Royal Thai Navy Medical Journal

An Experience of Participating in the World Conference on Drowning Prevention in Sharm El Sheikh, Egypt

Thanasawat Chaiyakul — 2026-04-23

None

Editorial

Wannaporn Thongsangchan — 2026-04-23

None

Factors Predicting Severity of Respiratory Infection in Children Aged 2 to 6 Years

Jutharat Prasert — 2026-04-23

This predictive correlational study aimed to determine the prevalence of severe respiratory tract infection (RTI) in children and identify predictive factors influencing RTI severity, including nutritional status and vaccination status of children, caregivers’ perception of disease severity, caregivers’ infection prevention behaviors, and PM_2.5 levels. The sample consisted of 143 caregivers and children aged 2 - 6 years diagnosed with RTIs. Participants were recruited by inclusion and exclusion criteria. Data were collected by questionnaires and were analyzed using descriptive statistics and logistic regression.
Results revealed that the prevalence of severe RTI symptoms among children was 75.50%. Underweight children were more likely to have severe RTI symptoms than those with normal weight (OR = 9.50, 95% CI = 1.147 - 78.734, p < .037). Children whose caregivers perceived a moderate level of RTI severity were 9.23 times more likely to have severe RTI symptoms than those whose caregivers perceived a low level of severity (OR = 9.23, 95% CI = 2.331 - 36.567, p = .002) Children whose caregivers perceived a high level of severity were 13.79 times more likely to have severe RTI symptoms (OR = 13.79, 95% CI = 3.043 - 62.500, p < .001). Children whose caregivers demonstrated low levels of infection prevention behavior were 0.24 times more likely to develop severe RTI symptoms than those with high levels of infection prevention behavior (OR = 0.24, 95% CI = 0.087 - 0.677, p = .007). Neither vaccination status nor PM_2.5 exposure showed a statistically significant association with severity. Nurses should promote caregivers’ ability to assess symptom severity, strengthen infection prevention practices and improve children’s nutritional status. The findings suggest that caregiver training should be prioritized focusing on the early identification of severe symptoms and the implementation of effective home-based infection prevention strategies.

The Effects of a Basic Life Support Training Program on Knowledge, Skills, and Attitudes of Lower Secondary School Students: A Case Study of a Secondary School in Pattani Province

Sareena Suksomboon — 2026-04-23

This research aimed to study the effects of a basic life support (BLS) training program on students' knowledge, skills, and attitudes toward BLS. The sample consisted of 228 lower secondary school students from a secondary school in Pattani Province, selected through purposive sampling. The intervention included a BLS instructional program and a CPR training mannequin. Data were collected through a personal information form, a knowledge test, a skill assessment form, and an attitude questionnaire regarding BLS. The content validity was assessed by 3 experts, yielding an Item-Objective Congruence index (IOC) of 1.00. The instrument was then pilot tested with 30 participants who shared similar characteristics to the target population. The reliability of the instrument was analyzed using the Kuder-Richardson Formula 20 (KR-20), resulting in a reliability coefficient of 0.96. Data analysis involved descriptive statistics and a paired t-test for dependent samples.
The results revealed that after participating in the program, students showed significantly higher mean scores in knowledge, attitudes, and BLS skills compared to their pre-program scores, with statistical significance at the .01 level. These findings indicate that the instructional program effectively enhanced students’ knowledge, fostered positive attitudes, and improved BLS skills, which can be applied in real-life situations. Furthermore, this study provides a foundation for developing scout training curricula at the lower secondary school level.

