Journal of Primary Care and Family Medicine (PCFM)

Health Literacy and Access to Quality of Care

2026-08-31T13:05:24+07:00

“…อุตส่าห์หยุดกินยาเบาหวาน ความดันแล้ว แต่ก็ยังเป็นโรคไตอยู่ โชคร้ายจริง”

วาทกรรมสะท้อนความเข้าใจผิดข้างต้นเป็นสิ่งที่บุคลากรทางการแพทย์ได้ยินอยู่เสมอในคลินิกโรคไม่ติดต่อเรื้อรัง (Non-Communicable Diseases: NCDs)

ผู้ป่วยจำนวนมากมีความเชื่อฝังหัวว่า “ยาแผนปัจจุบันคือสารเคมีสะสมที่ทำลายไต” จึงเลือกที่จะหยุดยาหรือลดขนาดยาเอง โดยหารู้ไม่ว่าพยาธิสภาพของระดับน้ำตาลในเลือดและความดันโลหิตสูงที่ควบคุมไม่ได้ต่างหาก คือตัวการหลักที่ทำลายหลอดเลือดฝอยในไตจนนำไปสู่ภาวะไตวายเรื้อรังระยะสุดท้าย (End-Stage Renal Disease: ESRD) ^1,2

ปรากฏการณ์นี้ไม่ได้เป็นเพียงความล้มเหลวของการสื่อสาร แต่เป็นภาพสะท้อนชัดเจนของ "ภาวะขาดความรอบรู้ด้านสุขภาพ" (Health illiteracy) ซึ่งเป็นอุปสรรคสำคัญที่บั่นทอนการเข้าถึงคุณภาพการรักษาอย่างแท้จริง

A Comparative Study of Health Belief Model Factors and Diabetes Screening Behaviors among People Aged 35 and Over in Loei Municipality, Mueang District, Loei Province

2026-01-26T13:25:43+07:00

Background: To compare health belief model factors and diabetes screening behaviors.

Design: Cross-sectional Descriptive Study

Methods: The study population consisted of individuals aged 35 years and older residing in the Loei Municipality, Mueang District, Loei Province. A total of 420 participants were selected using simple random sampling. Data were collected using a structured questionnaire. Descriptive statistics were used to analyze baseline characteristics. Comparisons of factors were conducted using t-tests and analysis of variance (ANOVA), with multiple comparisons performed using Scheffé’s method at a 95% confidence level (p < 0.05). Statistical analyses were conducted using statistical software.

Results: The group that underwent screening had significantly higher mean Health Belief Model (HBM) scores in all dimensions compared to the group that did not undergo screening (p < 0.05). Among the screening group, differences in educational level and occupational characteristics were associated with differences in perceived susceptibility to diabetes. In contrast, in the non-screening group, differences in educational level and income were associated with differences in perceived benefits and perceived barriers to diabetes screening, showing statistically significant differences at the 0.05 level.

Conclusions: The HBM should be integrated into the development of diabetes screening systems to enhance efficiency and promote, prevent, and control diabetes within the relevant areas.

Keywords: comparison, Health Belief Model, diabetes screening

Assessment of Health Literacy Level and Associated Factors Among Urban Adult Population in Thailand: A Cross Sectional Study

2026-01-08T18:08:00+07:00

Background: Health literacy reflects individuals’ abilities to access, process, and understand essential health information for appropriate decision-making. Despite health literacy’s importance, especially emphasized by the World Health Organization, research in urban populations remains limited. This study therefore examines the health literacy level of urban adults and identifies factors influencing their health literacy.

Design: A cross-sectional study was conducted from December 2024 to April 2025 at the Family Medicine Outpatient Clinic and the Primary Care Unit of Vajira Hospital.

Methods: The study included 524 participants ranging in age from 35 to 75 years, living in the urban area. The Thai Health Literacy Scale was used as an assessment tool. Descriptive statistics and inferential statistics were conducted in the data analysis of this study to explore factors affecting the level of health literacy.

