandemics prevention in educational institutions consisted of (1) driving operations with participation by the committee driving public health measures in preparation for the opening of the semester on COVID-19 prevention under the integrated policy cooperation at the central level and regional operations at the area level; (2) setting the direction of measures guidelines for practice and policy proposals; (3) transferring policies and implementation measures to network partners and educational institutions; and (4) monitoring the performance of educational institutions through digital technology. Among the overall educational institutions, 78.40% of them participated in the self-evaluation which covered 6 dimensions; 99.36% of them passed all 20 items; and 0.45% passed the first-dimension measure, items 1-12. The analysis results found that the higher percentage of provinces with educational institutions that had passed the preparation assessment after the school opening compared to the period before the start of school season indicated the effectiveness of the measures and the high level of compliance of the educational institutions. As a result, there was no COVID-19 case detected in educational institutions; which led to the confidence on the preparedness and safety for school opening. It was recommended that the systems and mechanisms should be developed to drive measures to COVID-19 prevention of other communicable diseases in educational institutions. and creating cooperation network with partners to drive forward health promotion work for vulnerable children.

Development of Surveillance and Health Care System among People are Living with Long COVID, a Case Study on Primary Care Unit, Kut Chum District, Yasothon

Jit Mongkholmafai — 2024-06-30

Long COVID is a set of symptoms that occurs in people with COVID-19 infection. Thus, a surveillance and health care system for people living with long COVID is needed. The objective of this study was to develop and evaluate of a surveillance and health care system for people living with long COVID in the primary care unit, Kut Chum District, Yasothon Province. This action research was conducted by using collaboration process with the 4-step PAOR concept which includd: (1) Planning, (2) Action, (3) Observing, and (4) Reflecting. The samples were 20 persons taking care for COVID-19 infected patients and 176 patients who received treatment during January to May 2022. The data were collected using a questionnaire, focus group discussion; and were analyzed by conducting a content analysis and summarizing the issues for the need to develop a surveillance model and participatory care. Descriptive data were analyzed by mean, percentage, and standard deviation. It was found that after implementing 2 cycles of the PDCAs, the patients who had severe symptoms were kept under surveillance by village health volunteers to provide support, refer and treatment with interprofessional team. Elderly people and patients with underlying diseases and had severe symptom or abnormal chest x-ray received home visits. Based on the review of the practice, a flowchart for surveillance people living with Long COVID was initiated leading to the improved practice in accordance the context and problems. It was also found that 92.45% of clients and 94.17% of health care professions were satisfied with the system. Thus, the surveillance and health care system for people at risk with long COVID based on participation continued to provide positive effects on daily life of people living with COVID-19.

Long-Term Mortality and Morbidity at One Year among Universal Coverage (UC) Thai Patients Undergone Coronary Angiography without Further Cardiac Interventions (CAG Only) from 2020 - 2022

Panthep Khananuraksa — 2024-06-30

Coronary angiography (CAG) has been considered as a safe invasive procedure since it carries low mortality (<0.8%) and overall morbidity rates (<2.0%). Previously, our group reported a high short-term (in-hospital and 30 days) adverse events among 59,373 Thai patients underwent CAG Only from reimbursement data of the National Health Security Office (NHSO), Thailand 2016-2020, including death 2.90%, stroke 1.25% and acute kidney injury 7.50%. However, the claimed data did not provide clinical details to determine possible causes. Thus, NHSO had designed a short clinical data form to be filled up by service centers accompanying with reimbursement. However, low complications were reported from total CAG 5,019 cases, only 2.35% (95%CI 1.92, 2.78) including death, stroke, and acute renal failure (ARF) which 86.40% of them occurred within 24 hours of CAG Only suggestive of procedure-related events. Thus, we studied the long-term (from admission to one years) adverse clinical outcomes, including death, acute renal failure (ARF) and acute stroke, which had not been diagnosed before admission, of 53,300 patients underwent CAG Only (from total 141,605 CAG cases recorded) in the fiscal year 2020- 2023 of the NHSO system. It was found that proportion of CAG Only remained high, 37.63% (37.36-38.05%) among patients receiving CAG, and they carried a high in-hospital mortality rates of 2.6-2.7%. The highest mortality was observed in patients diagnosed with ischemic heart diseases (IHD), 7.15-8.06%, other cardiovascular diseases (CVD), 5.00-5.35%) and other diseases, 3.75-3.80%. Importantly, the mortality rates had increased by 1.5-1.7 times, from 7.5% (30 days) to 12.17% (one-year), accumulated to very high one-year mortality of 19.66% (18.71-20.22). We found relatively high rate of ARF, 4.24-5.37%, and acute stroke 1.05-1.28% which had not been diagnosed before admission. In addition, new diagnosis of ARF and acute stroke were re-admitted after CAG only, accumulated to the total average ARF of 9.54% and stroke of 3.46% which likely contributed to high one-year mortality. Conclusions: this analysis showed unacceptably high long-term mortality and morbidity of Thai patients undergone CAG Only. Although it could not be concluded as procedural related events but it should be a wake-up call for care providers, budget regulators and researchers, to improve case record details for risk factors, co-morbidities, to follow current practice standard guidelines and to provide preventive interventions for patient safety, hopefully to reduce unnecessary cost of these adverse events in the future.

