Introduction/Objective Early stroke recognition and EMS activation reduce prehospital delay. This study assessed stroke-related health literacy and EMS utilization among patients with acute stroke in Thailand, as well as factors associated with timely hospital arrival (≤4.5 hours). Methods A multicenter cross-sectional study included 1,292 patients with acute stroke from four tertiary hospitals in Thailand. Structured interviews and medical-record review assessed stroke knowledge, perceived severity, EMS awareness, attitudes toward EMS utilization, and healthcare access. A generalized linear mixed model with hospital as a random effect was used to examine factors associated with timely arrival. Results Moderate stroke knowledge was observed among 600 participants (46.4%), moderate perceived severity among 500 (38.7%), and moderate EMS attitudes among 560 (43.3%). Awareness of the national EMS number (1669) was reported by 640 (49.5%), and 625 (48.4%) had previous EMS experience. Timely arrival occurred in 650 (50.3%). Significant factors were sudden symptom onset (aOR 2.50, 95% CI 1.85-3.35), moderate NIHSS severity (aOR 2.00, 95% CI 1.40-2.85), severe NIHSS severity (aOR 4.50, 95% CI 2.80-7.20), awareness of 1669 (aOR 1.70, 95% CI 1.30-2.20), caregiver assistance (aOR 3.75, 95% CI 2.79-5.05), and distance ≥35 km (aOR 4.10, 95% CI 3.00-5.60) (all p <0.001). Discussion Stroke-related health literacy was generally moderate, but gaps in EMS awareness remained. Timely arrival was associated with symptom characteristics, stroke severity, EMS awareness, caregiver support, and access factors. Conclusion Strengthening stroke-symptom recognition, EMS number awareness, caregiver preparedness, and access to emergency care may support earlier hospital arrival.
Introduction/Objective Hypertension is a major global public health issue and a major cause of death globally. It is a major risk factor for heart failure, myocardial infarction, stroke, coronary heart disease, and renal failure. Accordingly, this study aimed to investigate the factors associated with adequate health literacy among an at-risk group for hypertension in Sam Sung District, Khon Kaen Province. Methods A Cross-sectional study was conducted between July and December 2025. The study selected a purposive sample of 1,215 high-risk individuals. Data were collected via a structured questionnaire and analyzed using STATA version 15. Multiple logistic regression was employed to determine the direction and magnitude of associations, reported as Adjusted Odds Ratios (AOR) with 95% confidence intervals (95% CI) and p -values. Results After adjusting for covariates, six factors were significantly associated with adequate health literacy regarding hypertension. Females were significantly less likely to have adequate health literacy compared to males. (AOR = 0.53; 95% CI: 0.38-0.71). Individuals engaged in agriculture and wage labor demonstrated a significantly lower likelihood of adequate health literacy compared to the unemployed. (AOR = 0.27; 95% CI: 0.13-0.60) and wage laborers (AOR = 0.40; 95% CI: 0.17-0.95). Conversely, those with an average income of average income of 5,001-10,000 Baht were 1.45 times more likely to have sufficient health literacy than those earning less than 5,000 Baht (AOR = 1.45; 95% CI: 1.07-1.96) Regarding health status, individuals with diabetes had lower health literacy than those without comorbidities (AOR = 0.31; 95% CI: 0.17-0.58). Meanwhile, for hypertension preventive behaviors, participants with high levels of preventive practices had a significantly higher proportion of adequate health literacy compared to those with low levels (AOR = 5.05; 95% CI: 2.82-9.06). Lastly, participants with high levels of hypertension knowledge were significantly less likely to demonstrate adequate health literacy compared to those with low knowledge levels (AOR = 0.15; 95% CI: 0.05-0.33) Discussion Health literacy among high-risk hypertensive individuals is significantly influenced by sociodemographic factors (sex, occupation, income), diabetic comorbidity, disease knowledge, and preventive behaviors. These findings underscore the necessity of assessing health literacy to identify vulnerable groups, particularly females and socioeconomically disadvantaged individuals. Healthcare providers should leverage these insights to design targeted educational programs and personalized interventions, ultimately improving self-care practices, encouraging healthy behaviors, and reducing cardiovascular disease risks in chronic disease management. Conclusion Our findings demonstrate that the majority of individuals at risk for hypertension still exhibit inadequate health literacy. This underscores an urgent need to educate and empower these high-risk groups to enhance their health literacy and promote healthier lifestyles, serving as a core component of community health promotion.
