Effectiveness of a Health Educational Program Based on Self-Efficacy and Social Support for Preventing Liver Fluke Infection in Rural People of Surin Province , Thailand

Liver fluke infection caused by O. viverrini remains a major public health problem in many parts of Southeast Asia including Thailand, Lao PDR, Vietnam and Cambodia (IARC, 1994; Kaewpitoon et al., 2008b; Sripa et al., 2010; Sitthithaworn et al., 2012; Kaewpitoon et al., 2015a). Infection is acquired by ingestion of undercooked cyprinoid’s fish harboring infective metacercariae (Kaewkes 2003). Liver fluke is endemic among human populations in northeast and north Thailand, where the most common raw fish “Koi pla” is frequently consumed

Behavior on prevention and control of liver fluke infection are essential for decreasing the disease.Previously studied indicated that knowledge, attitude, and practice related to liver fluke infection in rural communities (Kaewpitoon et al., 2007).Therefore, health modification is need required in this areas particularly improvement of corrected knowledge, and practice in the risk group or people who had a history with opisthorchiasis.Improvement of high knowledge, perception, and practice regarding diseases, depend on varieties of health education.Boom (1971), Becker andMaiman (1975), andJanz andBecker (1984) indicated that the success behavior modification should be used many methods and continuous intervention.In addition, self-efficacy and social support influencing behavior modification, common used in the health education program (House and Kahn 1985).
According a serious data on liver fluke in the epidemic areas, therefore, this study aimed to study the effectiveness of health education program based on self-efficacy and social support model on liver fluke in Tha Tum district, Surin province, Thailand.The health education program may useful and effective toward liver fluke prevention and control in the epidemic communities.

Materials and Methods
A quasi-Experimental study was approved by the human research ethics committees of Suranaree University of Technology, 2013.The study was performed during October 2014 to July 2015 in Tha Tum district, Surin province, northeastern Thailand where reported the epidemic areas.Of 70 participants was assigned to 2 groups; 35 participants were experimental group and received health education programs, meanwhile 35 participants were a control group that without the same health education program.Health education program was applied based on self-efficacy and social support theory for health behavioral modification regarding liver fluke.Health education program included Week 1; knowledge improvement which composed of lectured with multimedia, demonstration regarding general knowledge on the epidemiology, morphology, life cycle, transmission, sign and symptoms, pathogenesis, related diseases, diagnosis, treatment, prevention and control of liver fluke, Week 2; lectured with poster, brochure, and handbook regarding general knowledge toward liver fluke similar to week 1, Week 3; lectured toward susceptibility and severity of opisthorchiasis, benefits and perceived barriers to prevention of opisthorchiasis, Week 4; group discussion with their health belief, sharing their ideas and experience toward liver fluke prevention and control, and Week 5-10; social support from village health volunteers (VHV), head village (HV), friends, their member of family, and public health officer (PHO).The followed-up by PHO/VHV/HV, and giving certificates and flag for household that did not eat raw fish.The study was implemented for 10 weeks.Pre-and-post-test was measured with questionnaires.

Results
The majorities of participants were female (80.0%), age between 31-70 years old (48.6%), married (80.0%), primary school (85.7%), agriculture (88.6%), and income <4,000 Baht (Table 1).The results reveal that after the experiment, experimental group had mean score of knowledge higher more than before the experiment (mean difference=3.1,t=3.915, 95%CI-3.3,-1.8 p-value=0.001),and control group (mean difference=2.5,t=4.196,95%CI=1.4,3.6, with a statistical significantly.The results also found that after the experiment, experimental group had mean score of practice higher more than before the experiment (mean difference=4.6,t=4.331,and control group (mean difference=4.4,t=6.142,95%CI=4.2,7.9,) with statistical significantly.The perceived susceptibility and perceived severity of opisthorchiasis, perceived benefits and perceived barriers to prevention of opisthorchiasis, more than before the experiment and control group was significantly (p-value <0.001).All data was shown in Table 2 and 3.

Discussion
Development of a community-based approach to opisthorchiasis control has been recommended (Duangsong et al., 2013).Toward integrated opisthorchiasis control in northeast Thailand: the Lawa project was showed to be the best model (Sripa et al., 2015).Community-based health education and communication model development for opisthorchiasis prevention has been also implemented in a high-risk area, Khon Kaen Province, Thailand (Promthet et al., 2015).This quasi-experimental study was conducted in the epidemic areas where is the top ten of high prevalence of liver fluke infection in Thailand (Wongsaroj et al., 2014).All participants was purposive selected from who had a history with opisthorchiasis.The majorities of participants were female (80.0%), age between 31-70 years old (48.6%), married (80.0%), primary school (85.7%), agriculture (88.6%), and income <4,000 Baht.This recent results is similar to that several approaches for reducing opisthorchiasis-linked CCA.All participants were 30-69 years of age.Of all the participants, more than 60% had regularly participated in activities to prevent CCA following health official advice.Age and health behavior to prevent CCA were factors associated with community participation for CCA (p<0.001) (Songserm Recently, the results reveal that after the experiment, experimental group had mean score of knowledge more than before the experiment and control group.This result is similar to that Boom (1971) suggested the success of behavioral modification should be composed varieties activities.Here, we have lectured, demonstrated, and trained.Therefore, experimental group had a high score of knowledge.Furthermore, after experiment, the experimental group had a high mean score of perception more than before and control group, this similarly to Becker andMaiman (1975), andJanz andBecker (1984).Discussion and sharing of the perceived susceptibility and perceived severity of opisthorchiasis, perceived benefits and perceived barriers to prevention of opisthorchiasis, effecting their improve perception.In addition, the results indicate that the experimental group had mean score of practice more than before the experiment and control group.This continuous good practice is dependent on social support that influencing behavior modification, this is similarly to House and Kahn (1985).
This health education program is success to health behavior modification in the rural communities therefore it may useful for further work behavior modification in the other epidemic areas.

Table 1 . Demographical Characteristics of Experimental and Control Groups
-16.1 points.The questionnaires were completed a content validity by 3 experts on liver fluke knowledge, and then tryout in closely neighbor communities for reliability test.The questionnaires has reliability value according to knowledge part with Kuder-Richardson-20: KR-20 = 0.78, perceive and practice with Cronbach's Alpha Coefficient = 0.75, 0.73, 0.73, and 0.76.Descriptive and analytical statistical data were analyzed with SPSS software.Percentage, mean, standard deviation, Paired t-test, Independent t-test, the statistical significance level of .05 were employed for data analyzes.Health Educational Program Based on Self-Efficacy and Social Support for Preventing Liver Fluke Infection in Rural Thailand