Multi-level Factors Influencing Community Empowerment in Community Health System Management, Phetchabun Province

Abstract

Community health systems serve as essential mechanisms for health promotion and disease prevention, particularly within the context of transferring sub-district health promoting hospitals to provincial administrative organizations. This cross-sectional survey aimed to 1) assess community empowerment levels using Laverack’s nine-domain framework, 2) analyze multi-level factors based on the Social Ecological Model, and 3) compare and analyze the relationships between multi-level factors and community empowerment. The sample comprised 385 Family Health Leaders across 11 districts of Phetchabun Province, selected via multi-stage sampling. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, multiple regression, and path analysis. Results revealed that overall community empowerment was at a moderate level (M = 3.10, SD. = 0.47), with the external agent role scoring highest (M = 3.64) and program management scoring lowest (M = 2.34). The five-level factors collectively explained 22.6% of variance (R² = .226, F(5, 379) = 22.16, P-value < .001); individual-level factors exerted the strongest positive influence (β = .333, P-value < .001), followed by the organizational level (β = .227, P-value = .001), whereas community                  (β = −.157) and policy (β = −.139) levels showed significant negative coefficients. No significant differences in community empowerment were found by sex or demographic characteristics, and no significant mediating effect of policy through the organizational level was detected. Recommendations include developing individual-level capacity-building programs for health leaders, strengthening the weakest domain (program management), establishing integrated community health information systems, and conducting qualitative research to understand the negative associations of community- and policy-level factors.