Factors Associated the Success of Uretero-Renoscopic Lithotripsy in One Day Surgery

Thawat Dhamborvorn — 2024-06-30

Urolithiasis is a high prevalent disease that impact to the health resources in Thailand. One-day uretero-renoscopic lithotripsy is one of the surgical procedures that can relieve this problem. The purposes of this study were to explore the outcomes and identify factors associated with the success of one-day uretero-renoscopic lithotripsy in ureteric calculi treatment. It was conducted as a prospective cohort study in 65 patients with ureteric calculi treated with uretero-renoscopic lithotripsy at Udon Thani and Nongbualamphu hospitals, Udon Thani province, between October 2022 and August 2023. Non-contrast computed tomography was used to determine stone characteristics. The success was defined by the present of completely done of URSL and length of stay <24 hours. The overall success rate was 95.4%; and the complication rate was 7.7%. There was no patient who needed an unplanned admission. Chi-square demonstrated the sigmificant association between success and operative time, double stent insertion, post-operative pain, and post-operative fever (p<0.05). Binary logistic regression analysis demonstrated that operative time was a significant predictor of one-day URSL success (OR 0.875, 95% C.I. 0.820-0.933, p<0.05). This study showed a safe and effective treatment of ureteric calculi with One-day URSL. Operative time is a strong predictor for the success of one-day URSL. Finally, one-day URSL operation can be used to alleviate the problems of crowdedness and a long wait for operation quite successfully.

Dietary Behavior Modification by Lifestyle Medicine to Improve Kidney Function in CKD Patients

Sompong Chaiopanont — 2024-06-30

This quasi-experimental research aimed to develop the capacity of health personnel to carry out dietary behavior modification according to nutritional therapy principles (NTP) and to organize a project for patients with chronic kidney disease (CKD) to modify their dietary behavior following NTP to restore kidney function. The project was assisted by health personnel according to lifestyle medicine practices. The research method was adapted from the study of the main author who conducted a quasi-experimental study in patients with CKD which resulted in kidney function improvement over a period of four weeks in the year 2019. The present study was conducted in two phases between February 2024 and May 2024. The first phase involved two training sessions to develop the capacity of health personnel according to lifestyle medicine guidelines, including thirteen volunteers, nursing staff and nutritionists. In the second phase, the trained health personnel implemented dietary behavior modification in accordance with lifestyle medicine guidelines for volunteer groups of CKD patients. A total of fifty-one participants attended 4 visits. The results of Phase 1 among personnel showed that the overall knowledge score improved significantly (25.69±2.18 vs 27.08±2.10, p<0.05). Additionally, the knowledge score of CKD increased (12.08±0.86 vs 12.62±0.87, p<0.05), and the NTP for CKD knowledge score also showed significant improvement (11.15±1.14 vs 12.39±1.33, p<0.05), and all personnel gained the capability to do motivational interviewing skills. The results of Phase 2 showed that dietary behavior of the CKD patients significantly improved (71.58±10.17 vs 74.28±9.93, p<0.05). Improved kidney function was observed in 49.02% of patients at the second visit,41.18% at the third visit, and 41.18% at the fourth visit included serum creatinine levels decreased. Noticeably, fasting blood glucose levels were controlled in every visit.

Policy Recommendations from Impact Assessment of Transferring Queen Sirikit Health Centers (QSHC), and Sub-District Health Promoting Hospitals (SHPH) to Local Government Organization

