Development of a School-Based Health Literacy Model for Liver Fluke Prevention and Control Using Participatory Action Research

Document Type : Research Articles


1 Faculty of Public Health, Khonkaen University, Khonkaen Province, Thailand.

2 Faculty of Public Health, Valaya Alongkorn Rajabhat University under the Royal Patronage, Pathumthani Province, Thailand.

3 Parasitic Disease Research Center, Nakhon Ratchasima, Thailand.

4 Department of Public Health, Faculty of Nursing and Allied Health Sciences, Phetchaburi Rajabhat University, Phetchaburi, Thailand.

5 Department of Nursing, Faculty of Nursing and Allied Health Sciences, Phetchaburi Rajabhat University, Phetchaburi, Thailand.

6 Kuchinarai District Public Health Office, Kalasin Province, Thailand.

7 ASEAN Cancer Epidemiology and Prevention Research Group, Thailand.


Background: Liver fluke caused by Opisthorchis viverrini is a serious health problem in the northeastern region of Thailand. It is associated with endemic cholangiocarcinoma (CCA) in this region. This study was performed to develop a school-based health literacy model for liver fluke prevention and control using participatory action research.   Method: The participants of this study included 3 school administrators, 5 teachers, 45 senior high school students, 2 health officers, and 5 health volunteers. in Phanom Phrai District, Roi-et Province, Thailand. The study employed mixed methods for data collection, including qualitative methods namely policy analysis, interview, and problem-solving as well as quantitative methods namely pre and post-tests and implementation of health literacy. Six months later, researchers evaluated the outcome. The average scores of the participants’ health literacy and their practical skills were measured. Result: The participants’ health literacy and practical skill mean score increased after the intervention (mean difference=20.20, 95%CI 15.37-25.03, p-value <0.001) and (mean difference=21.10, 95%CI 19.10-23.10, p-value <0.001). School activities were concluded regarding public relations for one time a week, exhibitions, learning summary speech contests, and organizing a school food safety club. In addition, school rules were agreed and included: (1) cooked food consumption (2), stopping undercooked cyprinoid fish by the household cooker (3), correcting misunderstanding in each household in the community (4), hygienic defection, and (5) reminding friends to stop consumption of undercooked food. Conclusion: The results indicated that school-based model was effective. The stakeholder experiences and learning processes using teamwork will help the development of skills to cooperate and coordinate students choosing the best method for Liver fluke prevention and control. Moreover, they should continue to improve the suitable network for each school to ensure that the models are sustainable.


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