The increasing number of COVID-19 patients during the pandemic posed a great challenge for health care services. Nurses play a vital role in in providing care to these patients and managing other health care services, which created a significant challenge in regard to work force management and competency varied with a hospital’s resources. This qualitative research aimed to discover the lessons we can learn from the COVID-19 crisis experience which can lead to policy suggestions regarding workforce management and nurse competency at the secondary and tertiary care levels in the 10th Public Health Region of Thailand. Document analysis, in-depth interviews, and focus group discussions were used to collect data from October 2021 to April 2022. The 293 key informants included the Ministry of Public Health (MoPH) inspector for the 10th Public Health Region, representatives of the Thailand Nursing and Midwifery Council and the Nursing Division of the Ministry of Public Health, the Provincial Chief Medical Officer, a group from the Emergency Operations Center (EOC) Committee, hospital directors, heads of nursing departments, physicians, infection control (IC) nurses, and nurses engaged in COVID-19 patient care. The data were analyzed using content analysis. The study revealed two major findings as follow: First, workforce management in responses to the Covid-19 crisis in both the secondary and tertiary care setting included several similar strategies, namely: 1) implementation of pooled staffing using personnel from different units including nurses who volunteered when asked or were given direct ordereds, 2) using mixed-skill nursing staffing, and 3) assigning the head nurses of the units with lower workloads as supervisors in the COVID-19 cohort wards. However, some different strategies were implemented at the secondary care setting, including modifying working hours from 8-hour shifts to 12-hour shifts Last, having different nursing competency development models for COVID-19 care, which varied from setting to setting. The majority of competency development was on-the-job training, followed by pair-mentoring and self-directed learning strategies where staff searched the internet for available COVID-19 related resources to improve their knowledge about how to provide care for their patients. The IC nurses played a major role in increasing the hospital staff’s infection control competency, as well as updating and distributing the COVID-19 practice guidelines. Moreover, in the tertiary care settings, nurse competency development was focused on the essential skills required to care for critically ill and complicated patients and the technical skills related to using advanced technology medical equipment, negative pressure rooms, and other equipment related to COVID-19 patient care. The most common education and training conducted in the hospitals were related to the donning (putting on) and doffing (removing) of personal protection equipment (PPE) or powered air purifying respirators (PAPR), intubation of COVID-19 patients, Auto CPR, prone positioning of COVID-19 patients experiencing Adult Respiratory Distress Syndrome (ARDS), and mechanical ventilator care. The key to the success of the response to the crisis was the collaboration from all of the partners and stakeholders. The policy suggestions focus on designing and planning a comprehensive nursing workforce management and competency policy to handle crisis situations, developing the nursing workforce system and mechanisms in order to retain nurses in the system, implementing education and training programs to promote the continuous maintenance and improvement of nurses’ competencies, and creating a working environment which allows nurses to maintain their roles in providing direct patient care.


In response to the COVID-19 pandemic crisis over the past two years, the Ministry of Public Health had implemented several measures and policies to lower the risk of contracting the coronavirus and enhance the safety of health services for both patients and health care workers. The alleviation of hospital’s overcrowding situations was one of the most significant policies being the impetus for the mailed-order medication system (MOMS), the system offering a continued access to medication services for patients at homes. This study aimed to examine the situations, strengths, weaknesses, opportunities, threats, and the quality of the MOMS among patients with diabetes mellitus before and during the COVID-19 pandemic, and to establish policy recommendations for the future MOMS. This research had employed the Mixed Method Approach and adapted the World Health Organization's Six Building Blocks as the research framework to evaluate the MOMS in diabetic patients before and during the COVID-19 pandemic situation in the six public hospitals throughout Thailand. Data were collected between January and December 2021, using semi-structured interviews with senior officials from the Ministry of Public Health, professional councils, hospitals’ staff, and mailing operators. Interviews and self-administered questionnaires about satisfaction towards the MOMS were applied to diabetic patients who received the mail-order medication service. Content validity was determined by 5 experts. The range of Index of Item-Objective Congruence was 0.60-1.00. The items that had scores lower than 0.5 were revised. Cronbach alpha of satisfaction questionnaire was 0.91. Qualitative data were analyzed using the Content Analysis Method and quantitative data were examined through frequency and percentage distribution. The study found that prior to the outbreak of the COVID-19 pandemic, four out of six hospitals had already distributed medications to minimize hospital overcrowding situations using the MOMS. Nonetheless, because of the COVID-19 pandemic, all six hospitals supplied all diabetic patients regardless their health insurance entitlements with the MOMS as their major mean to serve patients both within and beyond the hospital's catchment areas. Each hospital's MOMS was the integration of the multidisciplinary efforts involving the use of patient records and technologies to assist both patients and medical staff, such as scheduling a check-up or drug pickup date through an application or using the telepharmacy and the telemedicine systems to examine and explain drug use to patients, or to inquire about a variety of health issues interactively. On average, patients with stable diabetic symptoms were prescribed medication every two to three months and were asked to revisit their physicians once or twice a year. The mailed-order medication service fee was between 50 and 100 baht and the delivery took one to two days on average, and two to three days for remote areas. The MOMS was able to help the hospitals to reduce the number of outpatient department capacity by 20 to 30 percent, lowered the burden of pharmacists and related staff during rush hours, decreased patient waiting time for medications by 10 to 20 percent, and was able to save travel expenses for patients. For all six hospitals, the MOMS had just a small number of errors such as unsuccessful or misplaced deliveries. When patients received their parcels, mailed-order medication physically arrived in decent conditions, since the foil packaging was unbroken, and the quantities matched with their original prescriptions at hospitals. Overall, more than 95 percent of diabetic patients were satisfied with the MOMS. Policy recommendation is that although the MOMS helps improve patient’s access to and coverage of health services, particularly in times of crisis, there are additional restrictions on medications that are not pills. This may necessitate temperature control and special transport and delivery procedures. In addition, patients should not be responsible for the incurred cost of mailed-order medication; rather, the government should cover such charges by allowing each health insurance fund to be responsible for disbursing the cost of medication delivering fee according to the health insurance entitlements of patients. Also, the professional councils, the Ministry of Public Health, the National Health Security Office, and mailing operators must explicitly define the practical standard for the MOMS. Additionally, pre-existing healthcare networks in communities, such as community hospitals, sub-district health promoting hospitals, drugstores, and village health volunteer networks should be employed as alternatives to assist in the delivery of medicines according to community needs.


The coronavirus 2019 epidemic has forced health workers to work harder and risk more health hazards. including having to experience stress and pressure from working in various fields which affects health condition and quality of work life. The health service system, the nursing professional is the main manpower and an important factor in providing health services to the people. While the shortage of registered nurses is an ongoing problem. this study. The objective of this research aimed to study the factors of persistence in the nursing profession. and develop policy proposals to promote professional persistence of registered nurses in Thailand. Collected data both qualitative research using in-depth interviews Semi-structured interview and group chat with executives at the policy level operational level hospital administrators 70 head nurses and professional nurses working in primary, secondary and tertiary health care units, collecting data in the central region, Bangkok, Nonthaburi, the eastern region, Chachoengsao, Chanthaburi, the north, Chiang Rai, Phitsanulok, the northeastern region, Khon Kaen, and the region. South, Songkhla, Krabi. The research was conducted for 6 months from September 2021 to May 2022. The reliability of the data was tested with a triangular test. Analyze data with content analysis As the results, from the literature review and research, it was found that the factors affecting nurses' persistence in their jobs and professions during the COVID-19 epidemic were experiences of quarantine. Bed management authority for COVID-19 having adequate protective equipment receiving infectious disease prevention training self awareness Low perceived risk of COVID-19, social support corporate commitment job satisfaction Low stress levels and burnout ability to adapt Recognizing professional benefits Growing up from the wounds of the heart lack of depression worry-free and the frequency and duration of appropriate patient care. From the data collection, it was found that the work of nurses in the situation of COVID-19 can be divided into 3 areas, namely, in the community, which performs an outbreak investigation, creating health knowledge for people in the community. Liaison with internal departments and outside the community Active case finding (ATF) work in the vaccination unit (vaccination Observing symptoms after vaccination First aid to patients with post-vaccination emergencies referral Advice on action after vaccination preparation of materials In some areas, nurses will act as administrators in the overall picture of vaccination. and mostly perform duties In field hospitals, these include tasks related to nursing care, such as nursing records, medication dispensing, health counseling. food and nutrition care; liaising with various departments; receiving and referring patients. Other immediate and in-service solutions include patient registration. epidemic investigation working in the vaccination unit. The study, it was found that the factors affecting the persistence of nurses in the situation of COVID-19 were financial burden. Extra money from working in the covid situation professional ties professional pride and self-esteem organizational ties colleague and teamwork participation of the team in the work and efficient management systems such as on-time compensation appropriate workload Support and empowerment from executives Executives have clear policies in management. The COVID situation is a learning opportunity. Create a network of work across professions. Integrated work between professions and see the benefits of being a public health worker, such as accessing information about disease obtaining certain rights, such as being in a pre-vaccinated group As for the factors that may cause nurses to decide to quit their jobs during the covid situation, is the employment situation such as being a civil servant. Employment and compensation for work inconsistent with the current situation Policy proposal. From studying the persistence in the profession of nurses, for example, the Ministry of Public Health should have a manpower management system. both in normal situations by adjusting the management of the professional nurse workforce structure to be in line with the context of areas such as urban areas, semi-urban areas, rural areas; or in emergency situations There should be preparation of nurses. Both in terms of professional and academic competence, practical skills, and should have a professional nursing workforce management plan in emergency situations. The period of the epidemic should plan and coordinate manpower management and acting (Skill-mixed) and there should be a rotation of manpower (Rotation) and the post-epidemic phase. Should enhance work power and create happiness at work. The creation of motivation in working Ministry of Health Career advancement and compensation should be reviewed in accordance with the work system. and current situation and should be encouraged and reviewed about entering higher positions of nurses should be adjusted to have more specialized types of expertise in other areas; Ministry of Health and Nursing Council Continuing education systems of nursing professions should be supplemented, for example nurses specializing in emergency crises. and the Ministry of Health There should be a hiring system and the management of professional nursing personnel in emergency situations, such as the retirement nurse employment system. and a co-payment management system between health service units under the Ministry of Public Health. with local government organizations and should consider the number of infection prevention nurses in the hospital.


