Development of a Health Education Modification Program Regarding Liver Flukes and Cholangiocarcinoma in High Risk Areas of Nakhon Ratchasima Province Using Self-Efficacy and Motivation Theory

  • Published : 2016.06.01


A quasi-experimental study was conducted to develop a health education modification program based on self-efficacy and motivation regarding liver flukes and cholangiocarcinoma development in Keang Sanam Nang district, Nakhon Ratchasima province, Thailand. A total of 36 individuals were invited to participate in the program and were screened for population at risk of liver fluke infection and cholangiocarcinoma using SUT-OV-001 and SUT-CCA-001. Development of health education modification program regarding liver fluke and cholangiocarcinoma prevention included 3 steps: (1) preparation, (2) health education program, and (3) follow-up and evaluation. The study was implemented for 10 weeks. Pre-and-post-test knowledge was measured with questionnaires, Kuder-Richardson-20: KR-20 = 0.718,and Cronbach's Alpha Coefficient = 0.724 and 0.716 for percection and outcome expectation questionnaires. Paired and independent t-tests were applied for data analysis. The majority of the participants were female (55.6%), aged between ${\leq}50$ and 60 years old (36.1%), married (86.1%), education level of primary school (63.9%), agricultural occupation (80.6%), and income <4,000 Baht (44.4%). The results revealed that after the health education program, the experimental group had a mean score of knowledge, perception, and outcome expectation regarding liver fluke and cholangiocarcinoma prevention significantly higher than before participation and in the control group. In conclusion, this successful health education modification program for liver fluke and cholangiocarcinoma, therefore may useful for further work behavior modification in other epidemic areas.


Supported by : Suranaree University of Technology (SUT)


  1. Sripa B, Kaewkes S, Intapan PM, et al (2010). Food-borne trematodiases in Southeast Asia: epidemiology, pathology, clinical manifestation and control. Adv Parasitol, 72, 305-50.
  2. Sripa B, Tangkawattana S, Laha T, et al (2015). Toward integrated opisthorchiasis control in northeast Thailand: the Lawa project. Acta Trop, 141, 361-7.
  3. Suwannahitatorn P, Klomjit S, Naaglor T, et al (2013). A follow-up study of Opisthorchis viverrini infection after the implementation of control program in a rural community, central Thailand. Parasit Vectors, 6, 188
  4. Thamavit W, Bhamarapravati N, Sahaphong S, et al. (1978). Effects of dimethylnitrosamine on induction of cholangiocarcinoma in Opisthorchis viverrini-infected Syrian golden hamsters. Cancer Res, 38, 4634-9.
  5. Wongsaroj T, Nithikathkul C, Rojkitikul W, et al (2014). National survey of helminthiasis in Thailand. Asian Biomedicine, 8, 779-83
  6. Wykoff DE, Harinasuta C, Juttijutada P, et al (1965). Opisthorchis viverrini in Thailand-the life cycle and comparison with O. felineus. J Parasitol, 51, 207-14.
  7. Becker MH, Maiman LA (1975). A new approach to explaining sick role behavior in low income population American of Public Health. Southeast Asian J Trop Med Public Health, 3, 330-6.
  8. Best JW (1977). Research in education (3rd ed). Englewood Cliffs, NJ: Prentice-Hall.
  9. Bloom BS. (1971). Handbook on formative and summative of student learning. New York: Mc Graw-Hill Book Company.
  10. Harinasuta C, Vajrasthira S (1960). Opisthorchiasis in Thailand. Ann Trop Med Parasitol, 54, 100-05.
  11. House JS, Kahn RL (1985). Measures and concepts of social support. In S. Cohen & S. L. Syme (Eds.), Social support and health. New York, NY: Academic Press, 83-108.
  12. IARC. (1994). Infection with liver flukes (Opisthorchis viverrini, Opisthorchis felineus and Clonorchis sinensis). IARC Monogr Eval Carcinog Risks of Hum, 61, 121-75.
  13. Janz NK, Becker MH (1984). The health belief model: A decade later. Health education Quarterly, 11, 1-47.
  14. Kaewpitoon N, Kaewpitoon SJ, Pengsaa P., et al (2007). Knowledge, attitude and practice related to liver fluke infection in northeast Thailand. World J Gastroenterol, 13, 1837-40.
  15. Kaewpitoon N, Kaewpitoon SJ, Pengsaa P (2008). Opisthorchiasis in Thailand: review and current status. World J Gastroenterol, 14, 2297-302.
  16. Kaewpitoon N, Kaewpitoon SJ, Pengsaa P, et al (2008). Opisthorchis viverrini: the carcinogenic human liver fluke. World J Gastroenterol, 14, 666-74.
  17. Kaewpitoon N, Kootanavanichpong N, Kompor P, et al (2015). Review and current status of Opisthorchis viverrini Infection at the community level in Thailand. Asian Pac J Cancer Prev, 16, 6825-30
  18. Kaewpitoon SJ, Thanapatto S, Nuathong W, et al (2016f). 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. Asian Pac J Cancer Prev, 17, 1111-4.
  19. Preuksaraj S, Jeeradit C, Satilthai A, et al (1982). Prevalence and intensity of intestinal helminthiasis in rural Thailand. Con Dis J, 8, 221-69.
  20. Sadun EH (1955). Studies on Opisthorchis viverrini in Thailand. Am J Hyg, 62, 81-115.
  21. Sithithaworn P, Andrews RH, Nguyen VD, et al (2012). The current status of opisthorchiasis and clonorchiasis in the Mekong Basin. Parasitol Int, 61, 10-6.