Journal of Health Science of Thailand

Strategies for Preventing Suicide in Elderly Individuals Experiencing Stress and Depression

Krittikawin Promchumsa — Wed, 24 Jun 2026 00:00:00 +0700

Thailand is entering a fully aged society, accompanied by an increasing burden of mental health problems among older adults, particularly stress, depression, and suicide. This academic article aims to synthesize existing knowledge and analyze risk factors associated with suicide among older adults in Thailand, encompassing psychological, social, economic, and health-related dimensions. Based on a comprehensive review of relevant studies and literature, depression, loneliness, bereavement, lack of social support, and economic insecurity were identified as major factors significantly associated with suicidal ideation and behaviors among the elderly. The synthesis further revealed an underlying mechanism linking chronic stress, depressive symptoms, and perceived burdensomeness, which collectively heightened the risk of suicide among older adults. The article proposes suicide prevention strategies at four levels: individual, family, community, and national policy, emphasizing the integration of mental health care, the strengthening of social support networks, and the development of proactive mental health service systems. Key effective practices identified include proactive screening, active involvement of family and community networks, reduction of economic inequality, and the systematic development of suicide-related data and surveillance systems, which together contribute to risk reduction and long-term improvement in quality of life among older adults. Policy recommendations focus on scaling up successful interventions, enhancing collaboration among governmental agencies, community organizations, and health service systems, and promoting sustainable, integrated approaches to suicide prevention within the Thai sociocultural context.

Factors Influencing Oral Care Behavior in The Elderly Banruan Subdistrict, Pasang District, Lamphun Province

Notegamom Chedthong, Thawatchai Sattayasomboon, Kongprai Tunsuchart — Wed, 24 Jun 2026 00:00:00 +0700

Good oral health is essential for overall physical well-being and the quality of life among the elderly. This cross-sectional analytical study aimed to investigate the factors associated with oral health care behavior among elderly individuals residing in Banruan Subdistrict, Pasang District, Lamphun Province. The study sample consisted of 285 elderly participants. Data were collected using a structured questionnaire with a reliability coefficient ranging from 0.73 to 0.80. Descriptive statistics were used to analyze general characteristics and levels of behavior, while Pearson’s correlation coefficient and multiple linear regression analysis were employed to examine associations between variables at a significance level of 0.05. The findings revealed that a majority of participants (84.91%) exhibited good oral health care behavior. The overall level of oral health literacy was found to be sufficient (82.81%). The factors significantly associated with oral health behavior included the presence of underlying diseases, oral health knowledge, oral health self-management skills, access to oral health information and services, perceived susceptibility to oral health problems, and social support (p<0.05). These 6 variables collectively explained 39.5% of the variance in oral health care behavior among older adults, as analyzed by multiple regression analysis. In conclusion, key factors influencing oral health care behavior included underlying health conditions, components of oral health literacy, access to oral health services, perceived susceptibility to oral health problems, and social support. To promote better oral health behavior among the elderly, health administrators and dental health professionals should focus on enhancing oral health literacy and strengthening the perception of susceptibility to oral health problems.

Knowledge, Self-Awareness, Preventive and Control Behaviors Related to Dengue Hemorrhagic Fever among Congested/Semi-Urban Community with Continuing Epidemics: a Case study of Samransuk Community, Hat Yai District, Songkhla Province

Wed, 24 Jun 2026 00:00:00 +0700

During 2017 - 2021, a continuing outbreak of dengue hemorrhagic fever (DHF) occurred in a semi-urban, densely-populated community in Khlonghae Sub-district of Hat Yai City, Songkhla Province. No qualitative study was conducted to explore in-depth knowledge, self-awareness, and DHF prevention and control behaviors from perspectives of community health volunteers (CHVs), patients, household contacts, and high-risk populations in the affected community. The objective of this study was to assess knowledge, self-awareness, and DHF preventive behaviors among community health volunteers (CHVs), patients, household contacts, and high-risk populations. A qualitative research design was utilized together with quantitative method. Data were collected between 15 August - 31 December 2022, using semi-structured questionnaires, participatory observation, and gathering secondary data. Purposive sampling was used to recruit 34 eligible participants. Content analysis and descriptive statistics were used to analyze data. It was found that overall of study groups had a moderate level of knowledge (mean = 7.89), with low levels of self-awareness and DHF preventive behaviors (mean = 6.26 and 5.64 respectively). Most of the study participants (except the group of CHVs) minimally participated in DHF preventive activities, as most perceived it to be the direct responsibility of the CHVs and community leaders. Patients and household contacts had a moderate level of knowledge regarding self-care when getting ill (mean = 8.00, and 8.80 respectively). In conclusion, health care personnel should endorse knowledge to reach community target population frequently, through providing risk communications regarding the danger of DHF disease. In addition, they should also seek ways for implementation by emphasizing the importance of destroying breeding sites of Aedes mosquito larvae, according to the measures recommended by the Department of Disease Control, Thai Ministry of Public Health. These strategies could help raising up self-awareness and support DHF prevention and control behaviors among these target populations to achieve sustainable success in the future.