Factor Analysis of Nursing Students’ Well-Being in Nursing Colleges Affiliated with the Praboromarajchanok Institute, Central Region Network

Parinyaporn Thanaboonpuang — 2026-04-23

            This descriptive research aimed to: (1) study the well-being of nursing students in nursing colleges affiliated with the Praboromarajchanok Institute in the Central Region Network; and (2) analyze the component of their well-being. The participants were 580 nursing students selected through multi-stage sampling from nursing colleges affiliated with the Praboromarajchanok Institute in the Central Region. The research instrument was a well-being questionnaire, divided into 5 sections: general information, having, loving, being, and health. The reliability coefficients of the instruments were 0.89, 0.92, 0.86, and 0.84, respectively. Data were analyzed using descriptive statistics and confirmatory factor analysis.
            The findings revealed that: (1) the well-being of nursing students comprised 4 key components: having, loving, being and health. The well-being model was consistent with the empirical data (c² = 2.87, df = 2, p = .24, CFI = .99, TLI = .99, RMSEA = .03, SRMR = .01, c² /df = 1.44). The most important aspect was loving, which a standardized factor loading of .91, followed by being (.89), having (.69), and the least important aspect was health (.53); and
            (2) Overall, the well-being of nursing students was at a good level (Mean = 4.00, SD = 0.40). Among the components, loving had the highest average score (Mean = 4.14, SD = 0.44), followed by being (Mean = 4.05, SD = 0.46), having (Mean = 3.94, SD = 0.49), and health (Mean = 3.82, SD = 0.54), all indicating a good level of well-being.

Self-Management and Its Associated Factors among Patients after Heart Valve Replacement Therapy in China: A Cross-Sectional Study

Xiaojing Hu — 2026-04-23

            This study aimed to describe patients' self-management after heart valve replacement and investigate relationships between age, self-efficacy, social support, depression, and self-management. A cross-sectional correlational design was employed to conduct the study. A simple random sampling was used to recruit 135 adults after mechanical valve replacement who came for follow-up at the cardiac surgery outpatient department of one hospital in Wenzhou, China. Instruments included the demographic information questionnaire, The Chinese versions of the Self-Management Scale, the General Self-Efficacy Scale, the Perceived Social Support Scale, and the Self-Rating Depression Scale. The Cronbach’s alpha coefficients were 0.91, 0.96, 0.90, and 0.80, respectively. Data were analyzed using descriptive statistics and Pearson correlation.
            The results showed that participants reported moderate self-management scores (M = 102.07, SD = 5.86). Self-efficacy and social support correlated positively with self-management (r = .347, p < .01; r = .474, p < .01, respectively). In contrast, age and depression correlated negatively with self-management (r = -.201, p < .05; r = -.325, p < .01, respectively).
            In conclusion, results inform targeted interventions to improve early postoperative self-management, including enhancing self-efficacy, strengthening social support, managing depression, and providing disease education. Such interventions may reduce complications, promote cardiac recovery, and improve quality of life.

The Challenges and Needs in Developing a Healthcare Service Model for People with Uncontrolled Type 2 Diabetes Mellitus in the New Normal Era

Nongnaphat Rungnoei — 2026-04-23

            This qualitative study aimed to explore the challenges and needs in developing a healthcare service model for people with uncontrolled type 2 diabetes in the new normal era. Purposive sampling was used to select 16 registered nurses working in diabetes clinics and 30 people with uncontrolled type 2 diabetes receiving care at diabetes clinics across eight hospitals affiliated with the Ministry of Public Health in central Thailand. Data were collected through in-depth interviews and analyzed using content analysis.
            The results revealed key service-related problems during the COVID -19 pandemic in diabetes clinics included shortages of equipment, inadequate staffing in terms of both expertise and quantity, temporary clinic closures, patients reported delays, overcrowding, and inaccurate information. Contributing factors to uncontrolled blood glucose levels included insufficient knowledge about appropriate dietary choices, excessive consumption of high-sugar foods, low commitment to dietary control, insufficient physical activities, work-related constraints affecting meal schedules, inconsistent and incomplete medication intake, and limited access to appropriate food.
            The needs for improving healthcare service models included continuous self-management support, risk-reducing and time-efficient services, increase qualified healthcare providers, sufficient and ready-to-use equipment, clear and accessible learning materials, courteous and friendly service, and telenursing monitoring and consultation system.
            This study provides insights into the context and deepens understanding of the challenges and needs of people with uncontrolled type 2 diabetes, offering guidance for developing responsive and effective health service systems in the new normal era. It emphasizes continuous self-management support, convenience, timeliness, and responsiveness to the evolving needs of people with type 2 diabetes.