Results: Of the 524 participants, the majority were 35–59 years old (57.06%), with most being female (65.65%). The results from the health literacy assessment showed that 62.60% had inadequate health literacy. An inadequate level of health literacy was associated with older age, having never had a health check-up, and receiving services at pharmacies.

Conclusion: The results suggested that the majority of the participants had inadequate health literacy. Thus, promoting and educating people living in urban areas about health literacy should be implemented to improve and care for their health effectively and sustainably.

Keywords: health literacy, adult, urban area

Association Between Perceived Health Status and Life Satisfaction Among Urban Older Adults with Non-Communicable Diseases: A Cross-Sectional Study

2026-02-06T19:45:24+07:00

Background: Thailand has become an aging society, with most older adults living with non-communicable diseases in urban areas, which may affect life satisfaction. Perceived health status is a key subjective factor reflecting older adults’ capacity to adapt and live independently. This study examined the association between perceived health status and life satisfaction among urban older adults with non-communicable diseases, as well as related demographic, social, and health factors.

Design: Cross-sectional study

Methods: A total of 170 participants were recruited using convenience sampling from older adults aged 60 years and above with non-communicable diseases who had received continuous care for at least three months at the Family Medicine Clinic and the Urban Primary Care Clinic, Vajira Hospital, and provided informed consent. Data were collected using a demographic questionnaire and the Life Satisfaction Index A (LSI-A) to measure life satisfaction. Factors associated with life satisfaction were analyzed using univariate and multivariate logistic regression models.

Results: Most older adults reported high life satisfaction (53.53%). Perceived good health status was significantly associated with life satisfaction (p < 0.05). Other factors significantly associated with life satisfaction included older age, employment status (particularly retirement), use of healthcare coverage other than the Universal Coverage Scheme, living with relatives or others, and close family interactions.

Conclusions: Perceived health status was the key factor associated with life satisfaction among urban older adults with non-communicable diseases, highlighting the importance of promoting positive health perceptions alongside medical care.

Keywords: life satisfaction, non-communicable diseases, perceived health status

Effect of Medication Album and Medical Adherence in Patients with Chronic Disease in Primary Care

2026-03-04T13:59:19+07:00

Background: Patients with chronic diseases who fail to achieve target levels of disease control in the service areas of Ban Wat Cai and Bang Muang Primary Care Units, Nakhon Sawan, Thailand, often require medication adjustments to optimize disease management. However, incorrect medication use following these adjustments has frequently been observed, resulting in suboptimal disease control. To address this issue, a medication album was introduced to support medication adjustments among patients with chronic diseases. Nevertheless, evidence regarding the effectiveness of this intervention remains limited. This study aimed to compare the medication adherence of patients with chronic diseases who underwent medication adjustments in a group that used a medication album supported by verbal counseling and a group that received medication adjustments with verbal counseling alone.

Methods: This study was conducted as a Quasi-experimental study with a non-equivalent control group design. Patients with chronic diseases receiving services at Bang Muang Primary Care Unit underwent medication adjustments supported by a medication album and verbal counseling, whereas those at Ban Wat Cai Primary Care Unit received medication adjustments with verbal counseling alone. Medication adherence was evaluated by assessing patients’ ability to explain their medication regimens and through pill counts. Evaluations were performed by pharmacists who were blinded to the intervention groups. Comparative analyses between groups were conducted using multivariable log-risk regression.

Result: A total of 144 patients with chronic diseases were included. After excluding patients according to the exclusion criteria, 106 patients remained. Of these, 42 patients received medication adjustments supported by the medication album, whereas 64 received medication adjustments without the medication album. Multivariable log-risk regression analysis demonstrated that patients who received medication adjustments supported by the medication album were 1.31 times more likely to use their medications correctly than those who did not receive the medication album (95% CI, 1.08–1.59).

Conclusion: Integrating a medication album with verbal explanation during medication adjustment significantly enhances medication adherence among patients with chronic diseases and a history of inappropriate medication use in primary care. This study recommends using a medication album as standard care for patients with chronic disease in primary care.

Effectiveness of Intensive Behavior Intervention for Type 2 Diabetes Patients in NCD Remission Services Under Primary Care

2026-02-11T09:28:47+07:00

Background: Type 2 diabetes mellitus (T2DM) is a major global and national health problem with increasing prevalence. Intensive behavioral intervention has been proposed as a promising approach to improve glycemic control and reduce diabetes-related complications.