Prevalence of Distal Symmetrical Polyneuropathy in Type2 Diabetes, IWGDF Category 0, Aged 18-55 Years: a Cross-Sectional Study Using Nerve Conduction

Mattana Sareekam — Wed, 24 Jun 2026 00:00:00 +0700

This study aimed to explore the prevalence of distal symmetrical polyneuropathy (DSPN) among patients with type 2 diabetes mellitus, aged 18-55 years, who were classified as having a very low risk of developing foot ulcers. A cross-sectional descriptive study was conducted with a sample of 100 participants at the Social Security Clinic, Saraburi hospital. Nerve conduction study was utilized as the gold standard for diagnosis in conjunction with the Michigan Neuropathy Screening Instrument (MNSI). Data were analyzed using binary logistic regression. The results showed that the prevalence of DSPN was as high as 30%, even though the patients had an average disease duration of only 4.7 years. Important factors significantly related to the condition included diabetic retinopathy (adjusted OR=42.564), abnormal Tibial nerve conduction (adjusted OR=11.242), abnormal Medial plantar nerve conduction (adjusted OR=7.876), and abnormal MNSI history scores (adjusted OR=11.775). These findings indicated that nerve damage could occur in the early stages before clear symptoms appear, which might cause it to be overlooked during routine screenings. In conclusion, patients with a very low risk of foot ulcers still had a hidden risk of neuropathy. The study suggested that healthcare providers should focus on clinical history and effective tools like MNSI history section. Additionally, referring patients for specific nerve tests should be encouraged to prevent serious complications in the future.

Factors Related to Health Literacy for Medical Cannabis Use Among Thai People in the Southern Region

Araya Khoka, Prapaipim Surachetkomson — Wed, 24 Jun 2026 00:00:00 +0700

This descriptive research aimed to examine the levels of health literacy and attitudes toward the use of medical cannabis among Thai people in the Southern region, compare mean differences in health literacy levels according to personal factors and attitudes, and analyze the relationships between personal factors and attitudes with health literacy. The sample was selected using convenience and snowball sampling and included 1,100 Thai people aged over 20 years from the 14 provinces of the Southern region. Data were collected using an online questionnaire, which included general information, attitudes, and health literacy regarding the use of medical cannabis. Data were analyzed using frequency, percentage, mean, standard deviation, Mann-Whitney U test, Kruskal-Wallis H test, chi-square test and Pearson’s product moment correlation coefficient. The results indicated that health literacy regarding the use of medical cannabis was at a fair level (55.27%); and attitudes were at a moderate level (92.09%). Differences in personal factors and attitudes had a statistically significant effect on health literacy, including gender (p<0.05), religion, monthly income, educational attainment, occupation, province of residence, access to information about medical cannabis, experience, and attitudes (p<0.05), whereas age, marital status, and underlying diseases showed no statistically significant differences. The strongest factors associated with health literacy were access to information about medical cannabis, followed by monthly income, educational attainment, attitudes, gender, religion, experience, and occupation, all of which were statistically significant (p<0.05). Age, marital status, province of residence, and underlying diseases were not related to health literacy. This study recommends that relevant agencies provide training on medical cannabis knowledge for public health personnel, equipping personnel to serve as competent healthcare providers for people who require medical cannabis. Additionally, agencies should develop various media and disseminate information thoroughly. These will lead to appropriate health literacy regarding the use of medical cannabis.

