Thailand Journal of Health Promotion and Environmental Health

Development of a teaching guideline for human research ethics for graduate students, Faculty of Public Health, Mahidol University

Sutham Nanthamongkolchai — 2026-09-02

In modern public health research, researchers need to understand both scientific methodologies and ethical standards in human research. This article aims to present a teaching guideline on human research ethics for public health graduate students. The development process began with defining learning objectives and content based on three core principles of human research ethics: respect for persons, beneficence and non-maleficence, and justice. It also includes instruction on relevant laws and regulations related to human research ethics, key research characteristics, and the process of obtaining informed consent prior to data collection. Additionally, the guideline covers teaching methods, as well as evaluation and approval criteria. This learning approach aims to enhance students’ understanding and ultimately facilitate the process of applying for ethical approval from an institutional Ethics Committee.

Effects of a Kidney Deterioration Retardation Program on Self-management and Clinical Outcomes in Patients with Stage 3 Chronic Kidney Disease, Mae Sariang Hospital, Mae Hong Son Province: An Explanatory Sequential Mixed-Methods Study

Bundit Duangdee — 2026-09-07

Chronic kidney disease (CKD) is a growing public health problem, and Mae Sariang District, Mae Hong Son Province has the highest CKD incidence in the province, with ethnic minorities comprising the majority of the population. This explanatory sequential mixed-methods study evaluated a 12-week Lewin's Change Management Model-based kidney deterioration retardation program on self-management behaviors and clinical outcomes, and developed program improvement guidelines for 37 purposively sampled stage 3 CKD patients. Self-management (30-item, 4-domain, Likert 4-level, max 90 points) was measured at weeks 0, 5, 9, 12; eGFR, UPCR, blood pressure and fasting blood glucose were compared pre-post. Qualitative data (n=8; in-depth interviews and focus groups) and Expert Review (n=2 specialists) were conducted. Total self-management scores improved significantly from 46.44 to 66.38 (p<0.001; dz=1.350, very large effect). eGFR showed a favorable trend (p=0.183); 21.6% advanced from G3a to G2. Five qualitative themes and 17 Expert Review-endorsed program improvements across 6 domains were identified. This program provides a scalable model for remote multicultural communities.

Effectiveness of Motivational Interviewing Program on Self-care Behaviors among Type 2 Diabetes Mellitus Patients at The Lifestyle Medicine Clinic Metropolitan Health and Wellness Institution.

Wipada Roopngam — 2026-09-02

This quasi-experimental research aimed to evaluate the effectiveness of a motivational interviewing program on self-care behaviors among patients with type 2 diabetes mellitus at the Lifestyle Medicine Clinic, Metropolitan Health and Wellness Institution. The sample consisted of type 2 diabetic patients attending the Lifestyle Medicine Clinic at the Metropolitan Health and wellness Institute, Department of Health, Bangkok, Thailand. The sample size was calculated using G*Power 3.1.9.7 (Effect size = 0.80, Power = 0.95), yielding 70 participants; an additional 10% was added to account for attrition, resulting in a total of 78 participants. They were randomly assigned into either the experimental group (n = 39) or the control group (n = 39) using simple random sampling via drawing. The study was conducted from June to December 2025. The experimental group received a 4-session motivational interviewing program (the first and final sessions lasted 30 minutes in person at the clinic, supplemented by 2 telephone follow-ups lasting 5–10 minutes each). The control group received routine care. Baseline characteristics were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Mean scores of self-care behaviors and glycated hemoglobin (HbA1c) levels were compared using Paired t-test and Independent t-test.

The results showed that after receiving the program, the experimental group had significantly higher mean scores of diabetes self-care behaviors than before the intervention and than the control group (p < .001), with a mean score of 113.73 (SD = 6.37). In addition, the glycated hemoglobin (HbA1c) level of the experimental group decreased from 7.97% to 6.48%, which was significantly different from the control group (p < .001). Based on these findings, the motivational interviewing program was highly effective in promoting health behaviors and controlling HbA1c levels. Therefore, this program should be integrated into routine health care services to enhance the self-care capacity of patients with type 2 diabetes mellitus continuously and sustainably.

