JOURNAL OF LOEI PROVINCIAL PUBLIC HEALTH OFFICE

Development of a Thai Folk Medicine–Based Fall Prevention Model for Older Adults in Loei Province: A Mixed-Methods Study

Nanthagan Khawda — 2026-09-30

Falls are a leading cause of injury among Thai older adults. Balance-focused exercise has high-certainty evidence for fall prevention, yet culturally congruent, low-cost community models remain scarce. Objectives To analyse fall-risk situations, to codify Thai folk healers' knowledge of balance care, and to evaluate the effects of a coconut-shell exercise programme on functional mobility and balance. Methods An exploratory sequential mixed-methods design in three phases. Phase 3 employed a one-group, three-repeated-measures quasi-experimental design. Thirty-five community-dwelling adults aged ≥ 60 years in Na Din Dam Sub-district, Loei Province were purposively recruited; 34 completed the study (retention 97.1%). Participants performed a five-posture coconut-shell exercise programme 30 minutes/session, 3 sessions/week, for 8 weeks. Outcomes (TUGT, BBS) were measured at weeks 0, 4 and 8 and analysed using one-way repeated measures ANOVA with Greenhouse-Geisser correction and Bonferroni post hoc tests.

Mean TUGT decreased from (14.82 ± 2.91) to (11.46 ± 2.35) seconds, F(1.64, 54.12) = 70.34, p < .001, partial n² = .68. Mean BBS increased from (41.26 ± 5.14) to (48.09 ± 4.02), F(1.71, 56.43) = 34.75, p < .001, partial n² = .51. Adherence was (91.2)%, with no serious adverse events.

The programme was associated with clinically meaningful improvement in mobility and balance. Causal inference is limited by the absence of a control group; a randomised controlled trial is warranted.

Development of a Participatory Multi-Sectoral Collaborative Network Model for Reducing Road Traffic Accidents Among Youth in Dan Sai District, Loei Province

ศักดิ์ดา ดีสม — 2026-09-30

Road traffic injury is the leading cause of death among children and young people aged 5–29 years worldwide. Dan Sai District, a mountainous tourist district of Loei Province, Thailand, has a road traffic accident rate of 187.4 per 100,000 population, higher than the provincial (156.2) and national (142.8) averages.

The objective to develop a participatory multi-sectoral collaborative network model for reducing road traffic accidents among youth and to evaluate its outcomes.

Participatory action research with an embedded mixed-methods design was conducted in two action cycles from September 2025 to June 2026. The quantitative sample comprised 160 students aged 15–18 years from three schools (random selection of classrooms and students); the qualitative sample comprised 63 informants (15 key informants and four focus groups with 48 participants). A validated questionnaire (IOC 0.67–1.00; Cronbach’s alpha 0.87) was administered before and after implementation. Data were analysed using paired t-tests, McNemar’s tests, incidence rate ratios (IRR) comparing accident counts with the same six months of the previous year, and content analysis.

Results are The Dan Sai Safety Network (DSN) Model comprised five components: a three-tier structure, defined sectoral roles, an integrated participatory process, 4Es measures, and a monitoring and evaluation system. Mean knowledge, attitude and behaviour scores increased significantly (12.40 to 16.80, 52.30 to 64.70, and 78.50 to 98.20; all p < 0.001). Regular helmet use rose from 55.6% to 91.3% and speeding fell from 52.5% to 18.1% (both p < 0.001). Compared with the same period of the previous year, accidents decreased from 47 to 18 (IRR = 0.38, 95% CI 0.22–0.66) and injuries from 63 to 24 (IRR = 0.38, 95% CI 0.24–0.61); the reduction in deaths (5 to 1) was not statistically significant (IRR = 0.20, 95% CI 0.02–1.71).

Implementation of the DSN Model was associated with improved safety behaviours and fewer youth road traffic accidents. Because the study had no comparison group and a six-month follow-up, effectiveness cannot be concluded causally; evaluation using a comparison series and longer follow-up is needed.

Virological, Immunological, and Renal Outcomes after Fixed-Dose Tenofovir Disoproxil Fumarate–Lamivudine–Dolutegravir (TLD) among People Living with HIV at Phu Kradueng Hospital, Loei Province, Thailand: A Retrospective Cohort Study

Wattanapong Najantad — 2026-09-30

The fixed-dose combination of tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) is the preferred first-line regimen in the Thai national guidelines, but real-world outcome data from Phu Kradueng Hospital were lacking.

To describe virological, immunological and renal outcomes among people living with HIV receiving TLD.

This retrospective single-arm before–after cohort study included adults who received TLD continuously for at least 3 months with adherence ≥95% at Phu Kradueng Hospital (1 October 2022–30 September 2025). Data were extracted from HOSxP and NAPPLUS. The primary outcome was the proportion with viral load (VL) <50 copies/mL before and after TLD (exact McNemar test). Secondary outcomes were changes in CD4 count and in serum creatinine (SCr) and eGFR (CKD-EPI 2021), analysed with the Wilcoxon signed-rank test, with 95% confidence intervals and sensitivity analyses.