Association between Diabetic Neuropathy, Atherosclerosis and Peripheral Artery Disease on the duration of Diabetes Mellitus

Wed, 24 Jun 2026 00:00:00 +0700

Diabetes is a disease characterized by high blood sugar and insulin resistance, resulting in vascular complication throughout the body, including diabetic peripheral neuropathy (DPN), which is a major cause of lower limb amputations. The aim of this research was to study the relationship between diabetic peripheral neuropathy (DPN), arterial stiffness and peripheral artery disease (PAD) on the duration of diabetes. The sample size was calculated by using software. The inclusion criteria were type 2 diabetes patients aged over 30 years and had blood glucose test results from Tha Nang Ngam Health Promotion Hospital, Tha Nang Ngam Subdistrict, Bang Rakam District, Phitsanulok Province. Methods were basic information interviews, DPN was assessed by using the Michigan neuropathy screening instrument (MNSI) and sensory testing by monofilament 10 g, the arterial stiffness was measured by cardio-ankle vascular index (CAVI) and PAD was evaluated by ankle brachial index (ABI). The data was analyzed by using SPSS software. The results showed that a total of 87 diabetics patients were divided into 49 patients with diabetes duration of 5 years or more and 38 patients with diabetes duration of less than 5 years. DPN as assessed by MNSI and PAD as assessed by ABI were related with the duration of diabetics (p<0.05). Therefore, high-risk diabetic patients should be evaluated for DPN, arterial stiffness and PAD to reduction the risk of foot ulcers and eventually amputation

Factors Relationship to Preventive Behavior of COVID-19 among First-Year Students in Suratthani Rajabhat University

Wed, 24 Jun 2026 00:00:00 +0700

This study employed a cross-sectional study design to examine preventive behaviors of Coronavirus Disease 2019 (COVID-19) and to determine factors related to preventive behaviors of COVID-19 among first-year student in Suratthani Rajabhat University. The samples consisted of 377 students by stratified random sampling. The research instrument was an online questionnaire with a reliability coefficient of 0.89 and data were collected between February and April 2022. The data were analyzed by descriptive statistics, mean, standard deviation Pearson’s product-moment correlation coefficient and ETA correlation. The results showed that: receiving information through social media platform, attitudes, preventive behavior of COVID-19 were at high level (3.87±0.87, 4.06±0.84 and 4.25±0.92, respectively) as well as had a high level of perceived susceptibility, perceived severity and perceived benefits of COVID-19 prevention (4.07±0.64, 4.09±0.70 and 4.06±0.70, respectively). Perceived barriers were at moderate level (3.34±1.10). However, receiving information through social media platform was positively correlated with high level of COVID-19 preventive behavior with statistical significance of 0.01 (r=0.999). The findings of this study could serve as a guideline for planning interventions to promote and modify preventive behaviors, particularly by encouraging access to credible information sources, enhancing perceptions of susceptibility and disease severity, and fostering positive attitudes.These efforts may improve the effectiveness of COVID-19 prevention and control.

Movement Behavior Analysis Among Working-Age Populations Across Generations in Bangkok Metropolitan Area: A 24-Hour Time-Use Study

Kanyapat Suttikasem, Nontawatch Sankla-or — Wed, 24 Jun 2026 00:00:00 +0700

This study aimed to analyze differences in 24-hour movement behaviors among working-age populations across different generations in Bangkok Metropolitan Area, examined through the International Classification of Activities for Time-Use Statistics (ICATUS 2016) framework. The analysis encompassed three primary movement behavior dimensions: sleep, sedentary behavior, and physical activity. The sample consisted of 218 working-age individuals who completed time-use diaries recording activities every 10 minutes for 4 consecutive working days. Data were analyzed using descriptive statistics, one-way ANOVA, and T-test for between-group comparisons. The results revealed that sedentary behavior consumed the highest proportion of daily time, averaging 11.10 hours per day (46.2%), followed by sleep at 8.08 hours (33.8%). Moderate-to-vigorous physical activity (MVPA) averaged 0.92 hours (3.8%), which when calculated based on the 4-day observation period exceeds the daily average derived from the World Health Organization recommendations (150 minutes/week). However, it should be noted that this average reflected data collected over 4 specific recorded days rather than a full calendar week. Statistically significant intergenerational differences in behavioral patterns were observed, with Generation X exhibiting the shortest sleep duration. These disparities underscore an imbalance in daily time allocation, suggesting that health policies and interventions should be generation-specific to effectively promote sustainable health behaviors among urban workers.

