ABSTRACT
The evaluative instrument for the monitoring of primary medical care services in rural areas in Thailand, consisting of health risk, sickness-related dysfunction, health-specific coping index and health care of the patient's family, was developed and tested by 2,394 patients in the 4 regions. The patients had high health risk (70.8 +/- 14.0), high health-specific coping index (71.3 +/- 16.4), high health care of patient's family (76.1 +/- 10.0), and very low sickness-related dysfunction (13.4 +/- 15.6). The average time used for assessing the patients' perception of health was 37.9 minutes by sanitarians, 32.9 midwives, 29.9 by nurses and 24.8 by medical doctors. The reliability of the instrument was tested by paired interviewers; sanitarians and midwives, medical doctors and nurses, and was highly reliable for health risk and health-specific coping index. Language was the major obstacle in interviewing in the South.
PIP: An evaluative instrument designed to monitor primary health care services in rural Thailand was pretested on 2394 patients from district hospitals, health centers, and midwifery centers in all 4 regions of the country. The respondents, half of whom were agricultural workers, were most likely to suffer from perinatal disorders (25%), respiratory diseases (16%), and digestive disorders (15%). The evaluative instrument included items on health risk, sickness-related dysfunction in the preceding 6 months, health-specific coping strategies, and health care of the respondent's family. Factor analysis revealed that health risk and health-specific coping had eigenvalues exceeding 1. The Pearson correlation coefficients showed that health risk was positively associated with sickness-related dysfunction and health-specific coping styles, but negatively associated with health care of the family. In addition, there was an inverse association between health risk and both monthly family income and educational level. The mean health risk score was 64.1 in the South, 73.6 in the North, 70.9 in Central Thailand, and 73.1 in the Northeast. Health-related dysfunction was low in all regions and averaged 13.4 + or - 15.6. The average time required to complete the interview was 37.9 minutes for sanitarians, 32.9 minutes for midwives, 29.9 minutes for nurses, and 24.8 minutes for physicians. In the South, language was a major obstacle and the use of self- administered questionnaires should be considered. T-test findings indicated that the health risk and health-specific coping indices are highly reliable. The findings suggest that this instrument can be used effectively to monitor primary health care services from the district level down to the village level in rural Thailand.