Expectations and Perceptions of Service Users toward the Service Quality in Naval Primary Health Care Units

Chutima Kitpalo — 2026-04-23

            This descriptive research aimed to examine the level of service quality based on the expectations and perceptions of service users at Naval Primary Health Care Units and compare the expectations and perceptions regarding the service quality. The sample consisted of 450 service users from three Naval Primary Health Care Units, using a questionnaire that included: (1) demographic questions and problems or suggestions for improving service quality; (2) service quality expectation questions; and (3) service quality perception questions. The second and third sections of the questionnaire were modified from the SERVQUAL questionnaire on five dimensions: (1) tangibility; (2) reliability; (3) responsiveness; (4) assurance; and (5) empathy. The data were analyzed using frequency, percentage, mean, standard deviation, and the Wilcoxon signed-rank test to compare the expectations and perceptions of service quality.
            The research findings showed that: (1) the overall level of expectations of service quality at the Naval Primary Health Care Units was at the highest level (Mean = 4.38, SD = 0.50); (2) the overall level of perceptions of service quality at the Naval Primary Health Care Units was at the highest level (Mean = 4.42, SD = 0.49); and (3) there was a statistically significant difference between the perceptions of service quality and the expectations at the .01 level. Considering differences in age and purpose of using the service, it was found that the mean score of the quality of service perception was higher than the quality of service expectation.
            The findings can be used to improve service quality at the Naval Primary Health Care Units to better align with users’ expectations and to maintain high service standards.

Factors Influencing the Quality of Antenatal Care among the Pregnancy Group within the New Normal Period

Salintip Pansuwan — 2026-04-23

This study was a cross-sectional descriptive research aiming to analyze relationships and influences of predisposing, enabling, and reinforcing factors on the quality of antenatal care (ANC) among pregnant women who accessed ANC and delivery services in Samut Prakan Province during the new normal period. The PRECEDE-PROCEED Framework was applied as the conceptual framework for the study. The sample group consisted of 153 postpartum women who came for postnatal check-ups, selected through multi-stage random sampling. Data were collected using structured interview questionaires. Data were analyzed using descriptive statistics, chi-square test for relationships, and multiple logistic regression analysis to assess predictive ability.
The results showed that 72.5% of postpartum women received quality ANC according to the criteria. Statistically significant factors associated with quality ANC during the new normal period included age, occupation, health insurance, pre-existing conditions before pregnancy, pregnancy planning, pregnancy history, and delivery history (p < .05). The multiple logistic regression analysis revealed that age, pregnancy history, and delivery history were significant predictors of quality ANC during the new normal period (p < 05). Recommendations from the study suggest that nurses should develop educational programs focusing on self-care for pregnant women and fetal well-being, particularly targeting young pregnant women without prior pregnancy experience. The implementation of family planning counseling clinics, as well as practical training on maternal and fetal care, is also recommended to enhance preparedness and facilitate the transition into parenthood after childbirth.

The Effect of Self-Efficacy Enhancement Program Using Animation on Eating Behaviors of Late School-Age Children with Overnutrition

Sasiwimon Pimsri — 2026-04-23

This study employed a quasi-experimental research design with a pretest-posttest and a comparison group. The objective of the study was to examine the effect of a self-efficacy enhancement program using animation on eating behaviors of late school-age children with overnutrition who were enrolled in grades 4 - 6 at a school governed by the Bangkok Metropolitan Administration. The sample consisted of 30 children, divided into two groups: 15 children received the self-efficacy enhancement program using animation, and 15 children received regular care. The research tools included: (1) self-efficacy enhancement program using animation to improve eating behaviors of late school-age children with overnutrition, developed by the researcher based on Bandura's self-efficacy concept; (2) a questionnaire on eating behaviors of late school-age children with overnutrition; and (3) a questionnaire on self-efficacy perception toward eating behaviors of late school-age children with overnutrition. The content validity of all instruments was 1, and the reliability coefficients were 0.80 and 0.88, respectively. The data were analyzed using paired t-test and independent t-test.
The results showed that the eating behavior scores of school-age children with overnutrition significantly increased after they received the self-efficacy enhancement program using animation, compared to before they had received the program (t = 7.284, p < .001). The scores were also significantly higher than those of the group that received regular care (t = - 8.913, p < .001) at the .05 significance level.