Developing Caregiver’s Roles on the Oral Care of Dependent Elderly in Bann-Makham-Laung, Sanpatong District, Chiang Mai

Thatsanee Saladyanant, Nikom Benjakan, Patinya Chaiphakdee — Wed, 24 Jun 2026 00:00:00 +0700

The objective of this study was to develop the secondary caregiver’s role on the oral care of dependent elderly individuals in long-term care system. The study design employed participatory action research, utilizing community participation strategies. Fourteen secondary caregivers living at Bahn-Makham Laung, Sanpatong District, Chiang Mai Province were recruited. The study contained four core stages: planning, acting, observing, and reflecting; starting with data collection and processing to clarify the oral care performance of the caregivers in the study area. The processed information was presented to the target group, and then all participants were asked to take part in the planning process. In the action stage, all caregivers joined a one-day training program where they were trained for oral health screening and oral hygiene care for dependent elderly. The caregivers were asked to screen and give oral care instructions to dependent individuals during their home visits. Three months after training, results were collected by using an interview, a knowledge and attitude level test using a questionnaire. At the end, the study results were discussed among the participants using a focus group discussion. Data were analyzed using descriptive and content analyses. The results showed a better construction of the caregiver’s role after an action process and 71.42 percent of caregivers earned a high score in the knowledge test (Mean=8.36, SD=1.41). 85.71, 100 and 78.85 percent of them had a high level of attitude on the importance of oral care, receiving of social support, and influence of oral health on dependent individuals’ well-being, respectively. The developed roles conformed with the community context; therefore, a participatory process is suitable for oral health care system development for the elderly under long-term care.

The Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Slowing the Progression of Diabetes Patients with Stage 3-5 Chronic Kidney Disease

Ponlasate Kiattiyosnusorn — Wed, 24 Jun 2026 00:00:00 +0700

In managing chronic kidney disease patients, it is recommended to consider using SGLT-2 inhibitors with the aim of reducing urinary protein levels and slowing kidney disease progression in diabetic patients with chronic kidney disease. SGLT-2 inhibitors are a new class of drugs that can reduce urinary albumin levels and slow kidney disease progression, but most studies have been conducted in foreign countries.This research had objective of investigating the effects of SGLT-2 inhibitors on estimated glomerular filtration rate (eGFR) and urinary protein-to-creatinine ratio (UPCR) in patients with type 2 diabetes mellitus with chronic kidney disease, with the aim to compare the effects of SGLT-2 inhibitors on estimated glomerular filtration rate (eGFR) and urinary protein-to-creatinine ratio (UPCR) in patients with type 2 diabetes mellitus and chronic kidney disease with eGFR between 20 and 59 mL/min/1.73 m2. Data including baseline demographics, laboratory findings, and prescriptions, were collected from electronic medical records of Somdejphrajaotaksinmaharaj Hospital from January 2022 to December 2024. Statistical analyses were performed using Chi-square or Independent t-tests. The results found the study involved 260 patients divided into two groups: one receiving SGLT-2 inhibitors and the other not, with 130 individuals in each group. The findings at the end of the study revealed that the average eGFR in the group receiving SGLT-2 inhibitors was significantly higher than that in the group not receiving the inhibitors (40.26±21.08 mL/min/1.73 m² vs. 35.74±14.18 mL/min/1.73 m², p<=0.05). Similarly, the average UPCR in the group receiving SGLT-2 inhibitors was significantly lower than that in the group not receiving SGLT-2 inhibitors (2.23±1.87 mg/mg vs. 2.98±2.56 mg/mg, p<0.05). In patients with type 2 diabetes and chronic kidney disease, continuous treatment with SGLT-2 inhibitors for at least two years was associated with a significant slowing of kidney disease progression and a reduction in urinary protein levels.