Objectives: To evaluate the effectiveness of intensive behavioral intervention in patients with T2DM

Design: Retrospective cohort study

Methods: Medical records of diabetic patients attending a Primary Care Clinic from October 2023 to October 2025 were reviewed. Participants were classified into an intensive behavioral intervention group and a standard care group. The primary outcome was the change in HbA1c levels before and after intervention.

Results: A total of 480 patients were included, comprising 96 patients in the intensive lifestyle modification group and 384 patients in the control group. The intensive group had fewer older adults (≥ 60 years) than the control group (51.0% vs. 59.1%, p = 0.024), with a predominance of females in both groups (69.8% vs. 68.0%). The intensive lifestyle modification group demonstrated a significantly greater reduction in HbA1c levels than the control group (−6.6%; 95%CI −10.8 to −2.5; p = 0.001).

Conclusions: Intensive behavioral intervention in primary care settings is effective in improving glycemic control among patients with T2DM and can be applied to enhance the quality of diabetes care in community- based primary healthcare systems.

Keywords: intensive behavioral intervention, type 2 diabetes mellitus, primary care unit, chronic disease management

Development of a Community Participation Model for the Care of Uncontrolled Diabetes Patients Using the NCDx Model: A Case Study in a Primary Care Network, Mueang Rayong District, Rayong Province

2026-03-06T10:19:17+07:00

Background: The prevalence of diabetes-related complications, such as cardiovascular and kidney diseases, is increasing in the studied primary care network in Mueang Rayong. This study aimed to evaluate outcomes of a community-based care model for patients with uncontrolled diabetes using the NCDx Model, supported by the Health Systems Research Institute (HSRI).

Design: A Participatory Action Research Approach

Methods: (1) Situation analysis, (2) Development of the NCDx-based care model focusing on patient analysis, education, awareness, diet, exercise, and community participation, and (3) Evaluation of patient health outcomes.

Results: No significant differences were found in weight or capillary blood glucose. However, HbA1c levels significantly decreased after program participation (p < 0.001).

Conclusion: The NCDx model effectively improved glycemic control among uncontrolled diabetes patients, aligning with findings from relevant literature.

Keywords: NCDx model, diabetes care model, primary care network

Association Between Incomplete Sputum Smear Monitoring and Treatment Success in Pulmonary Tuberculosis

2025-04-21T13:49:14+07:00

Background: The six-month treatment regimen for pulmonary tuberculosis (TB) includes sputum monitoring at months two, five, and six. However, due to patient limitations, healthcare resource constraints, and service disruptions during the COVID-19 pandemic, some patients were unable to complete all three follow-ups. This study aimed to investigate the association between incomplete sputum smear monitoring and treatment success among patients with pulmonary TB.

Design: Retrospective cohort study

Methods: The medical records were analyzed for new or relapsed cases of adult pulmonary TB patients treated at Khon Kaen Hospital between 2021 and 2023. Patients were categorized into two groups: the incomplete monitoring group (missing ≥ one smear at months two, five, or six), and the complete group (smears at all three points). The primary outcome was treatment success, defined as cure or treatment completion. Crude analysis was performed using Fisher’s exact test. Poisson regression with robust standard errors was used to estimate adjusted relative risk (aRR).

Results: Of 396 patients, 223 were in the incomplete group and 173 in the complete group. The treatment success rate was 100% in the incomplete group and 98.8% in the complete group. The crude relative risk was 1.012 (95% CI: 0.996-1.028). After adjustment for age, sex, comorbidities, smoking, and alcohol use, the association remained in the same direction, with an aRR of 1.015 (95% CI: 0.995-1.036).

Conclusions: Incomplete sputum smear monitoring was not associated with the treatment success rate among pulmonary TB patients.