Prevalence and Factors Related to Dysbaric Osteonecrosis among Hyperbaric Chamber Inside Attendants of Naval Medical Department

Napisaree Subsookumnuay — 2026-04-23

Dysbaric osteonecrosis (DON) is a condition observed in hyperbaric chamber inside attendants, yet research on this topic remains limited. This study aimed to investigate the prevalence and associated factors of DON among hyperbaric chamber inside attendants under the Naval Medical Department. The study enrolled 37 hyperbaric chamber inside attendants from the Naval Medical Department. Research instruments included questionnaires collecting data on personal and occupational factors, and a record sheet for diagnosing DON based on the Ficat and Arlet classification. Factors associated with DON were analyzed using Fisher’s exact test. The study found the prevalence of DON to be 18.92%, with all cases classified as Grade 1. The hip joint was the most commonly affected area. Hyperbaric chamber inside attendants diagnosed with DON had a work duration ranging from 7 to 17 years, with an average of 11.43 years. The average daily exposure to hyperbaric pressure for these individuals was 5.836×10^-3 ATA/kg.d. These findings suggest that hyperbaric chamber inside attendants with more than 7 years of work experience have an increased risk of developing DON. Furthermore, gender was found to be associated with the occurrence of DON. Therefore, screening for DON and its risk factors should be considered for operators before they begin their duties. It may also be advisable to consider job reallocation or reducing the number of hyperbaric operations for female operators. For hyperbaric chamber inside attendants diagnosed with DON, job reallocation and ongoing medical follow-up are recommended.

Factors Influencing Hospitalization due to Falls in Elderly Patients: A Retrospective Case-Control Study

Chutimon Rojtanongchai — 2026-04-23

            This retrospective case–control study aimed to identify factors influencing hospitalization due to falls in elderly patients. Data were collected from medical records of patients aged 60 years and older who were admitted to Charoenkrung Pracharak Hospital between July 1, 2019, and June 30, 2024. Patients were categorized into two groups: those hospitalized due to falls (n = 100) and a control group hospitalized for other reasons (n = 200). A data collection form developed by the researchers was used to extract demographic data, health behaviors, history of falls, comorbidities, and a list of medications used within 90 days prior to hospitalization. Group comparisons were performed using independent t-test, Mann-Whitney U test, Chi-square test, or Fisher’s exact test, as appropriate. Logistic regression analysis was conducted to identify factors associated with fall-related hospitalization.
            The mean age of participants was 75.17 ± 9.37 years, with 64% being female. Most baseline characteristics between the two groups were not statistically different, except for a history of falls within the past year and the number of medications used. Logistic regression analysis revealed that a history of falls within the past year significantly increased the risk of fall-related hospitalization (adjusted OR = 8.14, 95% CI: 4.46 - 14.86, p < .001). In addition, polypharmacy was significantly associated with increased risk: those taking 5 - 9 medications had an adjusted OR of 3.54 (95% CI: 1.68 - 7.45, p < .001), and those taking 10 or more medications had an adjusted OR of 6.38 (95% CI: 2.70 - 15.11, p < .001).
            A history of falls within the past year and polypharmacy are key risk factors contributing to fall-related hospitalization in elderly patients. Fall prevention strategies, together with regular medication reviews to deprescribe unnecessary medications, should be implemented to improve the safety of elderly patients with these risk factors.