Desired Outcomes Under the Development of Regional Health Areas 1 - 12

Kasamsan Chaisil, Wilailuk Ruangrattanatrai — Wed, 24 Jun 2026 00:00:00 +0700

This mixed-methods survey research aimed to examine the desired outcomes of the development of Regional Health Areas 1 - 12, focusing on emergency and emerging disease management, chronic disease care, and elderly care; to compare desired outcomes before and after the implementation of Regional Health Areas; and to identify management factors influencing these desired outcomes. The study was conducted between June 2024 and March 2025 and consisted of two phases. The first phase employed qualitative research to identify variables for the quantitative phase. Data were collected through focus group discussions with heads of divisions and strategic and information personnel from Regional Health Areas 1 - 12, with four participants from each area, totaling 48 persons. Qualitative data were analyzed using content analysis. The second phase involved quantitative research to assess outcomes in accordance with the study objectives. The sample consisted of 256 executives from healthcare service units across Regional Health Areas 1 - 12, selected through multistage sampling. Data were analyzed using descriptive statistics and inferential statistics, including paired sample t-tests, chi-square tests, and multiple regression analysis, with a statistical significance level set at 0.05. Qualitative findings indicated that management factors influencing quality service delivery (independent variables) and the desired outcomes of Regional Health Area development (dependent variables) comprised components and indicators consistent with the literature review. Quantitative results revealed that post-development desired outcomes were at a high level (74.7%), and post-development outcomes were significantly higher than pre-development outcomes at the 0.01 level, with improvements observed across all dimensions. Furthermore, management factors related to health information systems and health technology demonstrated a significant positive influence on desired outcomes at the 0.01 level, explaining 54.4% of the variance. Therefore, it is necessary to develop operational guidelines based on the desired outcomes of the three areas of Regional Health Area development, in order to achieve sustainable healthcare services for the public and to focus on strengthening management, with priority given to the development of information systems and health technology.

Training Curriculum Development on Chemical Application Maintenance and Spray Equipment Standards Evaluation for Dengue Mosquito Control Personnel Based on Active Learning

Wed, 24 Jun 2026 00:00:00 +0700

The purposes of this research were to: (1) study a needs assessment for curriculum development, (2) develop a training curriculum on the training on chemical application maintenance and spray equipment standards evaluation for dengue mosquito control personnel, and (3) evaluate the effectiveness of the developed curriculum. A mixed-method research and development design was combined both qualitative and quantitative statistics. The research instruments included: (1) a focus group interview with 8 purposively selected participants to analyze and determine the curriculum content, (2) pre- and post-training knowledge tests on a 3-day training program involving 50 participants, which integrated lectures and practices, and (3) a satisfaction survey on the training curriculum. Data were analyzed by frequency, percentage, mean, standard deviation, and paired sample t-test. The research findings were as follows: (1) the personnel lacked skills in maintaining chemical spray equipment, had limited knowledge of insecticides, and needed practical training in both chemical preparation and equipment operation, (2) a five-unit curriculum was developed covering: (2.1) mosquito-borne diseases and general knowledge of Aedes mosquitoes, (2.2) prevention and control of mosquito-borne diseases, (2.3) operation of thermal fogging, (2.4) operation of Ultra Low Volume or ULV, and (2.5) basic standard evaluation of chemical spray equipment. (3) The post-training knowledge scores were significantly higher than pre-training scores at the 0.01 level. Participants reported very high overall satisfaction with the training (mean=4.62, SD=0.51). The curriculum was also certified by the Department of Disease Control as a standard product for disease surveillance, prevention, and control. In conclusion, the developed training curriculum effectively enhanced the knowledge and skills of dengue mosquito control personnel. Continuous monitoring and evaluation were recommended to ensure long-term effectiveness in practice.