Introduction/Objective Effective emergency management is essential for preventing serious complications among people with poorly controlled Type 2 Diabetes Mellitus (T2DM) in rural primary health care settings. This study examined how health beliefs, social-contextual factors, and self-efficacy are associated with emergency management behavior in rural Thailand. Methods This cross-sectional study included 1,074 adults with poorly controlled T2DM attending rural primary health care services. Participants completed a theory-informed questionnaire. Structural equation modeling was used to examine direct and indirect relationships among health beliefs, community participation, social support, self-efficacy, and emergency management behavior. Results The model explained 77.6% of the variance in emergency management behavior. Community participation was the strongest predictor of both self-efficacy and emergency management behavior. Self-efficacy was independently associated with better emergency management behavior and mediated the effects of social-contextual factors. Among Health Belief Model constructs, only perceived severity was directly associated with emergency management behavior. Discussion Social engagement and efficacy beliefs, rather than most Health Belief Model perceptions, accounted for emergency management behavior in this population, with self-efficacy linking social-contextual resources to behavior. Conclusion Community participation, self-efficacy, and perceived severity were the factors most strongly associated with emergency management behavior in this population. Strengthening community-based diabetes care and enhancing self-efficacy may support emergency preparedness in rural primary health care settings and inform strategies for similar resource-constrained communities.
Background Stunting remains a major public health challenge and a national development priority in Indonesia. Since 2018, the government has implemented multisectoral policies and integrated intervention programs to accelerate stunting reduction. This study aims to analyze the development of national stunting reduction policies and their implementation in Indonesia from 2018 to 2025. Methods This study employed a qualitative descriptive approach using a desk review of national policy documents and reports published between 2018 and 2025. Sources included presidential regulations, national strategies, ministerial reports, and official publications. Data were analyzed through thematic synthesis to identify policy developments, program implementation, achievements, and challenges. Results The findings indicate substantial but uneven progress in strengthening policy frameworks, institutional coordination, and intervention coverage. National stunting prevalence declined from 30.8% in 2018 to 19.8% in 2024. Key policy milestones included the National Strategy for the Acceleration of Stunting Prevention (2018) and Presidential Regulation No. 72/2021, which institutionalized multisectoral convergence. However, several indicators, such as iron-folic acid supplementation and adolescent nutrition programs, showed declining or suboptimal performance. Regional disparities, fragmented data systems, and uneven local capacity remain significant challenges. Discussion The findings suggest that Indonesia’s multisectoral policy approach has coincided with measurable progress in reducing stunting prevalence, although a direct causal contribution cannot be established from document analysis alone. Persistent disparities in implementation capacity, monitoring systems, and regional resource allocation continue to limit the equitable effectiveness of programs across provinces. Conclusions Indonesia has made notable progress in reducing stunting through strengthened policies and multisectoral approaches. However, the national target of 14% by 2024 has not yet been achieved. Strengthening local capacity, improving data integration, and enhancing community-based and behavior change interventions are essential to accelerate progress and ensure sustainable outcomes.
Introduction Chemical incidents pose a major threat to public health because of the wide availability of hazardous chemicals and their potential to cause mass casualties, often overwhelming health systems that lack specialized preparedness tools. This study aimed to develop and validate a conceptual model and a measurement instrument for assessing hospital readiness for chemical incidents in both military and civilian settings. Methods A sequential exploratory mixed-methods design was used. In the qualitative phase, semi-structured interviews were conducted with 9 experts selected through purposive and snowball sampling, and the data were analyzed in MAXQDA10 to identify codes and components. The resulting conceptual model was reviewed in two Delphi stages by the same expert panel. In the quantitative phase, a questionnaire was assessed for content validity by 10 specialists, and the finalized tool was assessed for inter-rater reliability by four independent evaluators. Results The analysis identified six core components — organizing and planning, structural facilities and physical space, medicines and medical equipment, communications and coordination, safety and security, and training and practice — comprising 28 sub-components, with decontamination emerging as a cross-cutting element. From 121 interview-derived candidate items, a 95-item preliminary questionnaire was developed; after content-validity review, deletion of 17 items, and modification/merging of 44 items, the final tool contained 66 items. Content validity was assessed by 10 specialists using CVR and CVI; the final tool was then assessed by four independent evaluators using inter-rater agreement and Cohen’s kappa. Discussion The six components reflect the multidimensional nature of hospital readiness for chemical incidents, with decontamination as the pivotal factor differentiating it from other disaster types. The model extends existing CBRN preparedness frameworks, such as the WHO Hospital Safety Index and the European TIER assessment tool, by incorporating elements specific to Iranian military-civilian healthcare settings. Conclusion This study offers a content-validated conceptual model and a preliminary assessment tool for hospital readiness in chemical incidents. Because construct and criterion validity and test–retest reliability were not established in the thesis, the tool should be regarded as a first step rather than a finished instrument; it nonetheless provides a structured starting point for evaluating and strengthening chemical-incident readiness. Future work should validate the tool against real incidents or simulations before it is used for accreditation or benchmarking purposes.