Periodontal infections are common problem in general populations, particularly in patients with inborn errors of immunity (IEI). The disease is chronic and deliberating, resulting in reduced quality of life. Due to limited understanding of oral characteristics of the IEI patients, the aims of this project were to investigate genetic variants, phenotypes, plaque microbiome, and salivary proteome of IEI and periodontitis patients using exome/genome sequencing, metagenomic sequencing, mass spectrometry, and bioinformatics. Seventy participants: 15 IEI, 15 periodontitis, and 45 healthy were recruited. Seventy-five plaque DNA, 75 salivary samples, 75 metagenome data, and 75 proteomics data were obtained. This project showed that the IEI patients had poor oral hygiene and gingival inflammation. Genetic variants in BTK, CD40LG, FERMT3, STAT3, ELANE, TTC37, and NCF1, and chromosome 22q11.2 deletion were identified. The diseases diagnosed such as X-linked agammaglobulinemia, hyper-IgM syndrome, leukocyte adhesion deficiency, and congenital neutropenia. Metagenomics revealed that IEI patients had alterations in oral microbe composition, alpha-diversity, and beta-diversity. Bacterial species that were significantly increased in IEI: T. denticola, S. gordonii, S. oralis, Actinomyces, and V. parvula were pathogenic species also observed in periodontitis patients. Moreover, salivary proteins, particularly those related to bacterial defense, host immunity, and glycolysis, were significantly changed in IEI and periodontitis patients. In summary, this project demonstrates IEI-causing variants, microbiome dysbiosis, and disturbed salivary proteome in IEI and periodontitis patients. The study expands understanding of genotype and phenotype of IEI, leading to identification of biomarkers of periodontal diseases and impaired immunity. We provide genetic counselling and personalized oral care to the patients and families, publish international papers, groom researchers and students, build network, and distribute knowledge in international conferences and organizations. The project produces outputs/outcomes in academics, research, community, and health care that will lead to utilization of research in policy-making in the future.


A cross-sectional study aimed to assess the impacts from the COVID-19 pandemic and adaptability to prevent and control the disease among the three groups (students, general population, and the elderly) of the hill tribe people lived in border areas in Chiang Rai province, Thailand. Validated questionnaires were used to gather information from participants. Data were collected between April 2021 and December 2021. A total of 2,208 participants were recruited into the study. Among students, their had got moderate level of the impact. Several barriers access education during the pandemic were detected such as inaccessible to internet and no educational technologies and materials available. The ability of their adaptations to follow COVID-19 prevention and control measures was found in moderate level. In general population, majority were impacted in moderate level. Several impacts were detected such as leaving job without compensation, salary reducing, not met the qualification from the national policy of compensation from the COVID-19 pandemic due to no Thai identification. Moreover, a large proportion had increased their family debt during the pandemic. The ability of their adaptations to follow COVID-19 prevention and control measures was found in moderate level. The elderly, a large proportion were working in agricultural section, and had got the impact in moderate level in particular their job and income. The main problem was unable to sell their agricultural products. The ability of their adaptations to follow COVID-19 prevention and control measures was found in good level. National educational policy should be focused on educational materials and technologies supported to children and schools. Creating and seeking markets and supply chains for general population and the elderly should be urgently executing. Moreover, the policy related to support prolong living environmental under the COVID-19 pandemic is crucial particularly those who are living in poor education and economic status.


A cross-sectional study was conducted to assess the capacities of COVID-19 prevention and control among healthcare workers and health system under the Ministry of Public Health and Ministry of Interior located in the border areas in Chiang Rai Province: Mae Fah Luang, Mae Sai, Chiang Saen, Mae Chan, Mae Suai, Wiang Pa Pao, Muang, and Chiang Khong Districts. Data were collected by validated questionnaires between April and December 2021. A total of 906 people were recruited into the study. In the aspect of management: healthcare workers working under health institutes belonging to the Ministry of Public Health, local government and health volunteers did not clearly understand the process of work. In the aspect of manpower: healthcare workers under the Ministry of Public Health reported having worked longer hours compared to the period of pre-COVID-19 epidemic, and healthcare workers shortage. In the aspect of communication: line application was favored among government officers. Mobile phones were commonly used among people in a community. In the aspect of materials for the implementation: N-95, PPE and face shield were not sufficient for working among healthcare workers, while the community members reported that masks and alcohol were not enough for them. In the aspect of budgetary: almost all government officers reported that they had a big challenge in the requesting process. Some of the officers did not get the compensation and used their personal money for buying equipment. In the governance aspect: the overload assigned from their director was the major concern. In the aspect of the health system: communities had established several commitments and agreements among them to prevent and control the disease. Moreover, most people followed the agreements. People in a community have good practices to prevent and control COVID-19. Personal and health system capacity related to COVID-19 prevention and control developments are crucial especially to people who are living in border areas. The main focus on improving the capacities are deploying processes of work in crisis situations to make them confident and accurately follow the instructions; the government sector is required to support budget sufficient and medical related materials to healthcare workers. Distribution of essential information to people should be prepared in appropriate languages. Communication channel is also one of the critical points to improve the prevention and control measures in a community. Encouraging people in a community in creating their commitments and implementing them are also very important concerns for improving the effectiveness of disease control and prevention.


A cross-sectional study was applied to assess the effectiveness of COVID-19 prevention and control measures in different kinds of schools (public schools, private schools, day care center, foreign language teaching schools, and religion teaching schools) located in border areas of Mae Fah Luang, Mae Chan, Mae Suai, Mae Sai, Muang, Wiang Pa Pao, and Chiang Saen Districts, Chiang rai Province. The study population were school directors, teachers, caregivers, students, and their parents. Validated questionnaires were used to collect data. Descriptive and inferential statistics were used to test the associations at the α = 0.05. A total of 2,240 participants were recruited into the study. Among 168 school directors, 50.50% were female, and working at the schools that belonged to the Office of the Basic Education Commission. Majority of teachers and caregivers were female (84.13%). While 66.18% of parents were female, and 21.75% were Akha. While 57.55% of students were female. 64.57% of primary schools and 64.29% of high schools were detected in the level of “pass but required improvement” according to the standard protocol of COVID-19 prevention and control measures which was able to operate their schools. While 78.29% of day care centers were detected in the level of “non-pass the safety level and could not operate their schools”. A large proportion of parents (97.43%), 93.81% of all primary schools, 92.86% of high schools followed the national COVID-19 prevention and control procedures to an excellent level. The size of day care centers and school, and types of administration departments were associated with the effectiveness of COVID-19 prevention and control of organization level significantly. Parents’ knowledge and practices related to disease control were associated with the effectiveness of COVID-19 prevention and control of organization level significantly. In implementation for COVID-19 prevention and control, it needs to focus on the size and their administration departments of schools including knowledge and practice in COVID-19 prevention and control of parents.


A community participatory action research aimed to assess knowledge, attitudes, and practices to prevent COVID-19 among the hill tribe population living in border areas including the impacts of the COVID-19. The ultimate goal was to to develop a model for preparedness and response COVID-19epidemic in the area. A validity questionnaire and special training programs developed were used as the tools. A total of 2,518 people were recruited. A moderate level of knowledge and attitude were detected. While a good level of practice to prevent the disease was found. Students were impacted from the pandemic of the COVID-19 in several dimensions such as having to stop studying and having trouble with online learning. The employees were terminated, and their salaries. Many people had debt during the pandemic. Farmers could not sell their products. A large proportion did not get the compensation from the government due to lack of Thailand national identification card (ID card). After the training, it was found that knowledge and attitude towards COVID-19 prevention and control of the participants improved significantly. The villagers were transformed from knowledge and prevention skills from people who attended the training program. There were many approaches to transferring knowledge and skills to the villagers: village broadcast, small group discussion, and small group training. All people in the villages had a better knowledge and skills in COVID-19 prevention and control with evidence of regular hands washing, wearing a mask and social distancing. Disease prevention and control implementation should be collaborated among community leaders, village health volunteers and villagers to maximize the effectiveness and efficacy especially under the situation of travelling restriction.


