Factors Predicting Health Literacy among Students with Multiple Risk Behaviors in Non-Formal Education

Main Article Content

Pantip Kul-ak
Arpaporn Powwattana
Sunee Lagampan
Naruemon Auemaneekul


Introduction: This study used an ecological model as a conceptual framework. The studied factors consisted of personal factors, familial factors, and social factors. Research Objective: To explore factors predicting health literacy among students with multiple risk behaviors in non-formal education. Research Methodology: This study was a cross-sectional survey. Sample was 326 high school students with multiple risk behaviors under the Non-Formal Education Center, East Bangkok Region. A stratified sampling method was used to recruit the participants. . Data were collected using a set of questionnaires. Data were analyzed using descriptive statistics, the Pearson’s Product Moment Correlation Coefficient, and Step-wise multiple regression analysis. Results: Factors associated with health literacy of students with multiple risk behaviors were female gender, class level, grade point average, attitude towards multiple risk behavior avoidance, family relationships, control and monitoring by the family, support from healthcare providers, and education. Stepwise multiple regression analyses showed that family relationships, support from healthcare providers, education, female gender, and grade point average together explained 27.8% (R2=0.278; p<0.05) of the variance in health literacy among students with multiple risk behaviors. Conclusions: Development of health literacy among students with multiple risk behaviors is supported and promoted by personal factors, familial factors, and social factors. These findings are consistent with the conceptual framework of the ecological model. Implications: The findings can be used as empirical data to develop a program for improving health literacy among students with multiple risk behaviors. Public health personnel should cooperate with the non-formal education system to promote education, health information accessibility, and attitude modification to avoid multiple risk behaviors focusing on family engagement and to promote good relationships in family.


Download data is not yet available.

Article Details

How to Cite
Kul-ak, P., Powwattana, A., Lagampan, S., & Auemaneekul, N. (2021). Factors Predicting Health Literacy among Students with Multiple Risk Behaviors in Non-Formal Education. Journal of Health and Nursing Research (Journal of Boromarajonani College of Nursing, Bangkok), 37(2), 86-99. Retrieved from https://he01.tci-thaijo.org/index.php/bcnbangkok/article/view/251176
Research articles


1. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Journal of Health Promotion International 2000;15(3):259-67.

2. Tachawitchitjaru C. Health literacy: a key Indicator towards good health behavior. Journal of The Royal Thai Army Nurses 2017;19(1):1-11. (in Thai).

3. Intarakamhang U. Health literacy: measurement and development. Bangkok: Sukhumvit Printing Company Limited; 2017. (in Thai).

4. Department of Health. Guidelines for the development of friendly health services for teens and youth. Bangkok: The agricultural co-operation federation of Thailand; 2016. (in Thai).

5. Kipping RR, Campbell RM, MacArthur GJ, Gunnell DJ, Hickman M. Multiple risk behaviors in adolescence. Journal of Public Health (2012);34(1):i1-i2.

6. Richter M. Risk behaviors in adolescence. Germany: Springer; 2010.

7. Neal LB. Neurobiology of nicotine addiction: implications for smoking cessation treatment. American Journal of Medicine 2008;121(4):3-10.

8. Thammarangsi T. Academic documents, alcohol and brain set. [Internet]. 2018. [cited 2019 Oct1].Available from: http://resource.thaihealth.or.th/system/files/documents/11.eksaarwichaakaarchud_aelkhlaelasmng.pdf. (in Thai)

9. Mwangi M, Waruru A, Waruiru W, Gichangi A, Toroitich RC, Kim AA. Factors associated with unsafe sex among Kenyan youth. East African journal of applied health monitoring and evaluation 2018;2(1):25-37.

10. Thammaraksa P, Powwattana A, Wannasuntad S, Tipkanjanaraykha K. Factors related to multiple risk behaviors among female secondary school students. Journal of Health and Nursing Research 2019;35(1):224 - 38. (in Thai).

11. Thaikla K. A set of facts about youth outside the school. [Internet]. 2016. [cited 2019 Oct 1]. Available from: http://medipe2.psu.ac.th/tsaan/content_info.php. (in Thai).