Development of the Personal Health Record System in Thailand, 2025

Pongsadhorn Pokpermdee — Wed, 24 Jun 2026 00:00:00 +0700

This study aimed to investigate, analyze, and formulate policy recommendations for the sustainable development of Thailand’s Personal Health Record (PHR) system. The research is situated amidst the structural challenges of the public health system and the momentum generated by the “30-Baht Healthcare Everywhere” policy. The study was conducted in two primary phases: (1) a comparative analysis of Thailand’s PHR system against nine leading digital health nations through a literature review and thematic analysis, categorized into three dimensions: Service Systems and User Access; Infrastructure and Technology; and Data Governance and Legal Frameworks; and (2) policy research utilizing the Ethnographic Delphi Futures Research (EDFR) method involving 30 Thai experts. Data were analyzed using content analysis and statistical tools to reach a consensus on critical issues and prioritize development strategies. The comparative findings indicated that: (1) Regarding Service Systems and User Access, Thailand demonstrated strength in reaching a broad user base through national platforms but needs to transition toward a more patient-centric model; (2) in terms of Infrastructure and Technology, the Thai system possessed a robust foundation with a flexible architecture and international data standards, facilitating efficient data exchange and scalability for emerging technologies; and (3) Data Governance and Law was identified as an area requiring urgent improvement, specifically through the enactment of specialized digital health data exchange legislation and the establishment of an independent, multi-sectoral regulatory body to ensure transparency and data protection standards. The expert survey further revealed a significant consensus that “Data Governance and Law” was the most critical dimension for PHR development. All expert groups reached a clear consensus that the highest priority was the expedited enactment of the “Digital Health Act,” which was viewed as the essential pillar for unlocking the system’s potential and fostering trust across all dimensions. Additionally, the research highlights the necessity of concurrently addressing other key areas, such as enhancing User Experience and User Interface (UX/UI) for inclusivity, investing in a National Health Information Exchange (HIE), and shifting policy from “promotion” to the “strict enforcement” of data exchange standards (HL7 FHIR).

Community Nurses and the Use of Telemedicine Platforms to Enhance Community Health Services: a Systematic Review

Supastra Sensai — Wed, 24 Jun 2026 00:00:00 +0700

The role of community nurses is crucial to the delivery of effective community health services. The advancement of telemedicine platforms has opened new avenues for improving service provision. This systematic review aimed to examine and analyze the roles of community nurses in utilizing telemedicine platforms, as well as the outcomes, challenges, and contextual factors associated with their use. The findings of this study were intended to inform policy recommendations that support the effective and sustainable implementation of telemedicine in community health settings. A literature search was conducted for articles published between 2019 and 2024. Of 69 articles initially identified, 13 met the inclusion criteria based on relevance, methodological rigor, and strength of evidence. These 13 studies were then analyzed and synthesized. The review found that community nurses primarily used telemedicine platforms to improve the efficiency of chronic disease monitoring and expand access to health services, particularly in remote areas with limited resources. Community nurses played key roles in providing health counseling, monitoring, and care coordination to ensure continuity of care. The use of telemedicine by community nurses was shown to enhance the quality of health services, improve access, reduce hospital congestion,and minimize patient travel time and expenses. It also enabled more precise and patient-centered care planning and fostered greater engagement of patients and their families. These outcomes offer a valuable foundation for policy formulation, the development of community health systems, and the advancement of community nursing competencies. However, several limitations and challenges remain, including internet accessibility in rural areas, workforce readiness to adopt technology, government support, and infrastructure development. Addressing these factors is essential to optimizing the use of telemedicine platforms in community healthcare.

Economies of Scale and Economies of Scope of Renal Replacement Therapy in Thailand: a Scoping Review

Kridsada Chareonrungrueangchai, Natcha Yongphiphatwong, Yot Teerawattananon — Wed, 24 Jun 2026 00:00:00 +0700

In 2022, Thailand revised its kidney replacement therapy policy to permit any appropriate method, shifting from a prior emphasis on peritoneal dialysis as the primary option. This policy changes significantly improved patient access to Kidney Replacement Therapy (KRT). To optimize service delivery, the unit cost, economies of scale, and economies of scope for KRT services should be determined. However, a literature review found no existing studies on this topic. To fill this gap, a scoping review was conducted to examine the unit cost of KRT in Thailand. Searches of the Thai Journals Online, MEDLINE, and Thai Digital Collection (TDC) databases identified 10 relevant studies. The review, adjusting costs to 2023 values, revealed that the unit cost of Peritoneal Dialysis (PD) ranged from 1,261 to 1,324 baht, while the unit cost of Hemodialysis (HD) ranged from 1,237 to 6,130 baht. The analysis suggests that HD may benefit from economies of scale when serving 50 or more patients, though no conclusions could be drawn about economies of scope. Additionally, the review highlighted deficiency in quality of unit cost studies on KRT in Thailand, including a lack of sensitivity analysis, comparison among patient subgroups, and consideration of indirect costs or resource specification. As a result, current unit cost data are insufficient for policymaking. Future research should focus on unit cost studies of KRT, especially among private sector providers, to enhance service efficiency and health system design.

Editorial Board