Factors Associated with Family Member’s Confidence in Decision-Making to Choose Palliative Care for Patients in Critical Care Units

Tanyathorn Poohpalee — 2026-04-23

            This descriptive correlational research examined the confidence of family members acting as surrogate decision-makers in choosing palliative care for their relatives receiving treatment in critical care units and its related factors, including knowledge and attitudes toward palliative care, information received, perception of the patient’s needs, and family support. The sample consisted of 105 family members who were involved in decision-making for palliative care, selected based on purposive sampling, from private hospitals within the Phyathai and Paolo hospital networks. Data were collected using six questionnaires, each of which had a content validity index (CVI) of 1. The reliability of the Palliative Care Knowledge Questionnaire was tested, using the Kuder-Richardson (KR-20), with a value of 0.64. The Cronbach's alpha coefficient of the Information Received Questionnaire, the Perception of Patient Needs Questionnaire, the Multi-Dimensional Scale of Perceived Social Support (MSPSS), and the Family Decision Making Self-Efficacy Scale were 0.94, 0.98, 0.98 and 0.91, respectively. The Attitudes Toward Palliative Care Scale, including emotional, cognitive, and behavioral aspects, had Cronbach's alpha coefficients of 0.94, 0.90 and 0.71, respectively. Data were analyzed using Pearson correlation statistics.
            The results indicated that the family members’ confidence in making palliative care decisions was at a moderate level (Mean = 10.27, SD = 3.10). Knowledge, information received, attitudes toward palliative care and perception of patient needs were positively correlated with the family decision-making confidence, with statistical significance (r = .196, r = .225, r = .295, r = .345, p < .05, respectively). However, family support was not significantly correlated with confidence (r = -.024, p > .05).
            The findings suggest the need to develop support services for family members facing decisions regarding palliative care. Emphasis should be placed on enhancing knowledge and fostering positive attitudes, providing information about the patient’s condition, and promoting advance care planning. These measures aim to empower families to make informed and confident decisions regarding palliative care.

The Relationship between Personal Factors, Health Literacy in Self-Care, and Continuous Service Utilization among Patients with Diabetes Mellitus and Hypertension Receiving Treatment at Tambon Phe Health Promotion Hospital, Mueang Rayong District, Rayong

Sirilak Sikhamkhong — 2026-04-23

This descriptive cross-sectional study aimed to examine the relationship between health literacy in self-care and the continuity of healthcare service utilization among patients with diabetes and hypertension at Phe Subdistrict Health Promoting Hospital, Mueang Rayong District, Rayong Province, Thailand. The sample consisted of 207 patients, selected through simple random sampling. Data were collected using a questionnaire assessing health literacy in self-care and continuous service utilization behavior among patients with diabetes mellitus and hypertension. Content validity was verified, with item-level scores ranging from 0.6 to 1 Instrument reliability was assessed using Cronbach's alpha coefficients. Parts 2 and 3 of the questionnaires demonstrated reliability coefficients of 0.94 and 0.74, respectively. Data were analyzed using both descriptive and inferential statistics, including the Chi-square test and Pearson’s correlation coefficient. The level of statistical significance was set at .05.
The research findings revealed that the majority of participants were female, with an average age of 64.16 years (SD = 10.7 years). Most had completed primary education (78.74%). Health literacy related to self-care and continuous health service utilization were rated at very good levels among participants (74.88% and 80.68%, respectively). The analysis of relationships revealed that personal factors were not significantly associated with the behavior of continuously accessing health services. Overall health literacy regarding self-care showed a moderate positive correlation with continuous service utilization behavior, which was statistically significant (r = .592, p < .001). When examining the specific dimensions, health literacy in the areas of access, understanding, appraisal, and application demonstrated statistically significant positive associations with continuous service utilization behavior. Therefore, relevant personnel should continuously promote patients' health literacy, focusing on all four dimensions of self-care literacy to enhance both self-care effectiveness and regular healthcare service utilization.

Effects of Nursing Therapeutics to Prevent Delirium in Older Patients Admitted in Medical Intensive Care Unit

