Analysis of a school-based health education model to prevent opisthorchiasis and cholangiocarcinoma in primary school children in northeast Thailand

Abstract

Infection with the liver fluke Opisthorchis viverrini is the major causative factor inducing cholangiocarcinoma in the Mekong region of Southeast Asia. Northeast Thailand has the highest incidence of this cancer worldwide leading to about 20,000 deaths every year. Infection with the liver fluke comes from eating raw or undercooked fish, a tradition in this area that can potentially be countered by education programs at school level. Here we develop a school-based health education model, based on protection motivation theory (PMT), including module design, learning materials, student activities, and capacity building amongst teachers. This education program was applied and tested in primary school to pupils (9-13 years) in Khon Kaen province, northeast Thailand. Using a randomized control trial, four schools served as intervention groups ( n = 118 pupils) and another four acted as controls ( n = 113 pupils). Based on PMT constructs, we found that the pupils in the intervention group had significantly greater knowledge and perceived the severity, vulnerability, response efficacy, and self-efficacy parameters concerning the dangers of eating raw fish and of developing cholangiocarcinoma than those in the control schools ( p < 0.05). All of the PMT constructs measured were significantly intercorrelated with each other ( p < 0.001). At the same time, some background knowledge, from community-based education programs, was present in the control schools. The result from this initial study suggests that PMT can be used to predict protective attitude as well as behavior changes in evaluating the consequence of school health intervention programs.

Current Perspectives on Opisthorchiasis Control and Cholangiocarcinoma Detection in Southeast Asia

“…School-based health education has been advocated for prevention of many infectious diseases ( 90 ) as well as for OV and CCA ( 91 ). Based on our initial trial ( 92 ), a school-based curricula program was established through the Faculty of Education, Khon Kaen University (KKU), and included primary to secondary school courses as well as vocational study. This has been implemented in 31 schools in 3 provinces in northeast Thailand.…”

Community- Based Approaches to Cancer Prevention in Rural Thailand Based on Experiences of Accredited Health Professionals

“…This is the way to improve health literacy for community people. Previous study showed enhancing knowledge and perceived self-efficacy could make concerning danger of eating raw fish and of developing cholangiocarcinoma (Laithavewat, 2018).…”

Public health interventions for preventing re‐infection of Opisthorchis viverrini: application of the self‐efficacy theory and group process in high‐prevalent areas of Thailand

“…No OVinfected Bithynia snails, the first intermediate host, were detected in the lake after six years of implementation [28]. Several studies in Thailand have also indicated a correlation between the self-efficacy application on the health education programme for preventing OV and CCA [12][13][14][15]. There is some critical evidence that public health programmes are beneficial: without behavioural modifying public health processes, 86% of the infection could relapse [29].…”

“…Many studies have presented models for behaviour modification and reducing CCA risk in northeast Thailand. Health education programmes for preventing OV and CCA by applying the self‐efficacy concept of Bandura [11] were designed in the Nakhon Ratchasima [12, 13], the Surin [14] and the Khon Kaen [15]. Moreover, a group process study was applied to change consumption behaviour causing OV infection risk in the Sakon Nakhon [16].…”