Keywords: pulmonary tuberculosis, sputum smear monitoring, treatment success

Development of a Tuberculosis Screening Service Access Model for Household Contacts through Community Participation in Nakhon Pathom Province

2026-07-10T09:32:55+07:00

Background: Household contacts of tuberculosis patients are at high risk of developing tuberculosis. Early access to tuberculosis screening and treatment can help reduce disease transmission within the community. This study aimed to develop a community participation-based model to improve access to tuberculosis screening services for household contacts in Nakhon Pathom Province.

Design: Research and development

Methods: The study consisted of four phases: (1) examining the current situation, problems, and factors associated with access to tuberculosis screening services among 260 household contacts and 41 network partners; (2) developing the model with seven tuberculosis control stakeholders; (3) implementing the model and evaluating its effectiveness in experimental and control groups, each comprising 40 participants; and (4) expanding the model and evaluating tuberculosis screening coverage. Data were analyzed using descriptive statistics, chi-square tests, Pearson’s correlation coefficient, independent and paired t-tests, and content analysis.

Results: The findings revealed that: (1) factors associated with access to tuberculosis screening services included sex and occupation (p < 0.05), duration of co-residence, awareness, and community support (r = 0.136, 0.250, and 0.514, respectively; p < 0.05); (2) the developed community participation-based model was named the PATHOM Model; (3) after implementation, the experimental group demonstrated significantly higher mean scores for awareness, community support, and access to tuberculosis screening services than both their baseline scores and those of the control group (p < 0.05); and (4) following model implementation and expansion, tuberculosis screening coverage among household contacts increased from 45.31% to 71.23%.

Conclusions: The PATHOM Model effectively improved access to tuberculosis screening services and increased screening coverage among household contacts. Therefore, it should be implemented in other settings to strengthen community-based tuberculosis prevention and control efforts.

Keywords: model development, service access, tuberculosis screening, household contacts, community participation

Factors related to access to health services for the elderly in Kabang Subdistrict, Kabang District, Yala Province

2026-03-05T09:22:59+07:00

Background: This research is a descriptive cross-sectional study aiming to investigate factors related to access to healthcare services for the elderly.

Methods: The sample consisted of 226 individuals from eight villages, selected using simple random sampling and purposive sampling, with sample proportions determined by the rule of three. Data were collected using a questionnaire with validated reliability (IOC= 0.66-1.0, α= 0.896). Data were analyzed using descriptive and inferential statistics, with Pearson correlation coefficient and chi-square test. All statistical tests were conducted at a significance level of 0.05.

Results: The study found that the level of access to healthcare services for the elderly was high at 67.70%, followed by a moderate level at 30.53%, and a low level at 1.77%. Income had a low negative correlation with access to healthcare services for the elderly ( r = -0.242, p < 0.05). Chronic diseases correlated with access to healthcare services for the elderly (p < 0.05). Perceived benefits and social support had a moderate positive correlation with access to healthcare services for the elderly in the Kabang Subdistrict, Kabang District, Yala Province (r = 0.517 and r = 0.416, p < 0.05, respectively).

Conclusion: It is recommended to promote income generation for the elderly and increase their awareness of healthcare benefits and access to healthcare services, as well as increase social support to further enhance their access to healthcare services.

Keywords: access to healthcare services, perceived benefits, social support, elderly

Comparison of Accessibility to Health Services of the Elderly Between Primary Care Cluster and Previous Primary Care Unit, Phranakhon Si Ayutthaya District

2026-04-08T15:04:41+07:00

Background: Access to health care services is a crucial determinant of quality of life among older adults. This study aimed to compare levels of access to health care services among older adults between family physician clinics and conventional primary care units, and to analyze factors associated with access to health care services.

Design: Cross-sectional Survey Research

Methods: A total of 320 older adults who received services at family physician clinics and conventional primary care units between January and May 2024 were enrolled. Data were collected using a questionnaire assessing access to health care services across five dimensions. Descriptive statistics and multiple logistic regression analysis were applied.

Results: The highest levels of satisfaction were observed in the dimensions of availability/accessibility of health care resources and acceptability of services, while convenience in accessing services received the lowest scores. Older adults who utilized family physician clinics were significantly more likely to report a high level of satisfaction with access to health care services compared with those attending conventional primary care units (adjusted OR = 1.81, 95% CI: 1.05–3.12).