Navaporn Pukpiboon — 2026-04-23

This quasi-experimental research aimed to compare acute confusion scores following the implementation of a nursing therapeutics model designed to prevent acute confusion in high-risk elderly patients admitted to the medical intensive care unit. The sample consisted of 102 high-risk elderly patients, divided equally into a control group (n = 51) and an experimental group (n = 51), selected through purposive sampling. The control group received standard nursing care, while the experimental group received care based on the developed nursing therapeutic model for the prevention of acute confusion in high-risk elderly patients. Research instruments included: (1) a personal information record form, (2) the Richmond Agitation Sedation Scale (RASS), (3) the Confusion Assessment Method for the ICU (CAM-ICU-7), and (4) the intervention tool, a nursing therapeutic care model developed by the researcher using the ABCDEF care bundle. Instrument validity was verified by five experts, yielding a Content Validity Index (CVI) of 1. Data were analyzed using descriptive statistics, Chi-square test, Fisher’s exact test, and Mann-Whitney U test. Results showed no significant difference in CAM-ICU-7 scores between the two groups on day 2 of program implementation. However, on day 3, the experimental group had significantly lower CAM-ICU-7 scores than the control group (U = 637, p < .05), indicating the effectiveness of the intervention.

The Experiences and Needs of School Health Teachers in Delivering Sexual Health Education in Schools: A Phenomenological Study

Dujduean Khiaolueang — 2026-04-23

This phenomenological research aimed to study the experiences and needs of health teachers in teaching sexual health in schools. The informants were selected through purposive sampling, consisting of 20 health teachers in Health Region 2. The research instrument was a semi-structured interview guide that underwent content validity testing by 3 experts and was piloted with 2 health teachers who had similar characteristics to the target group. Data were collected through in-depth interviews and analyzed using interpretative phenomenological analysis. The findings revealed four challenges: (1) lack of confidence and discomfort in teaching; (2) cultural and social norm constraints; (3) limitations in knowledge and teaching skills; and (4) limited resources and support. Teachers employed five teaching strategies: adapting language and communication methods, using media and technology, organizing active learning activities, separating learning groups by gender, and integrating local values and culture. Teachers' support needs included four aspects: developing knowledge and teaching skills, educational media and innovations, policy and environmental support, and networking and knowledge sharing. Key recommendations include developing context-specific teacher training curricula, creating appropriate and modern teaching materials, establishing clear policies, and building support networks for sexuality education teachers. These findings lead to recommendations for developing health teachers' capacity in effective sexual health education.

Hyperbaric Oxygen Therapy: Advancing Wound Healing in Irradiated Oral Cancer Patients

Thanapon Suwanapong — 2026-04-23

Hyperbaric oxygen therapy (HBO₂T) is an adjunctive treatment for enhancing wound healing in patients with oral cancer who have undergone radiation therapy. Radiation-induced tissue injury (RTI) leads to compromised healing due to hypocellularity, hypovascularity, and hypoxia, predisposing patients to complications such as osteoradionecrosis (ORN). HBO₂T improves tissue oxygenation by increasing plasma-dissolved oxygen under high atmospheric pressure, promoting angiogenesis, collagen synthesis, and immune function, while reducing inflammation. This article reviews the pathophysiology of RTI and ORN, the mechanisms of HBO₂T in mitigating radiation injury, and clinical applications, emphasizing its therapeutic role and potential complications.

Fit Testing of Hearing Protection Devices and Its Integration with Hearing Conservation Programs in the Workplace: A Literature Review

Kanokjan Atisakchanon — 2026-04-23

Noise-induced hearing loss (NIHL) remains a significant occupational health concern in several countries, including Thailand. Although hearing conservation programs (HCPs) are mandated by the Department of Labour Protection and Welfare, Ministry of Labour, the calculation of noise attenuation based on the Noise Reduction Rating (NRR) provided by hearing protection device (HPD) manufacturers often fails to reflect the actual protection achieved in real-world use. To address this discrepancy, fit testing has been developed as a method to assess the Personal Attenuation Rating (PAR), providing a more accurate measurement of individual noise attenuation while wearing HPDs. A number of previous studies have demonstrated that fit testing alongside extensive training programs significantly enhances the effectiveness of HPD use among workers. However, in the context of Thailand, studies on the effectiveness of fit testing remain limited. This literature review examined the problem of noise-induced hearing loss among workers, synthesized existing knowledge on hearing conservation programs implemented across different countries, and explored the concept of hearing protection device fit testing and how to integrate fit testing into hearing conservation training programs. The review further proposes comprehensive recommendations for policymakers to strengthen legislation on hearing conservation and to promote best practices among industrial organizations and occupational health professionals.