The outbreak of COVID-19 had caused businesses to shut down. As a result, unemployment incidences soared. Being unemployed not only affected ones’ incomes, Physical and psychological well-being were also adversely affected as well. These undesirable effects were more predominant among new graduates, unskilled workers, part-time workers and elderly workers. In Thailand, some of those affected were fortunate to be able to return to their original provincial residences. There were also those who decided to stay due to lack of jobs in the communities or nearby areas to support them if they were to return home. These lack of employment opportunity issues were known to the government both at the national and provincial levels. Thus there were several initiatives on area-based job creation project to ensure that those who returned would find an employment to support them until the breakout subsided. Many of these initiatives tided their program to the improvement of community well-being. While employment benefits were apparent, other indirect social and economic benefits were more subtle. Assessing the success of these publicly-funded programs based only on apparent employment benefits would grossly underestimate the programs’ contributions. This study aimed at providing a broader view as to how such initiatives generated both direct and indirect social and economics benefits. With the use of Social Rates of Returns (SROI) as the key empirical workhorse, the study provided supplementary information of the magnitude of programs’ contributions whose values could be used as financial measure against the resources spent on the program; therefore, the benefit and cost ratios would be closer to their true boundaries. Five projects were chosen as case studies. SROI calculation based on primary and secondary sources had yielded the followings: 1. For Khok Nong Na Sufficiency Economy project, the SROI was 1 : 4.23; 2. For 1 Subdistrict 1 New Theory Agriculture Group project the SROI was 7.13; 3. For U2T Project, the SROI was 1 : 5.15; 4. For Local Volunteer Care-Takers, the SROI was 1 : 3.55; and 5. For Traditional Thai Massage Training, the SROI was 1 : 22.70. By and large, based on the above empirical findings, it could be concluded that these initiatives were sound investment of the public fund. There were three essential lessons learned from these projects. The first being finding the right match between the project participants and the need of communities. It was found that when the skills of participants matched with communities’ needs, participants would receive considerably more support from communities; this would increase the chance of the participant to successfully meet the requirements of the project. The second lesson was designing exit strategy prior to the implementation of the project. There were cases whose community capacity deteriorated significantly after the project participants were withdrew. This would not had happened if there were properly designed exit strategy to pass on all the responsibilities held by project participants to the designated persons in the communities. The third lesson was on enhancing participants’ soft skills, digital skills and communication skills so they could work more effectively with community members. This skill enhancement should be part of the pre-project orientation of the participants. The last one was integrating monitoring and evaluation process as a part of the project. This was because the project of this nature required certain time period before outcomes and impacts could be felt and measured. Without having a proper M&E process, there would be no way to collect required data to measure the true success of these endeavors.


“The Proposal-based Policy Synthesis of Social Return on Investment (SROI) in Tackling the Coronavirus Disease 2019 (COVID-19) Pandemic under the District Health Board (DHB)” aimed to analyze the social return on Society (Social Return On Investment: SROI) of coping with the COVID-19 epidemic situation under the District Health Board (DHB) and to synthesize stakeholder analysis for policy recommendation. There are 6 DHB studies, i.e. Na Thawi DHB, Songkhla province, Bang phli DHB, Samut Prakan province, Bang Bua Thong DHB, Nonthaburi province, Song Phi Nong DHB, Suphan Buri province, Khon Kaen Muaeng DHB, Khon Kaen province, and Mae Sai DHB, Chiang Rai province. This research, there is mixed method research using the Social Return on Investment (SROI) concept of the Coronavirus Disease 2019 Epidemic Management System under the District Health Board (DHB). The study process comprised quantitative, qualitative method and participatory action research methods, using documentary research, secondary data, focus group, in-depth interviews, and questionnaires. Moreover, we use social value, financial proxy, net present value (NPV), cost-benefit analysis, and SROI calculation using a discount rate government bond 3%. The result of SROI under the Covid-19 management system of the District Health Board (DHB): 6 Case Studies during 2020-2021 with discount rate government bond 3% showed the following results: 1) Song Phi Nong DHB, Suphan Buri province has SROI of 1.59 times meaning that every one baht invested in the management system of Covid-19 under Song Phi Nong DHB has generated social value of 1.59 baht 2) Mae Sai DHB, Chiang Rai province has SROI of 2.58 times meaning that every one baht invested in the management system of Covid-19 under Mae Sai DHB has generated social value of 2.58 baht 3) Na Thawi DHB, Song Khla province has SROI of 2.25 times meaning that every one baht invested in the management system of Covid-19 under Na Thawi DHB has generated social value of 2.25 baht 4) Khon Kaen Muaeng DHB, Khon Kaen province has SROI of 0.98 times meaning that every one baht invested in the management system of Covid-19 under Khon Kaen Muaeng DHB has generated social value of 0.98 baht 5) Bang Bua Thong DHB, Nonthaburi province has SROI of 13.59 times meaning that every one baht invested in the management system of Covid-19 under Bang Bua Thong DHB has generated social value of 13.59 baht 6) Bang Phli DHB, Samut Prakarn province has SROI of 13.39 times meaning that every one baht invested in the management system of Covid-19 under Bang Bua Thong DHB has generated social value of 13.39 baht, respectively.


This research is continuous innovation and an effective additional protocol to reduce and control the COVID-19 pandemic by creating free COVID-19-surfaces and environments without the required routine cleaning process. A prototype of a clear “DSci sticker” has been coated with a solution of Ag-TiO2/WPU nanocomposite, which is a smart material that can generate active species with long-lasting property. Our sticker with virucidal efficacy of 99.99% against SARS-CoV-2 according to ISO 21702: 2019 standard has been developed. The ROS and Ag+ accumulate on the surface of virus particles and denature the viral proteins, offering broad action against unspecified targets (all virus proteins, not just the spike proteins), which could be helpful in all SARS-CoV-2 variants of concern. In addition, the cytotoxicity test was determined according to ISO 10993-5: 2009 standard to ensure that our sticker is safe and non-toxic to humans and animals (% cell viability >70%). To take this research into real practice, we tested antiviral efficiency against SARS-CoV-2 under the simulated practical conditions following ISO 21702: 2019. We mimicked a spreading of virus in air (coughing and sneezing) using a direct spraying model. The results showed that our sticker completely eradicated SARS-CoV-2. Our sticker is used for medical equipment with clear readability and labelling. It reduces risks of high-touch contaminated surfaces and its virucidal efficacy lasts for at least three months (≥99.90%). The prototype is prompted for Thai FDA registration of class 1 medical devices. Furthermore, a production process in this work can be scaled up for an industrial production.


The Development of primary healthcare model for the elderly in new normal society is a challenge for the country to prepare for the hyper-aged society in the next 9 years. Innovative design of healthcare and nursing care to access health services by reducing the country's resource constraints and changing the emerging disease situation will help provide the elderly in the communities with well-being of health status and quality of life. This research aims to: 1) Study the situation of the problem, the needs of the elderly, the factors influencing the health status and quality of life among the elderly living in community; 2) Develop models of care and innovations for primary and geriatric care in the new normal society; 3) Evaluate the outcome of adopting innovative primary and gerontological care in community for the new normal society, using research and development to synthesize policy proposals for public health reform for primary care and elderly care in the new normal society. Quantitative and qualitative data were collected through random sampling from four health districts. 1-2 provinces per health districts and 16 setting to achieve differences in context and culture of elderly care. The samples were 800 elderly people, family caregivers, care managers and volunteer caregivers. Health care providers included doctors, public health officers, and health care workers, physical therapists, Thai traditional medicine practitioners, policymakers or health service advocates such as: the Provincial Public Health Office, Provincial Administrative Organizations, Tambon Administrative Organizations, the Provincial Office of Social Development and Human Security. Data were collected using six sets of questionnaires for the elderly. four sets of questionnaires for family caregivers of the elderly, three sets for care manager, three sets for volunteer caregivers, one set for public health officers and in-depth interviews. Focus group discussions were conducted to use data to design care innovations and geriatric healthcare treatments with evaluation of the outcomes of implementing the care innovations in four pilot areas in 16 health districts. The study found the majority of the elderly to be females, with a mean age of 78.54 years, primary educations, requirement for mobility aids such as walking canes for the most party, followed by wheelchairs and eyeglasses, respectively. More than half had 1-2 chronic diseases, the most frequent being cardiovascular diseases. The most common health problems were difficulty moving and urinary incontinence and the elderly were primarily assisted by family caregivers. The mean time spent in assistance and care for bedridden elderly was 22.90 hours per week. The homebound group received care for 23.31 hours per week and the social group received care for 19.18 hours per week. The activities with which the family caregivers of the elderly needed assistance as to provide the most support to the elderly by preparing food, followed by feeding, buying food or making smoothies, cleaning up after excretion from urinary and fecal incontinence. The nature of health services and the process of caring for the elderly found care managers to be the main leaders in home visits to the elderly at a mean of once a month. The elderly was visited at home by volunteer caregivers (mean=58.94%) at a mean of 1-2 times a month. According to the findings on the problems and needs of the elderly, the home visits conducted by the volunteer caregivers were no different from the public health volunteer caregivers of the elderly, usual care visiting, talking, encouraging and giving advice. The family caregivers of the elderly wanted to have knowledge and skills to properly care for the elderly. The care managers were overwhelmed with their workloads. Thus, an integrated care plan for the elderly covering all dimensions of chronic dependency and chronic disease is needed without increasing the workload of routine tasks. Furthermore, local administrative organizations need an environmental assessment tool that can quickly coordinate assistance for the elderly. The factors influencing the quality of life of the elderly include frailty, health literacy of elderly, health literacy of family caregivers, and environmental management, which can be predicted quality of life at 54.7%. (R2 = .547, p < .001). The development of innovative care models for gerontological nursing and medical care consist of the following: 1) Guidelines in caring for the elderly with chronic diseases and dependencies on 13 guidelines; 2) Implementation of the 13 guidelines; establishment of a Network Community Action Plan (N-CAP) for use in information systems for communication and care of the elderly through the use of "Awuso.net" for the elderly among healthcare professionals and elderly people, families and non-professional volunteers; 3) Elderly Care Knowledge Video Series with 18 videos; the results of the 12-month trial of care innovation in the pilot area with 521 elderly people, N-CAP's top five most frequently used issues were caring for the elderly with dependency, environmental management, hypertension, osteoarthritis, and diabetes mellitus in the community. The results of using N-CAP showed a statistically significant increase in the mean quality of life scores among the elderly (t=11.234 p<0.001). (pretest=42.25±8.89 points, posttest=46.01±8.62 points). Mean score for the performance of the activities of daily living increased with statistical significance (t=7.398 p<0.001) (pretest=8.92±5.44 points, posttest=10.54±5.75 points). Mean health literacy score increased with statistical significance (t=12.016 p<0.001) (pretest=10.19±4.99 points; posttest=12.39±4.08 points). Mean frailty score decreased with statistical significance (t=8.954 p<0.001) (pretest=7.47±3.27 points, posttest=6.17±3.16 points). The users were very satisfied. (Mean±SD=4.03±0.88) The factors influencing the quality of life that increased after implementing the Awuso.net innovation included improved environmental management (ß=0.44, p<.000), number of times N-CAP was used (ß=-0.324, p<.000), number of assignments given by a care manager nurse per week (ß=0.192, p<.000), number of home visits by volunteer caregivers per week (minutes) (ß=0.162, p<.000), changes in ADL performance scores (ß=0.162, p<.000), changes in vulnerability scores (ß=-0.162, p<.000) and changes in health literacy scores. (ß=0.162, p<.000), respectively. Together, the above factors were able to co-predict the ADL performance of the elderly in the community at 54.4% (R2=.544, p<.000). Therefore, use of the Awuso.net should be expanded to other areas to be more extensive and comprehensive to ensure that the elderly have access to standardized medical care. The innovation is safe and produces clear health outcomes, reduces the working hours of nurses, care managers and volunteer caregivers. Thus, the elderly does not have to come to the hospital unnecessarily, thereby resulting in good quality of care and cost-effectiveness with quality of elderly health services in communities.


