Effectiveness of Nutrition Literacy Program on Oral Health among Thai Village Health Volunteers: A Mixed Methods Study

Articles in Press

Document Type : Original Article

Authors

1 Intercountry Centre for Oral Health, Department of Health, Thailand.

2 Sirindhorn College of Public Health Chonbrui, Praboromarajchanok Institute, Thailand.

3 Boromarajonani College of Nursing Chiang Mai, Praboromarajchanok Institute, Thailand.

Abstract

Background and Objectives: Oral health disparities remain a major public health challenge in Thailand, particularly in areas with limited dental care access. While village health volunteers (VHVs) are crucial for community health education, their role in promoting oral health through nutrition literacy remains underutilized. This study evaluated a nutrition literacy program's impact on VHVs' oral health knowledge, skills, and practice using mixed-methods research.

Materials and Methods: This study was conducted from January to March 2024 in Health Region 1, northern Thailand, using a mixed methods embedded experimental design. Sixty VHVs from mountainous areas with high oral health needs and limited dental access received a three-day training program delivered by dentists and nutritionists. Training covered nutrition literacy, communication skills, and practical community application. Data collection included pre-post tests using a researcher-developed 16-item knowledge assessment (α = 0.78) validated by experts, skill evaluations (6-item checklist, α = 0.85), observations from 5 qualified observers, and focus group discussions. Data analysis included paired t-tests and thematic analysis with methodological triangulation (p < 0.05).

Results: Participants (mean age 52.15 ± 7.20 years, 95% female) demonstrated significant knowledge improvement (mean difference = 7.38; p < 0.001) and effectiveness indices of 88.16/88.33, surpassing the 80/80 benchmark. Mean skill scores were 15.67 ± 2.319 out of 18 points. Qualitative results showed increased confidence, teamwork, technology use, leadership skills, and effective community knowledge application.

Conclusion: The program effectively enhanced VHVs' oral health knowledge and skills. Recommendations include: (1) incorporating the program into regular VHV training curricula with quarterly assessments, (2) establishing mentorship systems between experienced and new VHVs, (3) developing community-based oral health monitoring systems utilizing VHVs' enhanced skills, and (4) creating local support networks for continuous knowledge exchange and skill reinforcement. These recommendations aim to strengthen community oral health promotion by enhancing VHV capacity.

Keywords

Acknowledgement: The authors would like to thank Professor Kwanmuang Kaewdamkoeng and his team for their academic support on health literacy, Dr. Chalermpol Kongchit, Assoc. Prof. Waenkaew Chaiararm and the team from Chiang Mai University for their guidance on communication, and Asst. Prof. Umaporn Nimtrakul and the team from the Health Center Region 1 Chiang Mai for their advice on networking. This study was supported by the International Dental Public Health Center, Chiang Mai, Sirindhorn College of Public Health Chonburi, and Boromarajonani College of Nursing Chiang Mai.


Availability of Data and Materials: The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to ethical considerations in the research, some data cannot be publicly shared. Additionally, any third-party data used in this study is subject to reuse restrictions as imposed by the original providers.


Conflicts of interest: The authors confirmed that there is no conflict of interest in this study.


Consent for publication: Not applicable.


Ethics Approval and Consent to Participate: The study protocol received approval from the Human Research Ethics Committee of Sirindhorn College of Public Health, Chonburi (Certificate of Approval: COA 2023/T07, August 21, 2023). The research was conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki, emphasizing respect for the dignity, rights, safety, and well-being of all participants. All participants provided written informed consent after receiving comprehensive information regarding the study’s purpose, procedures, potential risks and benefits, measures for confidentiality protection, and their right to voluntary participation. Participants were explicitly informed of their right to withdraw from the study at any time without any consequences. Data confidentiality was rigorously maintained through the use of anonymized coding and secure data storage, accessible solely to authorized research team members. The study protocol included detailed provisions addressing potential ethical considerations, participant protections, and compliance with internationally accepted ethical standards. Approval from the Sirindhorn College of Public Health Human Research Ethics Committee (COA 2023/T07, August 21, 2023) ensures that all study procedures align with well-established ethical and scientific guidelines, prioritizing the welfare of study participants throughout the research process.

 

Funding: This research project did not receive specific research funding but rather evolved from ongoing work, utilizing research operation budgets from the Ministry of Public Health for its implementation.


Authors’ Contributions: Chollada Sorasak & Choosak Yuennan & Mansuang Wongsapai: Study conception and design; study supervision; critical revisions for important intellectual content. Worayuth Nak-Ai: Study conception and design; Data collection; literature review/analysis; manuscript writing; references. 

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

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Available Online from 15 October 2025

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