A covariance-based structural equation model of structural pathways influencing the performance of village health volunteers in Kranuan District, Khon Kaen, Thailand 10.55131/jphd/2026/240317
Article Sidebar
Main Article Content
Abstract
This cross-sectional study aimed to develop and test a model explaining the performance of Village Health Volunteers (VHVs) in Kranuan District, Khon Kaen Province, Thailand. VHVs are community residents selected and trained under the guidelines of the Ministry of Public Health and play a key role in community participation and access to primary healthcare services. A total of 413 VHVs were randomly selected for the study, of whom 384 completed the structured questionnaire and were included in the analysis (response rate: 92.98%). Covariance-based structural equation modeling (CB-SEM) was employed, with the measurement model first evaluated using confirmatory factor analysis (CFA) prior to testing the structural model. The final model demonstrated good fit to the data ( = 323.72, df = 286, p = 0.062; RMSEA = 0.019, 90% CI: 0.000 – 0.028; SRMR = 0.033; CFI = 0.994; TLI = 0.991) and explained 73% of the variance in VHV performance (. Empowerment and job satisfaction were directly associated with performance, whereas leadership, social networks, and work motivation were indirectly associated with performance through mediated pathways. In terms of total effects, empowerment emerged as the strongest factor associated with performance. Overall, the findings suggest that motivation, empowerment, leadership, and social networks are closely interrelated and jointly associated with VHV performance. These results highlight the importance of empowerment-oriented and motivation-supportive strategies within routine primary health care systems to strengthen VHV performance.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Health Systems Research Institute. Direction of primary health care in the fourth decade of Thailand 2009 [Internet]. Nonthaburi, Thailand: Health Systems Research Institute; 2009 [Cited 2024 Jun 2]. Available from: http://digital.nlt.go.th/dlib/files/ original/a36f945461a7893bc91459ff510a7a80.pdf.
WHO, UNICEF. Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens. Geneva, Switzerland: World Health Organization; 2022.
WHO, UNICEF. A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. Geneva, Switzerland: World Health Organization; 2018.
Bland J, Viedma C, Davies P, Ozorio P. World Health: the magazine of the World Health Organization: August-September 1988 [full issue]: Alma-Ata: 10 years after. World Health. 1988;(August-September):3-31.
Chotchoungchatchai S, Marshall AI, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Tangcharoensathien V. Primary health care and sustainable development goals. Bull World Health Organ. 2020;98(11):792-800.
Department of Health Service Support. Village health volunteers in the new era. Nonthaburi, Thailand: Ministry of Public Health; 2011.
Ministry of Foreign Affairs. Thailand’s Voluntary National Review on the Implementation of the 2030 Agenda for Sustainable Development 2021 [Internet]. Bangkok: Ministry of Foreign Affairs; 2021 [Cited 2024 Feb 17]. Available from: https://sustainable development.un.org/content/documents/279482021_VNR_Report_Thailand.pdf.
Jalagat R. Job performance, job satisfaction and motivation: a critical review of their relationship. Int J Manag Econ. 2016;5:36-43.
Aiamnui S. Factors influencing surveillance and prevention practices of COVID-19 among village health volunteers in Kongkrailat district, Sukhothai province. TJPHE. 2021;1(2): 75-90.
Ogutu M, Muraya K, Mockler D, Darker C. Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review. Hum Resour Health [Internet]. 2021 [Cited 2024 Jun 2];19(1):144. Available from: https:// doi.org/10.1186/s12960-021-00691-z
Khampeera A, Lirtmunlikaporn S, Unahalekhaka A. Factors related to practices of village health volunteers in preventing pulmonary tuberculosis transmission in community. Nursing J. 2021;48(1):174-86.