The impact of the COVID-19 epidemic as a result to change the service patterns at all levels of hospitals. The elderly has limited perception of the health care system. The situation of the outbreak of COVID-19 making access to health services more restrictive. This mixed method research aimed 1) to study the situation of accessibility to healthcare services among the elderly, 2) examine the factors predicting access to health services among the elderly with internal factors, interpersonal factor, and organizational factor. By using the quantitative method, the data were collected from 422 elderly persons aged 60 years and over who living in Pathum Thani Province. The data were collected from June to July, 2022 by using interview forms. The results were analyzed using descriptive statistics and Stepwise multiple regression. Aimed 3) to study the guidelines for improving accessibility to health services for the elderly in the context of the Covid-19 epidemic situation and in the next 10 years to support the emergence of new diseases, 4) to suggest policies for improving accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging diseases. By using the qualitative method, the data were collected from 45 people of public health personnel and person who involved in access to health services of the elderly. The data were collected from August to September, 2022 by focus group interview. Qualitative data were analyzed by content analysis method. The results of the quantitative study revealed that the majority of the sample groups were female, 73.7%, with mean aged 68.94+6.51 years. The most service facility used by the elderly when they were sick or feeling unwell was pharmacy, accounting for 55.9%, followed by the sub-district health promoting hospital, 23.7%. As for the services that the elderly used the most to see a doctor or receiving medication by appointment was at the sub-district health promoting hospitals at 33.2%, followed by the district hospital at 28.2%. Overall accessibility to health services for the elderly was at a moderate level (19.4 percent), followed by a high level (17.8 percent). The results of Stepwise Multiple Regression statistic was found that the factors predicting the elderly's access to health services with statistical significance (p-value<0.05) were satisfaction to the health care service, perceived health status, age and income. These variables accounted for 34 percent of the elderly's variation in access to health services (R2=0.34). The results of the qualitative study on the approach to improve accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging/re-emerging diseases revealed that there must be sufficient preparation in the service system which consists of personnel with potential in knowledge and skills in caring for the elderly. The location is convenient for access to services and adequate support for clients. Tools, equipment and medical supplies are always adequate and the arrangement of long-distance service systems (Telemedicine). It is also necessary to prepare the elderly to have health knowledge and technological literacy to access health information including the development of a service system that coordinates operations with local government organizations. Policy recommendations from the study consisted of 4 aspects: 1) Service aspect by developing a long-distance health service system, develop a proactive service system, applying technology to service, develop a service unit for the elderly, developing case management, develop hospital beds at home and coordinate operations with local authorities 2) Academics aspect by developing curriculum, arrange academic services, determine learning outcome according to the National Higher Education Qualifications Framework, develop curriculum identities and develop a network in educational management 3) Research aspect by researching drug and vaccine, development research and innovation toward enhancing health literacy and technology literacy; and 4) administrative policies of public health agencies and local administrative organizations to allocate budgets for producing and developing personnel, procurement of tools, medical supplies, building and expanding service units to care for the elderly.


Since the year 2019 till present (2022), all countries around the world have confronted with the Covid-19 pandemic. The Government of each country has launched several public health measures in responsive to the changes of the Covid situation as well as its own country context. The main objectives of this study were to prevent the spread of the disease and to reduce the infected cases and deaths. Public health measures included social distancing, city lockdown, travel restriction, and closure of public service places, restaurants, or schools. Those measures could cause negative impacts in several sectors, such as economic, environmental, and educational sectors. The Covid impact on education was of het concern as education is the foundation of human capital development. It has been found that approximately 1.6 billion children and adolescents (more than 90% of the total learners) in 190 countries could not physically attend their schools for several months due to school closure. In addition, above 100 million teachers and school staff had been affected by the rapid closures of schools. School closures resulted in the dropouts of about 24 million students. During the pandemic, many countries had adopted the online education approach in order to k continue the study activities for children. This study aimed to investigate the education management and health promotion and prevention activities for primary school children during the Covid-19 pandemic, and to develop policy recommendations for improving the quality of primary school education management and health promotion and prevention activities for children and parents for better preparation and responsiveness given any outbreaks in the future.


This cross-sectional research study aimed to study adverse events and unsafety after receiving types of Covid-19 vaccine. The sample of the study was people with sevem groups of chronic illnesses and older adults who received the Covid-19 vaccine from Ramathiodi Hospital, Bangkok. Purposive sampling was 1,254 cases. Data were collected by face-to-face interview, telephone, or online using the personal questionnaire and the Adverse Events questionnaire. Results showed that almost half of the participants received AstraZeneca+AstraZeneca of 48.79 %. Participants with chronic illnesses and older adults who received the different types of Covid-19 vaccine had the significant difference of adverse events both first dose (χ2=20.21, p<0.001), second dose (χ2=47.7, p<0.001), and the two-dose crossover vaccine (χ2=50.3, p<0.001). The participants who received the two-dose crossover vaccine of Astrazeneca+Pfizer/Moderna had the most adverse events of 67.7%. However, the two-dose from the same group vaccine of Sinovac/Sinopharm+Sinovac/Sinopharm reported only 28% of adverse events. People who were younger than 60 years old with chronic disease had a statistically significant difference in the greatest adverse events compared to healthy older adults with chronic disease who received both the first and second doses of the Covid-19 vaccine (χ2=24.36, p<0.001; χ2=18.31, p<0.001). In addition, Pfizer/Moderna reported the greatest adverse events of 17.4-38.7% such as local symptoms (pain, swelling, redness, hotness, itchy at the injection site), fever, and muscle pain. Moreover, twenty-two participants reported severe adverse events and need to receive first aid and visit the doctor. The results of this study suggested continuing the policy recommendations for vaccination by using the same type of vaccine Sinovac/Sinopharm or AstraZeneca. Using the cross-over type of vaccine is not recommended, especially, in-group of people who were less than 60 years old and had chronic illnesses to decrease adverse events and increase safety.


