Development of a community network empowerment model for seamless elderly care in the service area of Ban Kwang Khao sub-district health promoting hospital, Nikhom Phatthana sub-district, Khukhan district, Sisaket province

Abstract

This study employed a multi-phase participatory action research (PAR) design, with the evaluation phase adopting a one-group pretest-posttest quasi-experimental design. The objectives were to (1) examine the current situation, problems, and needs of community networks in providing older adult care; (2) develop a community network empowerment model for seamless older adult care; and (3) evaluate the effectiveness of the developed model. The study was conducted in the service area of Ban Kwang Khao Sub-district Health Promoting Hospital, Nikhom Phatthana Sub-district, Khukhan District, Sisaket Province, Thailand, between November 2025 and June 2026. Participants were recruited for each phase of the study as follows: In Phase 1 (situation analysis), 312 older adults were selected using Cochran's sample size formula, while 17 caregivers of dependent older adults and 40 village health volunteers (VHVs) were selected by purposive sampling, together with 10 key informants and two focus group discussion groups of 8–10 participants each. In Phase 2 (model development), a working committee of 32 representatives from all relevant sectors participated. In Phase 3 (effectiveness evaluation), the same analytical units as Phase 1 were used, comprising 40 VHVs, 17 caregivers, and 312 older adults. Research instruments included a current situation questionnaire, a knowledge test, a skills assessment, the WHOQOL-BREF-THAI quality-of-life scale, the Barthel Activities of Daily Living (ADL) Index, and a community network empowerment assessment. Content validity was verified by three experts, yielding an Index of Item-Objective Congruence (IOC) of 0.67–1.00. The developed model was assessed for appropriateness by five experts and rated at the highest level (mean = 4.67, S.D. = 0.37). Data were analyzed using descriptive statistics, paired samples t-test, and the Wilcoxon Signed-Rank Test.

The results revealed the following. (1) The majority of older adults (94.55%) were in the independent functioning group (ADL score 12-20). Problems across all community network groups were rated at a high level (mean = 3.58-3.90, S.D. = 0.54-0.74), with lack of knowledge and skills identified as the primary concern among both VHVs (mean = 4.20, S.D. = 0.64) and caregivers (mean = 4.24, S.D. = 0.66). Needs across all groups were also rated at a high level (mean = 4.00-4.32, S.D. = 0.48-0.72). (2) The "Ban Kwang Khao Seamless Care Model," comprising five components, was rated as highly appropriate by five experts (mean = 4.67, S.D. = 0.37). (3) Following two months of model implementation, VHV knowledge scores increased from mean = 10.15 (S.D. = 1.98) to mean = 16.71 (S.D. = 1.12) (t = 18.94, p < 0.001, Cohen's d = 3.00); participatory behavior scores increased from mean = 3.14 (S.D. = 0.71) to mean = 4.38 (S.D. = 0.51) (t = 8.94, p < 0.001, Cohen's d = 1.41); older adult quality of life scores increased from mean = 59.45 (S.D. = 11.24) to mean = 67.79 (S.D. = 9.87) (t = 8.76, p < 0.001, Cohen's d = 0.79); and community network strength improved from a high to the highest level (Z = -2.54, p = 0.011, Cohen's d = 1.36). These preliminary findings support the feasibility and initial effectiveness of the model. However, the absence of a control group and a follow-up period of only two months represent important limitations that preclude definitive causal inferences. Longitudinal research is warranted to confirm the sustainability of outcomes.