Chatio S, Welaga P, Tabong PT, Akweongo P. Factors influencing performance of community-based health volunteers' activities in the Kassena-Nankana Districts of Northern Ghana. PLoS One [Internet]. 2019 [Cited 2024 Nov 30];14(2):e0212166. Available from: https://doi.org/ 10.1371/journal.pone.0212166
Zimmerman MA. Empowerment theory: Psychological, organizational, and community levels of analysis. In: Rappaport J, Seidman E, editors. Handbook of community psychology [Internet]. New York: Kluwer Academic Publishers; 2000 [Cited 2024 Feb 2]. p. 43-63. Available from: https://doi.org/10.1007/978-1-4615-4193-6_2
Jiang F, Liu Y, Hu J, Chen X. Understanding health empowerment from the perspective of information processing: Questionnaire study. J Med Internet Res [Internet]. 2022 [Cited 2024 Jun 5];24(1):e27178. Available from: https://doi.org/10.2196/27178
Choi SL, Goh CF, Adam MBH, Tan OK. Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Hum Resour Health [Internet]. 2016 [Cited 2024 Jun 5];14(1):73. Available from: https:// doi.org/10.1186/s12960-016-0171-2
Chiu Y-W, Amin MW, Li ST, Ali M. Spiritual leadership influence on employee creative service performance: a moderated mediation analysis. BMC Psychol [Internet]. 2023 [Cited 2024 Jun 17];11(1):262. Available from: https://doi.org/10.1186/s40359-023-01294-0
Chatchaiphan T, Junprasert S, Rattanagreethakul S. Effects of Village Health Volunteers Empowerment on Perceived Self-efficacy and Caring Behavior for Persons with Diabetes in Community. JFONUBUU. 2016;24(3):83-93.
Ahmed Khan Z, Nawaz A, Khan I. Leadership theories and styles: a literature review. J Res Dev Manag [Internet]. 2016 [Cited 2024 Feb 15];16:1-7. Available from: https://www. iiste.org/Journals/index.php/JRDM/article/view/28273.
Donev D. Social networks and social support as determinants of health. In: Donev D, Pavlekovic G, Kragelj LZ, editors. Health promotion and disease prevention. Skopje: Hans Huber; 2005. p. 531-48.
Turkat D. Social networks: theory and practice. J Community Psychol. 1980;8(2):99-109.
Sato Y, Pongvongsa T, Nonaka D, Kounnavong S, Nansounthavong P, Moji K, et al. Village health volunteers' social capital related to their performance in Lao People's Democratic Republic: a cross-sectional study. BMC Health Serv Res [Internet]. 2014 [Cited 2024 Feb 2];14:123. Available from: https://doi.org/ 10.1186/1472-6963-14-123
Clark R. Fostering the work motivation of individuals and teams. Perform Improv [Internet]. 2003 [Cited 2024 Mar 11];42(3):21-9. Available from: https://doi.org/10.1002/pfi.4930420305
Sekhar C, Patwardhan M, Singh R. A literature review on motivation. Glob Bus Perspect [Internet]. 2013 [Cited 2024 Mar 11];1(1):71-87. Available from: https://doi.org/10.1007/s40196-013-0028-1
Irwan P, Siswoyo H, Agus SB. Effects of work motivation and leadership toward work satisfaction and employee performance: evidence from Indonesia. J Asian Finance Econ Bus [Internet]. 2020 [Cited 2024 Mar 12];7(6):387-97. Available from: https://doi.org/ 10.13106/JAFEB.2020.VOL7.NO6.387
Yaebkai Y, Wongsawat P. Factors affecting performance of village health volunteers in Sukhothai, Thailand. J Public Health Dev [Internet]. 2022 [Cited 2024 Jun 24];20(1):206-18. Available from: https://doi.org/ 10.55131/jphd/2022/200110
Christen M, Iyer G, Soberman D. Job satisfaction, job performance, and effort: a reexamination using agency theory. J Mark [Internet]. 2006 [Cited 2023 Nov 29];70(1):137-50. Available from: https://doi.org/10.1509/jmkg. 2006.70.1.137
Jacobson S, Carlton JS, Monroe M. Motivation and satisfaction of volunteers at a Florida natural resource agency. J Park Recreat Admn [Internet]. 2012 [Cited 2026 Jan 31];30(1):51-67. Available from: https://www.jscarlton.net/files/papers/volunteermotivation.pdf.