Background: The SARS-CoV-2 (COVID-19) pandemic has widely spread with numerous waves of different variants of concern, which resulted in shortage of COVID-19 vaccine. Fractional intradermal (ID) dosing regimens for COVID-19 vaccination could be considered as an alternative to minimize possible adverse effects and ease up vaccine supply. Methods: This randomized, open-label study was conducted at a single center, Siriraj Hospital, Bangkok, Thailand. This study was conducted in two sub-studies. The first study was to determine the safety and immunological response of fractional ID as a booster dose. The following study focused on the accelerated fractional ID as primary series. The first study was conducted among 150 volunteers who completed 2-dose IM primary series between 12 and 24 weeks earlier. Those participants who received the primary series of ChAdOx1 (IM) were allocated to vaccinated 0.05 mL BNT162b2 (ID) as booster, while participants previously vaccinated with primary series of BBIBP-CorV (IM) or CoronaVac (IM) were randomized to receive fraction doses of 0.1 mL ChAdOx1 (ID) or 0.05 mL BNT162b2 (ID). The second study was carried out among 90 volunteers who were naïve to SARS-CoV-2 infection. The two vaccinations, 2 injections for each vaccination on a separate arm at the deltoid area, given in an accelerated schedule of 7 days apart. In the initial part of this study, 50 participants were randomly assigned to 5 groups equally consisting of homologous primed ChAdOx1 and BNT162b2, and homologous primed between CoronaVac – ChAdOx1, CoronaVac – BNT162b2 and ChAdOx1 – BNT162b2. Additional participants were recruited in the two groups (20 per group) with the highest proportion of adverse events. The participants were observed for at least 30 min following the vaccination for any immediate adverse events, and self-reported adverse events were collected for 7 using an electronic diary in Google Form. The immunogenicity was determined by the level of anti-receptor binding domain (anti-RBD IgG) of the SARS-CoV-2 and neutralizing antibody (NT) against various variants. T-cell responses were measured by ELISpot using S-peptide and NMO-peptide stimulation. Results: In the first study among volunteers who completed the primary series, 105 eligible participants were randomly assigned to 3 study groups equally (n=35, 33.33% per group). The overall median age was 38 years, around half of participants were male, and the BMI was normal. There were no significantly different in baseline demographic characters. At 2 weeks following booster dose, participants who received 2-dose primary series of BBIBP-CorV (IM) or CoronaVac (IM) followed by BNT162b2 (ID) as booster induced the highest antibody IgG (GMC=1,723.00 BAU/mL). ID administration induced lower IgG than the reference IM of the same vaccine. Likewise, NT levels following ID route were generally lower than that following reference IM, except for the group that received ChAdOx1 (ID) boost which induce NT against Omicron in the similar level to that of the reference IM. Adverse events (AEs) were mostly mild to moderate levels of severity in all study groups. 28.57% of the injection site reaction and 64.74% of systemic AEs were reported. For the second study, 57 eligible participants were randomly assigned to receive 5 study groups of fractional accelerated ID as primary series. The overall median age was 35 years (IQR=28-45 years). At 2 weeks following the primary series, participants who received 2-dose (ID) of ChAdOx1 - BNT162b2 have induced the significantly highest antibody IgG (GMC=597.29 BAU/mL), followed by BNT162b2 - BNT162b2 (GMC=414.84 BAU/mL). Overall, ID have shown a significantly lower antibody IgG than reference IM of the same vaccine regimens (p<0.001). The regimen ChAdOx1 - BNT162b2 also induced the highest NT levels against Wuhan (GM=254.20) and Omicron BA.1 (GM49.34). All groups had similarly low NT against Omicron to the references IM (p=0.304). Likewise, the ELISpot-S response was highest in the group ChAdOx1-BNT162b2 (GM=441.34 SFU/106 cells). There was no significant difference in the proportion of AEs between the study group in this study. Conclusions: The fractional ID as a booster dose has generated antibody responses against SARSCoV-2 infection but in a lower level than IM references; however, well tolerated. It should not be the primary route of vaccination but may be considered in cases of vaccine shortage. Likewise, accelerated fractional ID dosing regimens as primary series is immunogenic for both humoral and cellular but with lower antibody levels than IM references. The accelerated ChAdOx1-BNT162b2 induced the highest immunogenicity and may be considered in the next pandemic that require rapid priming particularly when the vaccine supply is insufficient.


According to the situation of COVID-19 pandemic worldwide, policies and strategic measures
managing the new normal restrictions may impact the quality of life, especially in the aging population.
This study aimed to monitor and compare the quality of life across different periods of the COVID-19
pandemic in older adults stratified by regions in Thailand. Participants comprised 400 older adults living
in provinces representing five regions in Thailand with a total number of 2,000 participants. The self-reporting
questionnaires were applied for data collection, including personal and health information and
the EQ-5D-5L quality of life Thai version (of high reliability 0.89). Descriptive statistics was utilized for
overall personal and health information, and one-way analysis of variance was performed to examine
the change of quality of life among different pandemic waves. Findings revealed that most of the
provinces reported a higher quality of life and satisfaction of health at the first wave of the pandemic
than others. The restriction policy decreased mobility in older people. Comparing each province, findings
displayed that older people in Samut Prakarn had lower quality of life than others, such as Phrae
province. It might be because Samut Prakarn province with high number of cases imposed a maximum
infection control under a high restriction policy, while Phrae province with fewer cases enforced less
restriction requirement. The findings on quality of life informed that the maximum infection control
policy which decreased physical activity and lowered quality of life in older adults. Remarkably, the
results of the present study showed that quality of life varied depending on pandemic waves and regions.
These findings provided useful information to healthcare personnel and policymakers in Thailand to
develop further plans and services for older people to cope with future pandemics properly.


This study aimed to estimate the value of willingness-to-pay (WTP) for elderly care and study the
impact of factors on willingness-to-pay for the elderly care. A total of samples in this study were 420
people aged 18 years and older, living in Sa-Ad and Nongkung subdistricts, Namphong district, Khon Kaen
province. The study found that mean age of the samples was 57.6 years, 71.0% were females, 75.2%
had primary school education or lower, more than a half lived with a monthly household income of
<10,000 baht, more than a half reported having health problems, and 63.1% never provided care to
dependent elderly. The three major problems related daily activities reported were: 9.8% having difficulty
of physical movement, 8.3% feeling sick, and 6.9% having stress/depression. More than 90% of
respondents were willing to join and pay for the elderly care program. The mean value of willingness-to-pay
for the elderly care was 373.77 baht (SD=286.01). This study found that willingness-to-pay was significantly
associated with age, household income, smoking behavior, quality of life, selfcare problem, anxiety/
depression, willingness-to-join the care program and starting price (p < 0.05). The study also found
that WTP value was associated with household income, size of household, years of providing elderly
care, selfcare problem and starting price (p < 0.05). As willingness-to-pay for elderly care studies are still
limited in Thailand, findings of the present study could be good lessons for other areas or settings.


Tooth loss holds a complex relationship with oral health-related quality of life. A recent national survey reported only half of Thai elderly population with fewer than 20 remaining teeth had their
dentures made, despite a policy promoting denture fabrication free of charge. The aim of this study was to explore the perspectives of older adults’ perceived needs for tooth replacement. We purposefully selected older adults living in Dan Kwian subdistrict who were identified with a denture needed by a dental nurse but not currently wearing the prosthesis, for a face-to-face in-depth semi-structure interview. Data saturation was reached with 29 older adults. Inductive content analysis of the interview transcripts yielded two main themes. First, the factors influencing the needs for denture were: 1.1) “the word of mouth from neighbors & the village health volunteer as the main influencer” inducing the needs; 1.2) the socialization stimulated the needs; and 1.3) indirect cost despite free denture hindering the needs. Second, the dynamic of conflicting priorities: 2.1) from attach to detach once getting old or being ill; 2.2) changing perceived needs over time in response to changes in life circumstance. In sum, insights from this study may help reduce the discrepancies between professionally defined needs and the patient perceived needs.


The mechanical thrombectomy (MT) is the established standard and effective treatment for large
vessel occluded stroke patients. This research aimed to analyze whether MT was cost-effective when
compared with intravenous thrombolysis (IVT). This was a retrospective cohort study, reviewing medical
records of acute ischemic stroke patients with large vessel occlusion during 2015-2020. The study included
106 stroke patients treated with MT (n=66) versus IVT (n=40). The total cost of MT and IVT were estimated
at 568,587 baht and 121,582 baht, respectively. Both male and female patients treated with MT
had a greater quality-adjusted life years (QALYs) compared to those treated with IVT. The incremental
cost-effectiveness ratios for male and female patients treated with MT were 99,184 and 82,715 baht per
QALY gained, respectively. Conclusion: This study demonstrates that MT was cost-effective for treating
acute ischemic stroke judging against the willingness to pay of 160,000 baht per QALY of Thailand.


The present study’s objective was to investigate the claim behaviors of the insured persons
under Social Security Act’s Article 40 who had transportation related occupations. This would provide
lessons for other platform workers being prevalent during COVID-19 pandemic who chose to register
under Social Security Act’s Article 40. The Social Security Office’s administrative database between
2018–2020 provided a total of 417,135 insured persons for analysis. Descriptive statistics of number,
percentage, mean, and standard deviation were presented to reflect insured persons’ claim frequencies,
benefits and averaged days from registration dates to first claim dates by benefits. The analysis showed
that 4.1 percent of insured persons submitted claims. The average duration from the registration dates
to the first claim dates exceeded a year. The most benefit claims came from the sickness benefit. The
highest rate of denied claims came from the disability benefit. Developing effective communication
strategies for platform workers should consider potential claimants and their needs as found by this
study.


Aquaculture plays an important role in global food supply and in national economic development in low and
middle income countries. However, during the process of aquaculture production, farmer may inappropriately use
antibiotics to prevent and to treat infections. This may lead to antimicrobial resistance in humans and environment.
This study aimed to assess fisheries officers’ knowledge and awareness of antibiotic use, antimicrobial resistance, and
knowledge on regulations related to antibiotic use in aquaculture sector. A self-administered questionnaire survey was
conducted in 92 fisheries officers whose work was related to aquatic animal health and aquaculture management from
61 provinces in February 2019. The questionnaire comprised four parts: 1) knowledge about the Thailand’s National
Strategic Plan on Antimicrobial Resistance 2017-2021 (NSP-AMR); 2) knowledge on antibiotics; 3) awareness of antimicrobial
resistance; and 4) regulations on chemicals and antibiotic use in aquatic animals. Over half of the respondents
(57.6%) had heard about the NSP-AMR, but most of them (62.3%) did not know the content. The level of knowledge
of antimicrobial was measured using six true/false statements. Results showed that level of knowledge on AMR and
antibiotic use was high, as 73.9% of respondents gave correct answers to more than 3 out of 6. The majority of respondents
(more than 80.0%) correctly recognized the importance of antibiotic use and AMR problems, and all of the
respondents agreed that AMR was an important problem that needed policy attention. More than half of respondents
gave correct answers in all statements regarding the antimicrobial use regulations in aquaculture sector. This study was
the first study which assessed knowledge on antibiotic use and antimicrobial resistance among fisheries officers in
Thailand. We applied the questionnaire from the National Health and Welfare Survey 2019 and the results showed
that respondents had a high level of knowledge about antibiotic use and antimicrobial resistance. But, gaps remain in
the dissemination of antibiotic-related policies. Training should be provided to improve knowledge and awareness on
AMR and to support fisheries officers in regulating and ensuring rational use of antibiotics in the aquaculture.