Factors Associated with Quality of Life among Residents in the Lower Huai Luang River Basin Development Project Area

Panita Charoensuk — 2026-09-02

This cross-sectional survey study aimed to investigate the quality of life and factors associated with quality of life among residents living in the Lower Huai Luang River Basin Development Project area, Thailand. The study included 440 participants selected through multistage sampling. Data were collected between July and August 2025 using a structured questionnaire consisting of personal characteristics, health-promoting behaviors, access to health services, social support, and quality of life. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation coefficient, and multiple linear regression. The results showed that the overall quality of life of the participants was at a moderate level. Health-promoting behaviors, access to health services, and social support were also found to be at moderate levels. Correlation analysis revealed that age was negatively associated with quality of life (r = -0.113, p < 0.05), whereas household income (r = 0.156, p < 0.01) and health-promoting behaviors (r = 0.119, p < 0.05) were positively associated with quality of life. The multiple linear regression analysis showed that age, average family income, and health-promoting behaviors were significantly associated with quality of life, explaining 6.4% of its variance (R² = 0.064, p < .05). The findings suggest that promoting healthy behaviors, strengthening household economic stability, and supporting older adults are essential strategies for improving the quality of life of populations living in water resource development project areas.

Development of a Legionella spp. Surveillance and Control Model for Hotels in Thailand's Tourist Cities

Chamaiporn Pensuk — 2026-09-07

This study aimed to examine the situation of Legionella contamination and environmental health management practices, develop a surveillance and control model, and to formulate policy recommendations for Legionella prevention and control for hotels in tourist cities. The study samples consisted of Type 3 and Type 4 hotels. Quantitative data on outbreak occurrence and Legionella management were collected from 463 hotels using structured survey questionnaires. Qualitative data were obtained through water sampling for Legionella detection, questionnaires, and pre - post assessments of prevention and control measures. Focus group discussions and stakeholder consultations were conducted with representatives from 50 hotels and relevant sectors. Data were analyzed using descriptive and inferential statistics. Data collection was conducted between February and August 2025. The results showed that 263 hotels responded to the survey (56.8%), including 194 Type 3 hotels (73.8%) and 69 Type 4 hotels (26.2%). Among 176 hotels that conducted Legionella testing, 21 hotels (11.9%) reported positive Legionella findings, with tap water identified as the most frequently contaminated water source. Overall, 56.5% of hotels had established prevention plans, while 48.7%had implemented control measures; however, systematic monitoring and evaluation of these measures remained limited. Water sampling from 50 hotels detected Legionella in 14 hotels (28%) during the first survey and in 5 of the 14 positive hotels (35.7%) during follow-up sampling. Hot water from showerheads was the most commonly contaminated source. The temperature of contaminated hot water ranged from 37.0 to 50.0 °C, whereas free residual chlorine concentrations in contaminated cooling tower water and potable water systems ranged from non-detectable to 2.15 mg/L. Compliance with the Department of Health guidelines before the first and second rounds of water sampling was associated with effective reduction of Legionella contamination. Significant improvements were observed in the maintenance of cooling towers, potable water systems, and hot water systems following implementation of the intervention (p < 0.05). The proposed 3R2P Model provides a practical framework for strengthening Legionella surveillance and control in hotel settings. Policy recommendations include establishing a centralized surveillance and reporting system, promoting effective Legionella control technologies, developing national regulations and standardized guidelines, and strengthening intersectoral collaboration to support integrated policy implementation.

The Effectiveness of Health Promotion Programs for Enhancing Healthy Lifestyles Among Working Adults in Enterprises

Chonlaphan Piyathawornanan — 2026-09-23

This study aimed to evaluate the effectiveness of a workplace health promotion program on healthy lifestyles across four dimensions (physical, mental, social, and spiritual well-being). A one-group pretest–posttest design was conducted among 428 employees from 34 workplaces over a 6-week intervention. Following the program, participants demonstrated significant reductions in weight, body mass index (BMI), and waist circumference (p < 0.01). Significant improvements were also observed in dietary behaviors (reduced frequency of sweet, fatty, and salty food consumption) and alcohol-use patterns (p < 0.001). Furthermore, mental health, overall quality of life, family relationships, and satisfaction with the work environment improved significantly (p < 0.001). These findings suggest that an integrated workplace health promotion program has the potential to enhance health behaviors and well-being among the working-age population. However, given the study's lack of a control group and limited follow-up duration, these results should be interpreted as preliminary evidence.