Conclusion: Family physician clinics enhance access to health care services among older adults, particularly in terms of service acceptability and continuity of care. However, improvements in convenience and service hours are still warranted.

Keywords: access to health care services, family physician clinic, older adults

Prevalence and Risk Factors Associated with Underreported Urinary Incontinence Among Female Patients with Type 2 Diabetes Mellitus

2025-11-17T09:34:40+07:00

Background: Urinary incontinence is a common complication in female patients with type 2 diabetes, which negatively impacts quality of life. However, this condition is often underreported. Particularly in Thailand’s healthcare, due to the number of non-communicable disease patients and time constraints, symptom reporting may not be comprehensive. This study aimed to assess the prevalence of underreporting symptoms and identify associated factors.

Design: Cross-sectional descriptive study

Methods: The study involved 179 female patients with type 2 diabetes experiencing urinary incontinence between January and July 2025. Data were collected using questionnaires covering demographic factors, barriers to reporting, and health-related factors. Symptom severity and impact were assessed using the Thai versions of the UDI-6 and IIQ-7 questionnaires. Results were reported as Crude OR and Adjusted OR, with statistical significance of p < 0.05.

Results: The prevalence of underreporting symptoms was 76%. Factors that increased the likelihood of not reporting symptoms included polypharmacy (OR 17.19; 95% CI 2.74-108.01) and low income (OR 12.29; 95% CI 1.19-126.97). Protective factors that reduced the likelihood of underreporting symptoms were treatment with alternative medicine (OR 0.13; 95% CI 0.02-0.76), severity of symptoms (OR 0.95; 95% CI 0.90-0.99), and impact on quality of life (OR 0.77; 95% CI 0.77-0.91).

Conclusion: The prevalence of underreporting urinary incontinence symptoms among female patients with type 2 diabetes was 76%. Significant associated factors were polypharmacy, low income, alternative medicine, symptom severity, and impact on quality of life.

Keywords: urinary incontinence, type 2 diabetes mellitus, underreporting, quality of life

Factors Associated with Activities of Daily Living of Stroke Patients for Intermediate Care of Home Health Care Program in Sub-District Health Promoting Hospital of Mueang District, Suratthani, Questionnaire-Interview Study

2025-08-19T13:36:16+07:00

Background: Post-stroke intermediate care is crucial because most patients continue to experience physical impairments that affect their daily activities and require continuous rehabilitation during the first six months after the acute event. If not properly managed, this can lead to long-term disability or permanent dependence, resulting in financial and social burdens for both the patient and their family. Successful rehabilitation depends on multiple factors. Therefore, this study focuses on identifying factors associated with the ability of stroke patients to perform daily activities, in order to determine factors that should be promoted and factors that should be prevented to avoid deterioration. The goal is to develop an effective and sustainable rehabilitation model for post-stroke intermediate care. This study aimed to evaluate the factors associated with activities of daily living of stroke patients for intermediate care of home health care program.

Method: The descriptive study consisted of 62 stroke patients in the Sub-District Health Promoting Hospital of Mueang District, Suratthani, who were discharged from an intermediate care service and followed up for six months. Barthel Index Thai version and return to daily living activities were used for patients who received rehabilitation. Analytical statistics used in this study were Chi-Square and multivariate logistic regression.

Result: The result showed that 62 cases of stroke patients; 53.23% of patients were female. The majority, 72.58%, had ischemic stroke. The factors associated with the improvement activities of daily living of stroke patient for intermediate care were moderate to mild Barthel index before rehabilitation (BI = 11-19) (aOR = 9.662, 95%CI 1.913- 48.780, p = 0.006) non malnutrition (aOR = 6.382, 95%CI 1.168- 34.867, p = 0.032) and a high level of family relationships (aOR = 6.344, 95%CI 1.286- 31.295, p = 0.023)

Conclusion: Healthcare providers should be aware of and emphasize the Barthel index, malnutrition, and family relationships for consideration of rehabilitation.

Keywords: stroke, subacute phase, intermediate care service, intermediate care of home health care program, Barthel index