The International Health Policy Program (IHPP) has been using household surveys conducted by
the National Statistical Office (NSO) for more than two decades. These surveys contribute to the advancement
of several health policies. This article presents successful evidence of IHPP using household
statistics survey data to support the process of health policy and health system development. Nine NSO
surveys related to health under 12 health topics include 1) universal health coverage, 2) health financing,
3) the burden of disease, 4) health (in)equity, 5) antimicrobial resistance, 6) smoking and alcohol consumption,
7) food and nutrition, 8) breastfeeding, 9) physical activity and sedentary lifestyle, 10) non-communicable
disease risk factors, 11) health workforce and 12) health of urban refugees and asylum
seekers. Five predominant characteristics of NSO surveys include (a) one-stop data source available for
most health domains, (b) national representativeness due to large and probabilistic sampling techniques,
(c) standard proxies for global and national monitoring systems, (d) ability to track health equity, and (e)
compliance with international benchmarking systems. The future challenge lies on improvement of the
quality of data and ensuring the sustainability of surveys.


The United Nations Sustainable Development Goal 11 commits to inclusive, safe, resilient, and sustainable cities and human settlements. Rapid urbanization can result in increased non-communicable disease burdens attributed to physical inactivity among the urban population. The patterns of physical inactivity and interventions to promote physical activity in the urban setting in Thailand are largely unknown. This study reviewed evidence on physical activity epidemiology and interventions to promote physical activity in the urban setting from the international and national studies, and recommended policy interventions that promote physical activity in the urban setting. The results suggested that promoting active transport such as walking, cycling, and use of public transport, integrating transit-oriented development in city design and planning, and supporting recreational activities for all groups of people, were key leverage policies that addressed the sedentary problem in Thailand.


This research aimed to 1) evaluate the situation of primary care provision in Northeast of Thailand 2) lessons learned for the role model of primary care, strengths, key success factors, problems, and obstacles for the area-based service 3) home care by the three doctors’ team and 4) to make a policy recommendation. A questionnaire and guideline for in dept-interview and brainstorming were used as a research tool. The subjects consisted of 468 primary care team members selected by a simple random sampling method. Most consisted of nursing professional and public health technical officer working in the health region 7, 8, 9 and 10. It was found that the attitude of respondents was at a good level. The most of unit passed in quality outcomes framework (QOF) with 80.7%. Half of total lacked doctor and less than half lacked health personnel. Most of them received a lesser budget than the expense from the Contracting Unit for Primary Care. With a full score of 3, the overall mean of service was 2.61 (SD 0.84). The lowest was 2.29 consisting of consultation and communication channels (SD 0.57), and service system (SD 0.39). The lowest scores consisted of service delivery 1.73 (SD 0.51), health workforce 1.92 (SD 0.68), and health information system 2.39 (SD 0.52). The registered teams showed the statistically significant completion in service more than those with the non-registers (p-value 0.018, Adjusted Odds Ratio 5.16 with 95% confident interval 1.33 to 20.12). The service of primary care unit among urban, semi-urban and rural model were not different. The urban, and semi-urban showed superior in ability of team, a holistic care and advice by family doctors. The community participation, supported by public health volunteers and network of rural model were closer and stronger than of the urban and semi-urban. Key factors for the patients regarding to primary care unit were in a good location, quick service, easy to access and the familiarity of. Most of patient accepted the three doctors. The urban team with more experienced showed completely in the service and activities better than in the rural. The policy and the registration help to link primary care team and support for the patient care. The problems were lack of the family doctors and health personnel. Instrument was broken, and the data results inputting was overload. The Human Papilloma Virus (HPV) screening and Antenatal care (ANC) were not covered. It was concluded that primary care in urban, semi-urban, areas was found to be outstanding in home health care by the family doctors consisting of multidisciplinary teams. The continuing service delivery to patients’ home was duly covered. The small primary care in rural areas proved significantly with a pass in the QOF more than the medium size. Lacking the family doctor and health team, it was supported by the network in the rural areas. Training and knowledge were required to update within the health professionals. The management of health information by technology and reference systems should be improved for the patients’ benefit more than the staff workload. The telemedicine needed to be an innovative for all areas.


The purpose of this mixed methods research was to 1) study human resources management/ problem and obstacle in human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization 2) explore the competency of health personnel who transfer to the provincial administrative organization and 3) develop policy proposal for human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization. This research was conducted between May 2 to November 1, 2022. The data were collected from the stakeholder including the policy administrator, the person who was involved in the transfer of missions, the practitioner from the primary care center, the representative from the provincial administrative organization, and the representative from the public sector. The results were as follows: 1. The human resources management during the transitional period of the transfer health promotion hospital to the provincial administrative organization showed that healthcare personnel are willing to practice according to their responsibility and follow the manual guideline for transferring. Healthcare personnel could provide full services. There are enough human resources according to the structure stated in the manual. Healthcare personnel found their career advancement. Most of the healthcare personnel were ready to transfer to the provincial administrative organization including administration, academic and family medicine services as well as perform the services according to their professional position. However, there were some limitations such as coordination, the local health committee not functioning properly, the differences in the payroll, wages, and compensation, lack of confidence in the system of the local sector, and the allocated budget does not meet the agreement 2. The competencies of healthcare personnel in health promotion hospital were at a high level except for medical rehabilitation, management and development of emergency medicine and referral systems, motivational communication, creativity, and quality improvement. 3. Policy proposal for human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization were as follows: 3.1 Policy proposal on workload 3.1.1 Provincial administrative organization in each province should communicate a better understanding of the transfer of manpower, manpower rate, compensation, and career advancement. 3.1.2 Provincial administrative organization set the job description and job specification then transfer to personnel in all levels of the provincial administrative organization. 3.1.3 Provincial administrative organization and provincial health office must urgently work together to make a memorandum of cooperation for the development of the provincial administrative organization in primary health care services. 3.1.4 During the transitional period provincial health office should control the medical practice of personnel in health promotion hospital under the provincial administrative organization. 3.1.5 Ministry of public health should provide the option for those who do not wish to transfer by positioning, workplace, and job in the same area. 3.1.6 The local health committee should carry out the roles and duties as stated in the manual guideline for transferring in order to benefit the people in the area. 3.2 Policy proposal on manpower rate In long term, the provincial administrative organization should establish a manpower framework and allocate health personnel in all fields following the Primary Health System Act B.E.2562. Develop the personnel database to engage in executive decision-making and practitioner in planning for individual progress development following the manual guideline for transferring. 3.3 Policy proposal on career path progression Provincial administrative organization create guidelines for escalation, career path progression, and establish an understanding with personnel as well as push for promotion according to the established guidelines. 3.4 Policy proposal on competency development 3.4.1 Provincial administrative organization creates a better understanding of the working system of provincial administrative organization and gives the opportunity to personnel involved with the development of the public health system. 3.4.2 Provincial administrative organization should develop management readiness, financial and accounting, internal audit and control related to the regulations with the transfer personnel. 3.4.3 Department of local administration together with Praboromarajchanok Institute and other health education institutes should help to develop healthcare personnel competency including research and services according to primary healthcare services. 3.5 Another policy proposal 3.5.1 Provincial administrative organization establishes the guideline for wage disbursement, compensation and other follow the benefit of transfer personnel which is not lower than the previous amount and consistent with the decentralization of power to local government organizations in B.E. 2542 and the regulations of the Ministry of Interior on the compensation for staff who working in healthcare in health center under provincial administrative organization in B.E.2562. 3.5.2 Publicize to the public related management and services of health promotion hospital under provincial administrative organization. 3.5.3 Provincial administrative organization should develop the health promotion hospital according to its size (small, medium, and large) to be the master of primary healthcare unit in management and providing full services in primary healthcare.


The act determining plans and procedures for the decentralization of power to local government organizations in B.E. 2542, requires the transfer of public health missions to local government organizations. Health promotion hospitals under the local government organization should provide health services for people based on the Primary Health System Act B.E.2562. The purpose of this mixed methods research was to 1) explore the standard of primary care, availability of primary care services, and the accreditation process of health promotion hospitals under the local government organization and 2) to analyze, synthesize and then provide recommendations for the standard delivery in primary health care and standard service delivery of health promotion hospitals under the local government organization. The participants were recruited using purposive sampling. The study was composed of 3 phases: phase 1 was documentary research to identify situation analysis of policy and law related to the decentralization and primary care act, health promotion hospital quality assessment guideline and standard health care service of health promotion hospitals; phase 2 was quantitative research to identify standard service delivery of health promotion hospitals and to determine availability and gap of primary care services after the transfer to a local government organization, and phase 3 was qualitative research using in-depth interview and focus group discussion with the stakeholder who is involved with standard health care service of health promotion hospitals. The research instruments were a semi-structured interview. The characteristic information from health promotion hospitals and local government organizations was collected by a questionnaire. All the questionnaires were developed and validated by five experts. The qualitative data were analyzed using content analysis and the quantitative data were analyzed using descriptive statistics. The results of this study revealed that: 1. The component of standard primary health care service includes: 1) determinants of health such as infrastructure, health workforce, health information, medicine, other medical supply, and digital health technology; 2) service delivery including prevention, promotion, treatment (acute and chronic) rehabilitation and palliative care in all age groups; and 3) health system objective such as outcomes and impact of service delivery 2. The improvement criteria of Tambon Health promoting hospital (star hospital) is the highest quality standard for primary health care service delivery accreditation. However, there were some limitations. For example, some assessment criteria were inconsistent with the local context, and the audit team from the district and provincial level assessed and helped to pass. There for no actual quality improvement in some areas. Another standard evaluation criteria for primary health service in Bangkok was developed by The Healthcare Accreditation Institute (Public Organization) that can be extended to use with primary care units throughout Thailand. 3. Primary care units should be accredited by an external organization composed of healthcare teams that include physicians, nurses, and pharmacists, who know quality assessment, apprehend the working system and are not a stakeholder. The audit includes both internal and external audits. The process of audit may use the same method as the previous year which is using the network partners and mentor teams to provide support and advice for quality improvement and participation of people in the community. 4. Health promotion hospitals that are going to transfer to local government organization state that the structural readiness to provide services were at the right level or higher. However, the number of health professionals and supportive personal readiness was at a low level. 5. Most of the health promotion hospital rate their availability to provide standard service delivery after transfer to the local government organization were the same and more quality in all health services except dental care and physiotherapy which is reduced.