Effectiveness of a Performance and Muscle Mass Enhancement Program to Prevent Oral Frailty among Older Adults in Senior Clubs, Samut Prakan Province

Natthapong Kunthawong — 2026-09-22

This quasi-experimental study aimed to evaluate the effectiveness of a physical performance and muscle mass enhancement program for preventing oral frailty among older adults in senior clubs in Samut Prakan Province. The participants were 230 adults aged 60 years and older who were members of senior clubs. They were selected using purposive sampling and divided into two groups, intervention and control group, representing all districts of the province. The intervention was implemented over a 12-week period. Data were collected before and after the intervention using questionnaires and comprehensive assessments covering three dimensions: nutritional status, muscle mass and physical performance, and oral health. Nutritional status was assessed using body mass index, waist circumference, and protein intake. Muscle mass and physical performance were evaluated using the SARC-F questionnaire, Timed Up and Go Test, handgrip strength test, and five-times sit-to-stand test. Oral health was assessed using the Oral Frailty Index-8, Eating Assessment Tool-10, and Oral Health Assessment Tool. Data were analyzed using descriptive statistics, paired-samples t-tests, and McNemar’s tests. The results showed statistically significant reductions in the risks of oral frailty and dysphagia after participation in the program (p value <0.05). Significant improvements were also observed in the condition of the tongue, gums, oral tissues, saliva, natural teeth, and oral pain. Muscle performance, nutritional status, body mass index, and protein intake behaviors showed favorable changes; however, these improvements were not statistically significant. These findings demonstrate the potential effectiveness of a physical performance and muscle mass enhancement program in preventing oral frailty among older adults. The program may be further implemented and expanded in senior clubs and schools for older adults.

Factors Associated with Periodontal Disease Among Working-Age Adults Aged 35–44 Years in Thailand

Suchada Suralert — 2026-09-23

Periodontal disease is a major oral health problem among working-age adults. Untreated periodontal disease can lead to tooth loss in older age and negatively affect quality of life. This study aimed to identify factors associated with periodontal diseases among working-age adults in Thailand using data from the 9^thNational Oral Health Survey 2023. The sample included 3,670 adults aged 35–44 years. Data were analyzed using multinomial logistic regression the statistical significance level was set at p < 0.05. The results showed that farmers had 2.00 times higher odds of gingivitis (OR_adj= 2.00, 95% CI: 1.45–2.70, p < 0.001) and 2.07 times higher odds of periodontitis than government and state enterprise employees (OR_adj= 2.07, 95% CI: 1.47–2.91, p < 0.001). Participants with no income, including students, housewife, unemployed individuals, Buddhist monks, and persons with disabilities, had 1.76 times higher odds of periodontitis compared with government and state enterprise employees (OR_adj= 1.76, 95% CI: 1.08–2.85, p = 0.023). In addition, inappropriate oral health behaviors, including not using dental floss, smoking, and not having visited a dental service within the previous year, were significantly associated with higher odds of periodontal disease. In summary, the findings indicate that workers from the informal sector, particularly farmers and general laborers/taxi drivers, as well as individuals with no income tended to have higher odds of gingivitis and periodontitis than government and state enterprise employees. These findings highlight the need to prioritize workers from the informal sector and individuals with no income who are facing barriers to accessing oral health promotion and disease prevention services. Therefore, policy measures should include clearly targeted oral health promotion and disease prevention interventions for workers from the informal sector and individuals with no income, together with proactive dental services. Service delivery mechanisms should also be convenient, accessible, and appropriate to the specific contexts and needs of workers from the informal sector and individuals with no income.

Impact of Demographic Change on Thailand’s Healthcare System

Bunyarit Sukrat — 2026-09-23

This study employed situational analysis combined with predictive research, aimed to project the future size and structure of the Thai population and assess the subsequent impacts on healthcare service demand and expenditure. Population projections up to the year B.E. 2630 under three scenarios were conducted using the Demographic Analysis and Population Projection System (DAPPS). Future outpatient visits and inpatient admissions were estimated using the constant age-specific rate method, whereas future healthcare expenditures were projected based on the National Transfer Accounts framework. The findings reveal that Thailand is currently experiencing a severe population contraction. Under the medium-variant scenario, the total population is projected to decline by more than half, from 65.0 million in the year B.E. 2567 to approximately 26.2 million by the year B.E. 2630. The proportions of the child population (0-14 years) and working-age populations (15-59 years) will contract rapidly to 5.7% and 41.5%, respectively, whereas the elderly population (60 years and older) will surge to constitute 52.8% of the nation’s total population. Consequently, healthcare service utilization and spending will predominantly shift toward the elderly, who are projected to account for 82.0% of outpatient visits, 77.5% of inpatient admissions, and 72.8% of health expenditures. In contrast, the demand for maternal, pediatric, and obstetric services will decrease drastically. These profound structural shifts highlight an urgent need for comprehensive healthcare policy reform, focusing on strategic health workforce planning and the reallocation of public health resources toward elderly care to mitigate these impending impacts.