Development of a Collaborative Operational Model Between District Public Health Offices and Sub-district Health Promotion Hospitals in Transferred Areas to Enhance Access to Healthcare Services in Kamphaeng Phet Province

Abstract

This study had three objectives: (1) to identify factors influencing access to health services among populations in sub-district health-promoting hospitals (HPHs) transferred under administrative decentralization; (2) to develop a collaborative operational model between district public health offices and HPHs in decentralized areas; and (3) to evaluate the effectiveness of the proposed model. A research and development (R&D) design with an explanatory mixed-methods approach was. The sample consisted of 252 local residents and 252 HPH personnel in areas transferred to the Kamphaeng Phet Provincial Administrative Organization (PAO). Data were analyzed using analysis of variance (ANOVA) and structural equation modeling (SEM). Findings revealed that most service recipients at decentralized HPHs were female (72.2%), with one-third aged 50 years and above (33.7%). The majority were married (57.9%), and 38.5% had completed secondary education. Over half were engaged in agriculture (52.4%), while a small proportion worked in private companies (4.4%). Factors significantly associated with satisfaction included gender, age, marital status, and education level. Regarding HPH personnel, most were female (76.2%), with the majority aged between 30 and 39 years (35.3%). More than half (64.3%) held public health officer positions, and 67.1% had over six years of experience. All participants worked at HPHs. SEM results indicated that demographic, socioeconomic, knowledge, attitude, and decentralization impact components jointly predicted 52% of the variance in perceived decentralization impacts. The causal model of health service access in decentralized areas demonstrated good model fit (χ² = 37.826, p = 0.169, CMIN/DF = 1.243, RMR = 0.081, GFI = 0.971, AGFI = 0.948, RMSEA = 0.031). The development of the collaborative operational model through expert seminars based on the Connoisseurship approach yielded six operational guidelines, four strategies, and four expected outcomes. The evaluation of the model’s effectiveness, also through expert seminars, affirmed its practical applicability. It is recommended that relevant agencies apply the developed model to enhance cooperation among district public health offices, decentralized HPHs, and the PAO.