Thailand is entering an aging society completely. Osteoporosis is another disease that may become more frequent as it is more common among the elderly around the world. Osteoporosis increases the risk of bone fractures and, when fractures occur, is a contributing factor in increased mortality for the elderly. If fractures can be predicted for older adults with osteoporosis and solutions to prevent fractures can be found before they occur to the elderly, these will help to reduce the danger, loss of property, wasted time, and death of the elderly. The medical images obtained either as a direct diagnosis of fractures or in the diagnosis of other diseases can be further enhanced by combining with computer modeling techniques for biomechanically analysis based on finite element method, which are used in the diagnosis, treatment, and may include prognosis of various medical conditions widely, to analyze and predict fractures for elderly people with osteoporosis. However, this analysis technique is used mainly in research laboratory. This is due to a lot of resources required. If a sufficiently large number of analytical results can be obtained and used as a sample set input for the machine learning system to learn, then the current operating procedures may be reduced. It may result in faster diagnosis or prediction with adequate accuracy compared to traditional techniques. Therefore, the objective of this study was to predict fractures in the elderly due to various activities and conducting a study on the feasibility of collecting the biomechanical analysis results to be used as a sample input for future machine learning systems to use in learning with the aim of replacing the current procedure for performing part of the finite element analysis. From the study, it could be confirmed that the condition of osteoporosis greatly affected the force transmissibility. The external load was mainly experienced by the bone tissue which has a high bone mineral density, but this type of bone tissue is less common in patients suffering from osteoporosis. Therefore, occurring of osteoporosis affect bone strength directly. Moreover, the study was likely to find a relationship between the bone mineral density values obtained from medical imaging and stress values obtained from finite element analysis under various stress conditions. This may be the possibility of using machine learning to replace engineering analysis using the finite element method leading to the ability to reduce the process of finite elements in order to get a faster but still accurate diagnosis or prediction result.


Cardiovascular diseases are classified as non-communicable diseases (NCDs) that are dangerous and have an increasing trend nowadays. This disease is related to lifestyle behavior. It tends to accumulate symptoms gradually and become more severe if it is not treated properly and in time. Abdominal aortic aneurysm (AAA) is a dangerous disease and can cause sudden death if ruptured. This research project has applied an engineering tool called a computational fluid dynamic (CFD) for medical applications. Computed tomography images of patients with abdominal aortic aneurysms were acquired to perform a reconstructed geometry of AAA. There were 12 cases of patients who have AAA with a diameter larger than 3 cm. The blood properties and boundary conditions were assigned in the model. The results of this study found that the aortic aneurysm was highly turbulent in the diastolic phase and there was an increase in turbulence as the aneurysm size increased. This turbulent flow was also found during peak systole as well. Wall shear stress (WSS) in the artery was high at peak systole and during diastole. Furthermore, WSS was higher in the aortic aneurysm sac than in the rest of the aorta. The oscillating shear index (OSI) was higher at the aortic aneurysm sac than other areas. This may lead to a risk of rupture point of blood vessels. However, the results could not be directly compared in the same group of patients because each patient had a different geometries and degree of tortuosity. Therefore, this kind of calculation is individual as a personalized model. In addition, this work has 3D printed models of the abdominal aorta to create a testing mock-up for the aneurysm. However, it was found that the material used in the AAA phantom was not clear and flexible. These problems relate to the flow visualization in the blood vessels and the wall contraction simulation of the blood vessels. More studies are needed to explore suitable materials to mock-up the AAA model for flow testing.


The 14th Southeast Asia Regional Scientific Meeting of the International Epidemiological Association and International Conference on Public Health and Sustainable Development (IEA-SEA 2022) is the major forum for public health and medical epidemiologists to share their experiences and good practices especially in prevention and control several global health threats including COVID-19, HIV, TB. In 2022, the conference is organized by the School of Health Science, Mae Fah Luang University which is ranked the 1st university in Thailand for four (4) consecutive years by Time Higher Education (THE) World University Ranking, and other key partners such as the Southeast Asia Epidemiological Association (SEAIEA), World Health Organization (WHO), International Organization of Migration (IOM), Ministry of Public Health, Thailand (MOPH-Thailand), Health Systems Research Institute (HSRI), The Council of Community Public Health, Thailand, The Council of Public Health Education Institute of Thailand. Many organizations support scientific and excellent speakers to the conference such as the Centers for Disease Control and Prevention (CDC), United Nations Programme on HIV/AIDS (UNAIDS), etc. More than 15 keynote speakers from major health agencies in the world deliver their excellent information to the conference. In addition, more than 400 people participated in the conference with 150 excellent papers selected to present in the conference.


Background: The booster vaccination for Covid-19 prevention has been specifically recommended among high-risk populations such as older people. Previous studies have reported that intradermal (ID) vaccination could be as effective as intramuscular (IM) or subcutaneous (SC) vaccination In addition, ID vaccination causes less systemic adverse effects which are much concerned by older people giving rise to lower vaccination rate in this particular age group. Therefore, this study aims to compare the immunogenicity and adverse effects following ID and IM booster vaccination of mRNA vaccines against COVID-19 in older populations. Methods: This randomized, open-label study was conducted at a single center, Siriraj Hospital, Bangkok, Thailand, which was completed in July 2022. The eligible participants were individuals aged 65 years or older who already had received 2-dose IM primary series of ChAdOx1 vaccine within 12-24 weeks. Participant were randomly assigned to six vaccine groups: ID mRNA-1273 (20 mcg; 0.1 ml, n=35), IM mRNA-1273 (100 mcg; 0.5 ml, n=35), ID BNT162b2 (10 mcg; 0.1 ml, n=35 for each group of 65-79 and ≥ 80 years of age) and IM BNT162b2 (30 mcg; 0.3 ml, n=35 for each group of 65-79 and ≥ 80 years of age). Self-reported adverse events (AEs) were collected for 7 days consecutively following each vaccination using an electronic diary application. The immunogenicity was determined by the level of IgG antibodies against receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S1 subunit). The pseudotype-based neutralization assays (PVNT) were used to measure neutralizing antibodies against SARS-CoV-2 variants. The T-cell response was measured using S-peptide and NMO-peptide stimulation. Results: Of 210 participants, the majority (70.5%) were female, median age was 77.5 years old (Interquartile range (IQR): 71.0-84.0 years old). At 4 weeks after booster vaccination, the geometric mean concentration (GMC) of anti-RBD IgG increased in all groups by overall of 45.11 (95% CI: 38.82, 52.41) folds from baseline. The GMC among participants who received IM mRNA-1273 had gained the highest immunogenic responses and significantly higher than IM BNT162b2 (GMC of IM mRNA-1273: 3,837.12 BAU/mL, GMC of IM BNT162b2: 2,530.58 BAU/mL, p=0.021). ID vaccination had significantly lower GMC than IM of the same vaccine type. Across vaccine groups, the geometric mean titer against Omicron variant BA.1 was the highest among participants who received IM mRNA-1273 boosting (616.8), followed by ID mRNA-1273 (213.9), IM BNT162b2 (144.6), and ID BNT162b2 (82.1). The ID route had significantly more frequent local AEs than IM with the highest rate among ID mRNA-1273 and the lowest in ID BNT162b2 group. Conclusion: The IM mRNA-1273 group gained the highest immunogenic responses as well as experienced less systemic AEs than BNT162b2. Although ID route achieved lower level of antibody than IM route, the immunologic responses were highly enough to create vaccine efficacy and caused less systemic AEs. Therefore, the ID mRNA-1273 could be the alternative type of Covid-19 vaccination for older people.