175 patients analysed (157 switched from other regimens; 18 initiated ART with TLD), mean age was 43.5±11.9 years and 52.0% were male. Among switched patients with paired VL results (n=150), VL <50 copies/mL was 92.7% before and 94.0% after TLD (McNemar p=0.79); 95.7% (133/139) of those suppressed at baseline remained suppressed. At the latest test, 94.0% (158/168; 95% CI 89.4–96.7) of tested patients had VL <50 copies/mL. Post-treatment CD4 was available for only 84 of 175 patients, and re-testing depended on baseline CD4, so CD4 findings are exploratory (median 330 to 557 cells/mm³ among 83 paired patients). In the renal analysis (n=91 with a verifiable pre-treatment baseline), median SCr rose from 0.70 to 0.94 mg/dL and eGFR fell from 110.9 to 88.9 mL/min/1.73 m² (median change −18.8; p<0.001). An eGFR decline ≥25% occurred in 34.1% and new eGFR <60 in 2 patients (2.2%). No factor was associated with the magnitude of decline, and results were consistent across sensitivity analyses.

High viral suppression was maintained after TLD in a predominantly already-suppressed population; the CD4 increase cannot be attributed to TLD. The consistent rise in SCr and fall in eGFR is compatible with the known effect of dolutegravir on tubular creatinine secretion but cannot be separated from tenofovir toxicity with these data. Baseline renal values should be recorded and follow-up performed according to guidelines, with further evaluation for patients with large eGFR declines.

Development of Operational Capacity in Community Mental Health and Substance Abuse Care among Village Health Volunteers in Chiang Khan District, Loei Province.

Chainan Sonporm — 2026-09-30

Village health volunteers (VHVs) are frontline workers in community surveillance, screening and referral for mental health and substance use problems. A contextual review in Chiang Khan District identified gaps in confidence using screening tools, reporting channels, partner roles, and post-referral follow-up.

The objectives to (1) develop a community mental health and substance use service model for VHVs, (2) compare self-reported knowledge, attitudes and practices before and after implementation, and (3) assess VHVs' satisfaction.

An action research study with one PAOR cycle (5 February–5 August 2026) was combined with a one-group pretest–posttest quantitative evaluation. Participants were VHVs in Na Sao Subdistrict; 96 of 98 recruited completed all activities. The 3S-CARE Model comprised 18 hours of training and practice, supervision and reflection. Data were analysed with paired-samples t tests (95% confidence intervals and Cohen's dz) and content analysis.

The 3S-CARE Model had four components. Baseline scores were already in the "high" band on all three scales. Mean knowledge increased from 12.14 (SD 1.42) to 13.32 (SD 1.20; difference 1.18, 95% CI 0.94–1.44; dz = 0.97, 95% CI 0.72–1.21), attitude from 56.41 to 63.45 (difference 7.04; dz = 1.52), and self-reported practice from 10.94 to 12.98 (difference 2.04; dz = 1.41); all p < .001. The differences equalled 7.9%, 11.7% and 13.6% of the score ranges. Item-level satisfaction with the training and implementation ranged from 4.64 to 4.77 ("highest level").

VHVs reported consistently higher knowledge, attitudes and practices after the programme, although absolute gains, particularly for knowledge, were modest because baseline scores were high. With no comparison group, a repeated identical instrument, and no service-user outcomes, causal effects and system-level effectiveness cannot be concluded. Comparison-group designs and service-level indicators are needed before scale-up.

Development and Evaluation of an Online Emergency Triage Program at Phu Ruea Hospital, Loei Province

manthana jantafong — 2026-09-30

Paper-based emergency triage in community hospitals is prone to incomplete documentation and variable severity classification.

The objective to develop an online emergency triage program based on the Ministry of Public Health (MOPH) ED Triage five-level criteria and to evaluate its accuracy, data completeness, triage time and user satisfaction at a 30-bed community hospital in Loei Province, Thailand.

Methods: A four-phase research and development (R&D) study was conducted from 10 December 2025 to 25 July 2026 (ethics approval ECLOEI No. 031/2569, 9 December 2025). Evaluation used a separate-sample pre–post quasi-experimental design without a concurrent control group: 300 baseline paper-based encounters, 354 patients systematically sampled from 1,617 patients triaged with the program over three months, and 12 emergency nurses who rated satisfaction. Two blinded emergency physicians provided the reference standard. Proportions are reported with Wilson 95% confidence intervals (CI); completeness was compared item by item with Holm-adjusted tests, and triage time with Welch’s t-test.

The web application had six modules (expert-rated quality M = 4.49, SD = 0.42). Five-level agreement with the reference standard was 87.57% (310/354; 95% CI 83.73–90.61); all discordant cases differed by one level (under-triage 5.37%, over-triage 7.06%), and linearly weighted kappa was 0.88 (95% CI 0.85–0.92). For levels 1–2 versus 3–5, sensitivity was 95.0% (38/40; 95% CI 83.5–98.6), specificity 99.0% (311/314; 97.2–99.7), and under-triage among reference-standard emergent patients was 5.0% (1.4–16.5). Records with all seven items complete rose from 4.0% to 83.6%, and mean item completeness from 68.4% to 97.3% (p < 0.001 for every item). Mean triage time decreased from 6.64 to 4.37 minutes (difference 2.27 minutes, 95% CI 2.02–2.53; Cohen’s d = 1.42). Nurse satisfaction was high (M = 4.48).

