Technology Ladkrabang, Ladkrabang, Bangkok, Thailand 3 Clever Way Company Limited, Phayathai Plaza Building,

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1 135 (2): , December 2006 ISSN Evaluation of Public Relations and Behavioral Responses to Prevention and Control Measures Against Lymphatic Filariasis Afflicting People Living in Epidemic Areas in Thailand Tawadchai Suppadit 1, Pukkapong Poungsuk 2, and Suporn Chaikitmongkol 3 1 The Graduate Program in Environmental Management, School of Social and Environmental Development, National Institute of Development Administration, Bangkapi, Bangkok, Thailand 2 Department of Agricultural Education, King Mongkut s Institute of Technology Ladkrabang, Ladkrabang, Bangkok, Thailand 3 Clever Way Company Limited, Phayathai Plaza Building, Phayathai Road, Rajdhevee, Bangkok, Thailand The evaluation was conducted in order to find ways of improving public relations for greater efficiency. Questionnaires were used for data collection. Four hundred and sixty-two residents in epidemic areas were randomly selected to constitute the sample groups. Results indicated that most respondents had never attended meetings/training programs/seminars or participated in activities/exhibits related to LF. However, they had received related information through LF prevention campaigns. People s knowledge, attitudes and adoption of practices were at moderate level. Hypothesis testing showed that: (1) settlement period was related to knowledge about LF; (2) age, educational attainment and social membership were related to attitudes toward LF; (3) age, settlement period, educational attainment, occupation and social membership were related to adoption of practices on LF prevention; (4) meeting/training/seminar attendance, participation in activities/exhibits, and receiving information through campaigns were related to knowledge about LF; (5) knowledge was related to attitudes toward LF; and (6) attitudes were related to adoption of practices on LF prevention. Ways of improving public relations were recommended as follows: (1) use public relations continuously and encourage people to participate in developing public relations media; (2) emphasize production of audio-visual and public relations media which can best draw the attention of the people; and (3) produce different forms of media tools and materials. Key Words: attitude, knowledge, lymphatic filariasis, mosquito, practices, vector- borne disease INTRODUCTION Lymphatic filariasis (LF) is found mostly in tropical and subtropical regions of the world particularly in Africa, China, India, Indonesia, South Japan, Korea, Malaysia, Myanmar, and Thailand (Suppadit 2003). In Thailand, most LF victims reside in the southern part of the *Corresponding author: tawatc.s@nida.nida.ac.th country and in area near the Myanmar border. At present, approximately 120 million people around the world are afflicted with LF and about 40 million of them are crippled (Suppadit 2005). LF is caused by Wuchereria bancrofti and Brugia malayi, a kind of roundworm living in the human body. The disease normally enters the lymph glands and lives in the human body for about 4 to 6 years. It 131

2 can propagate millions of parasites in the blood stream and the disease can be transmitted when a mosquito that has bitten people infected with LF bites other people (Siamhealth Team 2004). The parasites cause inflammation and clogging of lymph glands. LF also causes swelling of the legs, arms, and the sex organ. Mosquitoes of Mansonia spp. and Culex spp. are LF carriers. (The Office of Disease Prevention and Control 3 Chonburi 2004) LF is an infectious disease that exacerbated public health problems in epidemic areas of Thailand, particularly near the Thailand and Myanmar border as well as in the southern part of the country. Although LF was successfully controlled in risk areas in the past (decrease in blood infection from 3.16% in 1964 to 0.190% in 2002), the government still continuously strives toward the total eradication of LF in the year 2006 or at the end of the National Ninety Plan for Social and Economic Development ( ) (Suppadit 2003). The World Health Organization also considers LF as one of the diseases that can be eradicated because there is an appropriate technology that can be used for its eradication (Department of Communication Disease Control 1998). The government policy aims reduce the number of LF patients that have accumulated for the past 5 years to less than 1 patient/1,000 population (Department of Communication Disease Control 1998). Toward this goal, public relations have been used as a means to broaden the knowledge and information on LF eradication. To assist in implementing such policy, researchers evaluated the use of public relations and the factors that influence knowledge, attitudes, and practices in the prevention and control of LF among people in epidemic areas of Thailand. Results obtained from the study can be used as input to improve public relations for greater efficiency. Six hypotheses in this study were tested for relationship of variables: (1) between personal factors (such as age, settlement period, educational attainment, occupation, and social class) and knowledge about LF; (2) between personal factors and attitudes toward LF; (3) between personal factors and adoption of practices LF prevention and control; (4) between meeting/training/seminar attendance, participation in activities/exhibits, and receiving information through campaigns on LF and knowledge about LF; (5) between knowledge about LF and attitudes toward LF; and (6) between attitudes toward LF and adoption of practices regarding LF prevention and control. MATERIALS AND METHODS Respondents in this research, aged 15 and above, live in 11 provinces along the Myanmar border and southern part of Thailand considered as epidemic areas: Maehongsorn, Chiangmai, Lamphoon, Tak, Kanchanaburi, Ratchaburi, Krabi, Suratthani, Nakhonsrithammarat, Ranong, and Narathiwat. There were 462 sample groups included in this study based on the sample grouping by Yamane (1967), following the guideline that when the population is more than 100,000 up to infinity at the level of reliability percentage of 95 and the percentage of deviation of 5, then 400 samples are obtained. Thus, the 462 sample groups included in this study are more than the number suggested by Yamane. Random sampling by non-purposive selection was patterned after the method used by Tirakanon (2001). The 462 respondents, who were asked to fill in the questionnaires, were considered as representatives of people living in the 11 provinces (22 tambols; 2 tambols/ province). Twenty-two tambols were the source of LF infection areas. Each area had a sample group consisting of 20 people and 1 person who was an LF patient/relative. A questionnaire consisted of 8 parts such as follows: Part 1 Personal factors such as age, settlement period, educational attainment, occupation and social class. Part 2 Meeting/training/seminar attendance, participation in activities/exhibits, and exposure to information through campaigns on LF. Questions were about experiences on information exposure and types of media. Part 3 Questions about LF patients and how to treat the disease. Part 4 Respondents knowledge about LF. The questions consisted of 10 items concerning appearance, prevention, and control. Five items were positive questions and the other 5 were negative questions. Correct answers were given 1 mark and incorrect ones were given 0. The level of knowledge was classified into the following criteria: low, moderate, and high as indicated by 0 3, 4 7, and 8 10, respectively. Part 5 People s attitudes toward LF. There were 12 questions, 6 of which were positive questions and the rest were negative. The answers are in principle as follows: the person with good, moderate, and low attitude refers to the respondent who scored in a period of (> + S.D.), ( ± S.D.), and (< S.D.), respectively. 132