Rational Drug Use (RDU) has been set to be a strategic policy since the first issue of the National Drug Information. In the fiscal year of 2560 B.E., the Ministry of Public Health defined RDU and antimicrobial resistance management were projects under the National Strategy (2018-2037) regarding public health, and announced that all hospitals were RDU hospitals. RDU hospitals were evaluated with 18 hospital indicators according to the guidelines of service plan development. Some researches reflected limitations and obstacles of the RDU hospital indicators administration; however, this research was undertaken. The objective of this study was to review and develop rational drug use indicators for healthcare facilities. A cross-sectional, convergent mixed methods design was conducted between May 10, 2021 and November 9, 2022. Quantitative research was carried out with an online survey and analyzed with descriptive statistics. Qualitative research included documentary research, semi-structured in-depth interview, field study with group discussion, and modified Delphi technique, and analyzed data with thematic analyses. Also, a public hearing inquiry was held in representatives or experts of hospitals, professional organizations, and policy makers. Research population were all public healthcare facilities in primary, secondary, and tertiary care. Samples were selected from multi-stage sampling in both Bangkok and upcountry. In research summary, all hospital indicators should be kept, although some indicators were suggested to be terminated. The reason was to be the national database of all healthcare facilities until there will be better quality, efficient, and effective indicators. At present, RDU indicators will be divided into three categories. First, the Monitor (M) category included indicators Item no. 2 and 5. The Amendment (A) category were indicators Item no. 3, 4, 8 and 11. The Existence (E) category, lastly, were indicators Item no. 1, 6-7, 9-10, และ 12-18. Further studies will be needed to develop Thailand to be a RDU country. For examples, researches related to 1) spatial environment, 2) non-communicable diseases, 3) drug labelling and information, 4) RDU curriculum, 5) political research, 6) drug use in upcountry, grocery store or community pharmacy, 7) drug use in food chain cycle, and 8) information and exchange system.


Introduction: Tuberculosis (TB) is a communicable disease caused by M. tuberculosis. Contacts of TB cases become clinically active TB or remain in the latent tuberculosis infection (LTBI), which is subsequent progression to tuberculosis disease. Currently, the available tests for LTBI diagnosis include tuberculin skin test (TST) and interferon-gamma release assay (IGRA). In Thailand, IGRA test is costly and has not been included in the benefit package. The results from this study can be used as an evidence informed policy whether IGRA test should be included in the benefit package and can be applied to support the strategies to eradicate TB. Objectives: To evaluate cost-utility analysis, budget impact analysis and feasibility analysis of LTBI diagnosis for contacts of TB patients using societal and government perspectives. Methodology: Cost-utility analysis using a decision tree and Markov model was performed to simulate the costs and utilities, and to estimate the budget impact of contacts with pulmonary TB patients. All parameters were obtained from published studies. Lifetime horizon was applied with both costs and outcomes discounted by 3%, as recommended by the guidelines of economic evaluation in Thailand. One way and probabilistic sensitivity analyses were conducted to examine the uncertainty of input parameters. This study considered three alternative diagnosis strategies as follows: 1) No screening, 2) TST alone to diagnose LTBI, if TST test was positive, treatment would be provided, and 3) IGRA alone to diagnose LTBI, if IGRA test was positive, treatment would be provided. Focus group discussion and literature reviews were applied for feasibility analysis. Results: The incremental cost-effectiveness ratios (ICER) of IGRA alone compared with TST alone was THB 1,220,287 per QALY gained. At the willingness to pay (WTP) THB 160,000 per QALY gained, IGRA would not be cost-effective. If the price of IGRA was decreased to THB 575 per test, the strategy of IGRA would be cost-effective. Five-year budget for TST and IGRA was estimated to be THB 148 million and THB 330 million, respectively. The barriers for IGRA implementation were lack of laboratory infrastructure and limited availability of laboratory personnel.


Cranioplasty surgery has many impacts to patients’ physical and mental health, for example, restoration of the mechanic of fluid flow inside the brain which protect from external danger with the reconstructive patient appearance that affected socialization emotional well-being. In the current years, Polymethylmethacrylate (PMMA) material has been famously used for the surgery for more than 50 years with the cost effectiveness and the inclusion in most of the government welfare in many countries. However, this material is not the best options for this surgery in term of strength and anti-infection, in other word, the PMMA may has a stellate pattern when receive a curtain point of external force that can lead to the death of the patient. The METICULY Patient-specific titanium mesh implant, model CraniMesh, was introduced in 2017 with the 3D printing technology and personalized design for the cranioplasty surgery. This product overcomes the strength and anti-infection problems of PMMA with additional properties of surgical time reduction. Despite the increased benefits and cost, the CraniMesh has not been listed in the Thai government welfare yet, also no evidence of the comparative pharmacoeconomic study between the CraniMesh and the PMMA cranioplasty plate to facilitate the listing process. This study has objectives to evaluate the safety and performance of the Cranimesh and the retrospective clinical study of usage between these 2 products in cranioplasty surgery, which comprises of 3 parts, as follow. The performance testing of the CraniMesh according to the accepted standard compliance utilize the requirement of the United States Food and Drug Administration (USFDA) for medical device control and registration. This study has shown the complied test protocols and reports of all the necessary tests required by the USFDA to confirm with one of the most restrictive standards. The results showed that the CraniMesh has equivalent safety and effectiveness in both the product and the manufacturing process in international level, and this can be used as the pathway for Thai medical device manufacturer to achieve the USFDA standard. In the retrospective clinical study for the implantation of the CraniMesh and the PMMA cranioplasty plate for 28 and 30 samples, respectively, with 6-month follow-up period in multicenter to confirm the safety and effectiveness of the device, the reoperation and infection rate of the PMMA plate is 16.7% while the CraniMesh had 0%. The CraniMesh had surgical time 169.3±71.4 minutes, while the PMMA plate had surgical time at 247.0±111.7 minutes. This data was considered with the statistical methods with p-value<0.05. The pharmacoeconomic study of the CraniMesh and the PMMA cranioplasty plate utilizing the comparative utility cost analysis with economic decision tree model for 10 years analysis showed that the Incremental cost-effectiveness ratio (ICER) has negative value in the social point of view. In other word, cranioplasty surgery with the CraniMesh will have decreased cost -11,990 baht with the increased Quality Adjust Life year (QALYs) 0.04 which is more dominant and cost-saving when compared with the PMMA cranioplasty plate. In the public point-of-view, ICER will equal to 91,330 baht for annually increased QALYs. These results showed that in the social point-of-view, the CraniMesh has 77% worthiness probability to the specified worthiness at 160,000 baht for annually increased QALYs in the context of Thailand, while the PMMA cranioplasty plate has 23% worthiness probability in the same context. For the public point-of-view, the CraniMesh has 56.3% worthiness probability and the PMMA plate has 43.7% worthiness probability. All the results from every parts of this project showed the efficiency of the CraniMesh in the phase of pre-clinical study, retrospective clinical study, and pharmacoeconomic study of medical device. This results will be lead to the decision-making support for the policy to add the CraniMesh in the medical device listing in the near future to help decrease the status quo gap in public health system of Thailand.


Bureau of Dental Health, Department of Health conducted of the National Oral Health Survey consequently, every 5 years. The 9th National Oral Health Survey (2022-2023) was held to assess oral health status, oral health behaviors, key factors related to oral health among Thai population. This survey is divided into two phases, phase 1 is the survey preparation and phase 2 is the data collection and report. The implementation of this phase 1 received research funding from the Health Systems Research Institute (HSRI) to develop tools, calibration and prepare the survey team to achieve its aimed. This cross-sectional survey conduct in 7 index age; 3 years, 5 years, 12 years, 15 years, 35-44 years, 60-74 years and 80-85 years and the impact of oral health related quality of life among 12 year-old-children. Survey areas are in 25 provinces, namely Bangkok (Phaya Thai, Wang Thonglang, Khlong Sam Wa, Phra Khanong, Thon Buri, Bangkok Yai) and 2 provinces per Health Region, cover 24 provinces, namely; Chiang Rai, Phrae, Tak, Phitsanulok, Kamphaeng Phet, Chainat, Ang Thong, Pathum Thani, Suphan Buri, Ratchaburi, Chachoengsao, Rayong, Kalasin. Nong Khai, Nakhon Phanom, Chaiyaphum, Buriram, Yasothon, Sisaket, Chumphon, Krabi, Phatthalung and Satun. And collect the impact of oral health related quality of life data from 7 provinces; Phrae, Kamphaeng Phet, Pathum Thani, Chaiyaphum, Sisaket, Krabi, and Bangkok. The National Oral Health Survey tools were developed. Workshop with experts was held as a part of quality of tools development. This allowed experts to suggest on content and suitability of the tools. The results of the experts meeting was used to improve the survey forms and questionnaires, Moreover, the content validity was performed by 3 experts and the Index of item objective congruence (IOC) was between 0.81–0.94 and the total IOC was 0.88. The pilot of the interview questionnaires in 4 age groups; 12 years, 15 years, 35-44 years, and 60-74 years, were done, in order to test the suitability of language and the understanding of the interviewees. Results were used to develop the interview questionnaires forms and interview guideline. Organized a workshop aimed to clarify the guidelines for the 9th National Oral Health Survey among coordinators and 25 survey areas. Including coordinating with the survey team in order to obtain a plan in the survey area of each province, prepare samples for data collection and management plan, to ensure accuracy and completion of data. Likewise in Bangkok area, held the workshop to staffs from 13 Public Health Service Centers. The manual/ guideline of the survey was done to be used as a guideline for conducting survey. Moreover, the calibration of examiners and interviewers workshop was done in order to ensure for the reliability of the data collection covered all examiners, recorders, oral health behavior interviewers and Child-Oral Impacts on Daily Performances (Child-OIDP) interviewers. The calibration of dentition status in primary teeth was done in 5 years old children and likewise in permanent teeth among aged 12, 35-44 and 60-74. Results showed that the Kappa and Percent agreement of all examiners met the target criteria within the acceptable range. (See in table 9) In addition, the calibration of Child-Oral Impacts on Daily Performances (Child-OIDP) interview was done in the 12-year-old child. Process consisted of interview practice and result showed the Intraclass Correlation Coefficient statistic (ICC) within the range of 0.73-0.92. (see in table 8)