12. Department of Disease Control. Report of 5 situations of sexually transmitted diseases in youth.
[Internet]. 2018. [cited 2019 Oct 1]. Available from: https://ddc.moph.go.th/uploads/publish/100602020050705 840.pdf. (in Thai).

13. Office of Learning Center. School of Health: Educational Innovation (Healthy school). [Internet].2017. [cited 2020 June 3]. Available from: http://resource.thaihealth.or.th/library/ hot. (in Thai).

14. Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health Education Research 2008; 23(5):840-47.

15. Panahi R, Ramezankhani A, Tavousi M, Koosehloo A, Niknami S. Relationship of health literacy with knowledge and attitude toward the harms of cigarette smoking among university students. Hamedan University of Medical Sciences 2017;3(4):38-44.

16. Thongnopakun S, Pumpaibool T, Somrongthong R. The association of sociodemographic characteristics and sexual risk behaviors with health literacy toward behaviors for preventing unintended pregnancy among university students. Journal of multidisciplinary healthcare 2018;11:149-56. (in Thai).

17. Khotnala F, Vonok L, Wawngam W, Kansin S, Suwannaphant K. Health literacy and alcohol consumption in senior secondary school students, Chaiyaphum province. Journal of Health Science and Community Public Health 2017;1(2):147 - 63. (in Thai).

18. Bronfenbrenner U. The ecology of human development: Harvard university press; 1979.

19. Ye XH, Yang Y, Gao YH, Chen, SD, Xu Y. Status and determinants of health literacy among adolescents in Guangdong China. Asian Pacific Journal of Cancer Prevention 2014;15(20):8735-40.

20. Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, et al. Maturation of the adolescent brain. Neuropsychia tric Disease and Treatment 2013;9:449-61.

21. Ghaddar SF, Valerio MA, Garcia CM, Hansen L. Adolescent health literacy: The importance of credible sources for online health information. Journal of School Health 2012;82(1):28-36.

22. Ngomsangad Y, Srisuriyawet R, Homsin P. Factors influencing health literacy related pregnancy prevention among female adolescent students in Si Sa Ket province. The Public Health Journal of Burapha University 2019;14(2):37 - 51. (in Thai).

23. Ran M, Peng L, Liu Q, Pender M, He F, Wang H. The association between quality of life and health literacy among junior middle school students. BMC public health (2018); 18(1):1183. doi: 10.1186/s12889-018-6082-5.

24. Daniel WW. Biostatistics: a foundation for analysis in the health sciences. USA: Edward Brother Malloy; 1995.

25. Duangkaew K, Powwattana A, Auemaneekul A. Factors related to multiple risk behaviors among vocational students in Bangkok. Journal of Public Health Nursing 2017;31(Special Edition):75 -96. (in Thai).

26. Wutisawat S. A study of relationship between students in level 2 [Master’s thesis]. Bangkok:Srinakharinwirot University; 2009. (in Thai).

27. Bucharoen W, Powwattana A, Pichayapinyo P. Factors related to sexual risk behaviors among secondary school students. Journal of Public Health 2013; 42(1): 30-40. (in Thai).

28. Department of Mental Health. Friendly health service standards for teens and youth Integrated version. Bangkok: Kaew Chao Chom Publications Center; 2014. (in Thai).

29. Roma W, Thanasukan C, Thipmongkolkun M, Emyong N, SamnuanKlang M, Khoiiam S. National health literacy survey project for Thai people aged 15 years and above (phase 1). Health Systems Research Institute (HSRI) 2017:1-115. (in Thai).

30. Intarakamhang U, Khumthong T. Measurement development assessment of health literacy and unwanted pregnancy prevention behavior for Thai female adolescents. Journal of Public HealthNursing 2017:31(3):19-38. (in Thai).

31. Tyan YS, Liao JR, Shen CY, Lin YC, Weng JC. Gender differences in the structural connectome of the teenage brain revealed by generalized q-sampling MRI. Journal of NeuroImage Clinical 2017;15(1):376-82.

32. Ajzen I. The personal and behavior (2nded). New York: two penn plaza; 2005.

33. Powwattana A, Auemaneekul N, Lagampan N. Prevention of risk behavior in adolescents, concepts and management at multiple levels. Bangkok: Danex; 2017. (in Thai).