Sunanta Kanchanapong — 2024-06-30

The purpose of this study was to assess impact of transferring the mission of Queen Sirikit Health Centers (QSHC), and Sub-District Health Promoting Hospitals (SHPH) to local government organization. The evaluation was structured into five critical stages: (1) data gathering and review, (2) development of tools for in-depth data collection, (3) data collection through field surveys, (4) data processing and content analysis, and (5) policy recommendation formulation. The findings suggested that the health sector stakeholders involving in the study felt that there were inadequate resources and unclear policy communication. The external economic, social, and governmental policy changes were pressures that, in the past, had not been adequately addressed before the transfer of responsibilities. Similarly, local government organizations faced these issues, but due to planned work processes, policy transmission, and comprehensive communication at all levels, the negative impacts from external factors were mitigated, leading to generally better outcomes. The evaluation resulted in policy recommendations including the integration of cooperative services between the Ministry of Public Health and local government organizations, and the creation of mechanisms for the participation of relevant network partners. For the Ministry of Public Health, it is recommended to have clear policies and plans for managing work at all levels, to support sufficient resources, and to ensure efficient and timely communication between policy and operational levels. For the local government organizations, it is recommended to develop public health system oversight capabilities that support both local and national systems seamlessly, with clear policies and mechanisms for transferring health personnel, enhancing skills and career advancement appropriately, integrating systems with the Ministry of Public Health, and efficiently allocating resources and budgeting.

Efficiency of Low-tube Voltage Protocols Combined with Iodine Contrast Reduction and Hybrid Iterative Reconstruction Techniques for Abdominal Computed Tomography: a Study in Patients

Jongkolnee Poonsub — 2024-06-30

This research aimed to evaluate the effectiveness of a newly developed protocol, incorporating lowtube voltage and iodine contrast reduction, along with hybrid iterative reconstruction, for abdominal computed tomography (CT) in Thai patients of small, medium, and large body sizes. A total of 105 patients underwent imaging using a GE Revolution CT scanner with dual-energy capabilities, employing tube voltages of 80 kV, 100 kV, and 120 kV for small, medium, and large body sizes, respectively. These were compared to a reference protocol using 120 kV, with a reduction in contrast agent volume by a percentage of 15.03%, 8.55% and 5.15%, respectively. The research revealed that the developed protocol significantly reduced the CTDIvol by 55.14%, 39.43%, and 28.16% in the small, medium, and large patient groups, respectively. While quantitative image quality metrics were lower than the reference protocol in the small patient group, qualitative assessments of image clarity by three radiologists, generating Visual Grading Characteristics (VGC), showed that the developed protocol provided comparable image quality in the small and large patient groups (AUC=0.5) and superior image quality in the medium patient group (AUC >0.5). Thus, the developed protocol demonstrates suitability for clinical application.

Development of Proficiency Testing Provider in Urine Pregnancy Testing, Urine Glucose and Urine Protein Testing of Primary Care Unites

Wanvisa Neadruengsang — 2024-06-30

This study aimed to enhance the proficiency testing program for urine pregnancy, glucose, and protein testing in primary care units. We developed processes for sample preparation, document delivery, and participant communication. The proficiency testing provider (PTP) improved sample preparation, ensuring homogeneity and stability in PT samples for urine pregnancy, glucose and protein testings throughout the reporting period. Document delivery transitioned from postal to electronic resulting in the reduction of expenses by 56.1% and paper usage by 80.0%. Improved participant communication increased the reporting rate from 81.3% to 98.4%. It has been a 5-year PT program from 2019 t0 2023, resulting in a reduction of expenses by 56,879 baht (35.43%). The analytical aspect of the PT program contributed to the development of both the PTP and participant advantages. Ultimately, the PT program results for primary care units could offer a policy proposal for organizations to oversee the quality of primary care unit laboratories.

The Influence of Administration via McKinsey 7’s Framework on Good Governance Principles in Udon Thani Hospital

Patcharaporn Chaisri — 2024-06-30

The study aimed to investigate the influence of McKinsey 7’s framework administration on good governance principles and analyze the impact of good governance elements on the rule of law, morality, and transparency in Udon Thani Hospital. Data were collected through questionnaires distributed to 353 individuals employed at Udon Thani Hospital, selected through stratified random sampling. Structural Equation Model and Path Analysis were employed for data analysis. The results demonstrated that McKinsey 7’s framework administration significantly influenced good governance principles (γ=0.87), predicting these principles at 76.0% (R2 =0.76). Regarding the elements of good governance, McKinsey 7’s framework administration significantly influenced the rule of law (γ=0.78), participation (γ=1.11), value (γ=1.10), and transparency (γ=0.28). Indirect influences were observed on responsibility (γ=0.66), transparency (γ=0.44), and morality (γ=0.76). Specifically, the elements of good governance that significantly influenced transparency were the rule of law (β=0.56), while the elements influencing morality were the rule of law (β=0.23) and participation (β=1.21). Morality was indirectly influenced by McKinsey 7’s framework administration (γ=0.76), the rule of law (β=0.54), and participation (β=0.73), predicting the rule of law at 61.0% (R2 =0.61), transparency at 63.0% (R2 =0.63), and morality at 67.0% (R2 =0.67).

Data Collection of Food and Beverage Marketing and Its Impact on Thai Children

Nongnuch Jindarattanaporn — 2024-06-30

Editorial Board