Veerasamy C, Sambasivan M, Kumar N. Individual skills based volunteerism and life satisfaction among healthcare volunteers in Malaysia: role of employer encouragement, self-esteem and job performance, a cross-sectional study. PLoS One [Internet]. 2013 [Cited 2024 Aug 2];8(10):e77698. Available from: https://doi.org/10.1371/journal. pone.0077698
Ministry of Public Health. Strategy policy by Ministry of Public Health. Nonthaburi: Ministry of Public Health; 2023.
Primary Health Care Division, Department of Health Service Support, Ministry of Public Health. Village health volunteer data per household. Internal report. Nonthaburi: Ministry of Public Health; 2023.
Primary Health Care Division, Department of Health Service Support, Ministry of Public Health. The role of village health volunteers during COVID-19. Nonthaburi: Ministry of Public Health; 2021.
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods [Internet]. 2009 [Cited 2024 Mar 25];41(4):1149-60. Available from: https://doi.org/10.3758/BRM. 41.4.1149
Meyerson G, Dewettinck B. Effect of empowerment on employees performance. AREMS. 2012;2(July): 40-6.
StataCorp. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021.
Tuaneh GL, Doodei W. Assessing the effects of financial inclusion on agricultural production in Nigeria: insights and implications (1999-2022). Asian J Econ Bus Account [Internet]. 2025 [Cited 2026 Jan 29];25(3):11-8. Available from: https://doi.org/ 10.9734/ajeba/2025/v25i31691
Sürücü L, Yikilmaz İ, Maslakci A. Exploratory Factor Analysis (EFA) in quantitative researches and practical considerations. GUJHS. 2024;13(2): 947-65.
Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive Goodness-of-Fit Measures. Methods Psychol Res Online. 2003;8:23-74.
Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res [Internet]. 1981 [Cited 2026 Jan 31]; 18(1):39-50. Available from: https:// doi.org/10.2307/3151312
Perkins DD, Zimmerman MA. Empowerment theory, research, and application. Am J Community Psychol [Internet]. 1995 [Cited 2024 Feb 17];23(5):569-79. Available from: https://doi.org/10.1007/BF02506982
Alrige M, Alshahrani F, Alharbi A, Aljuhani N, Aldini N. The effects of empowerment on health care worker performance during the COVID-19 pandemic in Saudi Arabia. Qual Manag Health Care [Internet]. 2022 [Cited 2024 Feb 10];31(3):143-8. Available from: https://doi.org/10.1097/qmh. 0000000000000337
Bumrungsri S, Chusak T. A Structural equation model of factors influencing role performance of village health volunteers, Nakhon Sawan Province. ART. 2017;22(1):124-36.
Chainant K, Boonchaleo J, Srilatham T, Methabutsayathon N. Factors related to the performance of village health volunteers in preventing complications in diabetic patients with type 2 in U Thong district, Suphan Buri province. JISD. 2025;3(2):119.
Kim SK, Jeong Y. Developing the healthy and competitive organization in the sports environment: focused on the relationships between organizational justice, empowerment and job performance. Int J Environ Res Public Health [Internet]. 2021 [Cited 2025 Mar 13];18(17):9132. Available from: https://doi.org/10.3390/ijerph18179132
Namsri W, Wongkumsin T. Health literacy, participation in the prevention of coronavirus disease 2019 and transformational leadership of village health volunteers in Phayao province. JPHCNE. 2021;39(1):61-74
Gonçalves T, Curado C. The role of ethical leadership and social networks in the promotion of workplace happiness and quality of care: A cross-sectional study. Int J Health Plann Manage [Internet]. 2023 [Cited 2024 Aug 2];38(5):1330-44. Available from: https://doi.org/10.1002/hpm.3663
