title: Diabetes knowledge levels and the learning journeys of health volunteers in Thailand: An explanatory sequential mixed methods study
Creators: name: Chonmasuk, J
Publisher: name: Liverpool John Moores University
Year: 2023

description: Diabetes is a non-communicable disease that requires continuous care and a knowledgeable healthcare workforce. The prevalence of diabetes has increased and is known to affect both the quality of life and finances of patients in countries without universal healthcare provision. Thailand is a developing country and has experienced the health care shortage for many years. In contrast, the number of people who need the health service is increasing day by day. It is challenging for the country to manage their population health within the limited budget and availability of the healthcare staff. For many decades, the HVs have been recognised and involved in several community health projects in Thailand. Employing HVs to work in the community is seen as a means of increasing service provision without increasing expenditure. Currently it is approximately one million HVs are active in Thailand. A HV is a lay person who is recruited by the community. The HV received the trainings from the healthcare staff, then delivered multiple health services for the community. They were also assigned to take care of 10-15 households in their community. As the HV is a voluntary job the HV is not required to work full time. The HV works only once a week or four times a month. Initially the HV was not given the monetary incentive; however, currently the HV earned monthly compensation from the government for doing service every month. In Thailand, the Health Volunteer (HV) plays an important role in providing care for diabetic patients in the community. However, the knowledge levels and learning experience of this workforce are key to the provision of high-quality patient care. Yet little is known about these phenomena. This study employed an explanatory sequential mixed methods design to explore the HVs’ knowledge of diabetes and their learning experiences. The study was undertaken in two phases. The first phase included amending, cross culturally adapting and translating, testing and administrating a diabetes knowledge questionnaire. This modified questionnaire was found to be valid (CVI=0.875-1) and reliable (KR= 0.830) and was therefore administered to 390 HVs in Thailand. The results of the study enabled the researcher to identify those with differing knowledge levels, a factor that was included in the purposive sampling framework for the second phase of the study where 15 HVs participated in a semi-structured interview. The findings of the first phase highlighted that 73.3% of the HVs lacked knowledge of diabetes with greater knowledge being noted in the management of diabetes and lower knowledge recorded in areas focussed on the prevention of the disease. HVs who possessed high knowledge levels were likely to be motivated to learn whereas the converse was true in those with lower knowledge levels, underlining the importance of motivation to learning. Classroom training was the main learning resource available for the HVs. HVs who attended the training were likely to have higher knowledge levels compared to those who did not attend class; however, findings from the second phase of the study found that the training was not prioritised due to financial pressures and family commitments. Although the classroom lecture-based training was deemed to be beneficial for the HVs, the high number of classroom attendees and the didactic teaching methods presented a number of barriers to learning including, noise, peer pressure and unfavourable teaching methods. In addition, poor memory, limited prior knowledge and a perception of a theory-practice gap inhibited the HVs’ effective learning. Although there were several online diabetes learning resources available, these were rarely accessed, the reason for which was unclear but may have been related to internet access. Conclusion: The study findings indicate that the current diabetes knowledge of the HVs may not be enough to provide holistic care for the population they serve, as the HVs possess knowledge gaps in several areas. The study findings also highlight that the large class teaching, inadequate relevance to practice, competing priorities and limited focus on the prevention of the complications of diabetes, contributed to a lack of knowledge among the HVs. It is necessary to eliminate many of the barriers to learning that have been identified in this thesis and reshape the educational provision to enable the HVs to play a more productive role in the management of people with diabetes in the local community.