Use of the program was associated with more complete records, shorter recorded triage time and high agreement with a physician reference standard. The under-triage estimate is imprecise, baseline accuracy was not measured, and time was measured differently before and after implementation; causal inference is therefore limited, and multi-site validation is needed.

Development of a Radiation Safety Management System for Healthcare Personnel and Patients at Wang Saphung Hospital, Loei Province, Thailand: A Research and Development Study

นางมยุเรศ ดงพระกิจ — 2026-09-30

Wang Saphung Hospital provides diagnostic radiology in the radiology department and in units using mobile X-ray equipment, involving staff from several professions, but no hospital-wide radiation safety management system linked these units.

Objectives to (1) assess the situation, problems and needs, (2) develop and appraise the appropriateness of a radiation safety management system (3) evaluate outcomes after implementation.

A three-phase research and development study (R1–D1, R2, D2) was conducted from August 2025 to July 2026.. Participants were all 36 staff involved in radiation use, 140 patients assessed before implementation and a separate group of 140 patients assessed after implementation, and three experts. Instruments were a situation and needs questionnaire, a knowledge test, an attitude questionnaire, a practice assessment form, a patient satisfaction questionnaire, an observation form for compliance indicators, and a system appropriateness form (IOC 0.67–1.00; KR-20 = 0.82; Cronbach's alpha 0.88–0.92). Data were analysed with descriptive statistics, Staff outcomes were analysed using paired-samples t-tests, whereas patient satisfaction was compared between the two independent patient groups using independent-samples t-tests, with 95% confidence intervals.

The developed system comprised three major components: clinical practice guidelines and an operational manual, a personnel training programme, and monitoring and evaluation tools. Experts rated the overall appropriateness of the system at the highest level (Mean = 4.64, SD = 0.37). Following implementation, staff knowledge increased from 12.86 ± 2.14 to 17.94 ± 1.56 (mean difference 5.08, 95% CI 4.25–5.91, p < .001), attitude scores increased from 3.42 ± 0.46 to 4.38 ± 0.39 (mean difference 0.96, 95% CI 0.77–1.15, p < .001), and practice scores increased from 3.31 ± 0.51 to 4.29 ± 0.42 (mean difference 0.98, 95% CI 0.78–1.18, p < .001). Overall patient satisfaction was higher in the post-implementation group than in the pre-implementation group (4.47 ± 0.35 vs 3.59 ± 0.46; mean difference 0.88, 95% CI 0.78–0.98, p < .001). Compliance percentages increased across all five monitored indicators.

Experts judged the developed system to be highly appropriate. Staff knowledge, attitudes, and self-reported practices, patient satisfaction, and compliance indicators were higher after implementation. Because the staff evaluation lacked a concurrent control group and several outcomes were self-reported, these findings should be interpreted as post-implementation changes rather than definitive evidence of causal effectiveness or improved radiation safety.

The Role of Utilization Review Nurses in Promoting Appropriate Use of Health Services within Thailand’s Public Health Insurance Schemes: A Narrative Literature Review and Evidence Gaps

Nitiya Intapot — 2026-09-30

Thailand's public health insurance schemes face pressure to use resources efficiently. Utilization Review (UR) nurses have been proposed as one mechanism to promote appropriate service use, but evidence on this role in the Thai context has not been synthesised.

The objectives to (1) synthesise the roles and processes of UR nurses, (2) identify factors related to the effectiveness of UR, and (3) appraise the evidence on UR/pre-claim review in Thailand's public health insurance schemes.

This narrative review, reported according to SANRA, searched PubMed, Scopus, Google Scholar, ScienceDirect, ThaiJO, and the websites of the National Health Security Office and the ABIM Foundation (June 2025–June 2026). Ten core documents were synthesised by content analysis using a five-domain coding framework; 46 supporting documents informed concepts and context.

Four themes emerged: (1) inappropriate and low-value care has multilevel drivers; (2) appropriateness assessment relies on clinical criteria and tools that need contextual adaptation; (3) documents describing the UR nurse role are largely descriptive, covering screening, record review, appropriateness assessment, multidisciplinary coordination and decision support; and (4) information technology and artificial intelligence are beginning to support UR in Thailand. No study evaluated the effect of UR nurses on low-value care or patient outcomes in Thailand, and no empirical evidence on pre-claim review was found among the selected documents.

The literature suggests that UR nurses' roles may extend from benefit and documentation checks to data-informed quality improvement, but this rests mainly on descriptive and conceptual sources. Evidence that UR nurses reduce low-value care or improve care value is lacking. Outcome evaluation, competency frameworks and safeguards against conflicts of interest are needed.