3 Part 6 People s behavioral response to LF was determined in terms of adoption of practices regarding LF prevention and control. The answers to 10 questions were scored in principle as follows: response at low level (0 5 points), medium level (6 14 points), and high level (15 20 points). Part 7 Audio and visual inputs from mass media and volunteers involved in public health were questions about information received through the public relations media. Part 8 Opinions and advice. The questionnaires arranged for testing were brought to qualified compilers, such as specialists and academic lecturers, for them to determine content validity and proper wording. Both specialists and academic lecturers were asked to provide advice in order to improve, correct, and select especially accurate wording. Next, the questionnaires were pretested by random sampling of 20 residents in Sripachan district of Suphanburi province; and then examined and analyzed for reliability by means of Cronbrach s Alpha method (Wanitbancha 2003). The calculated result on reliability of knowledge tool was 0.710, or high reliability, and the calculated result on reliability of attitude tool was 0.610, or moderate reliability. The calculated result on reliability of people s behavioral response was 0.830, or high reliability. The questionnaires were then improved before they were actually used in the assigned sampling. The study covered 4 months, from March to June The variables of the study and scope of the concept are presented in Figure 1. Dependent variables Independent variables Attending meetngs/training programs/seminars; participation in activities/exhibits, and information reception through campaigns on LF Personal Factors Age Settlement period Educational attainment Occupation Social class Knowledge about LF Attitude about LF Adoption of practices regarding LF prevention and control Figure 1. Conceptual framework of the study 133

4 The Statistical Package for the Social Sciences (SPSS) (Reungpraphan 2001) was used in this study, as follows: (1) descriptive method, for indicating general information obtained through the questionnaires and for analyzing data using mean, percentage, frequency, and standard deviation, and (2) hypothesis testing, using the chi-square, for analyzing the relationship between dependent and independent variables. RESULTS 1. Perception based on data or information about LF through public relations 1.1 Nearly three-fourths (71.8%) of the people sampled in the LF outbreak area responded that they had never attended any meeting or training program/ seminar on LF. A big majority (64.3%) said that they had never joined in any activity/exhibit on LF prevention. Most of the respondents (91.0%) had received information through LF prevention campaign materials handed out by public health volunteers (71.7%), or broadcast on television (67.5%), or over the radio (48.7%). 1.2 More than half (54.5%) of the sample groups who were LF patients/relatives reported that they had never attended any meeting or training program/seminar on LF, and 63.6 % stated that they had never joined in any activity/exhibit on the prevention of LF. Most of them (81.8%) had received information through LF prevention campaign materials distributed by public health volunteers (83.3%), or broadcast on television (77.8%), or passed on by neighbors/co-workers (61.1%). 2. People s knowledge about LF 2.1 More than half of the respondents (58.0%) sampled from the groups living in the area where there was LF infection were found to have a moderate level of knowledge about LF. 2.2 Similarly, more than half (54.6%) of the sample groups who were LF patients/relatives were found to have a moderate level of knowledge about LF. 3. People s attitudes toward LF 3.1 Results of the study revealed that a big majority of the respondents (69.8%) among the sample groups living in the LF-infested area had a moderate attitude toward LF. 3.2 A large majority of the respondents (72.7%) among the sample groups who were LF patients/relatives had a moderate attitude toward the disease. 4. People s practices regarding LF prevention and control 4.1 Slightly more than half of the respondents (52.5%) from the sample groups living in infested areas had a moderate level of adoption of practices on LF prevention. 4.2 A big majority of the respondents (63.6%) among the sample groups who were LF patients/relatives had a moderate level of adoption of practices on LF prevention. 5. Results of hypothesis testing Hypothesis 1. Chi-square tests revealed a significant relationship between settlement period and knowledge about LF (p<0.05). Although this variable in Hypothesis 1 was acceptable, no significant relationship was found between age, educational attainment, occupation, social class, and knowledge about the disease (p>0.05). Hypothesis 1 was therefore rejected. Hypothesis 2. Age, educational attainment, and social class were found to be significantly related to attitudes toward LF (p<0.05), indicating that these variables in Hypothesis 2 were acceptable. However, there was no significant relationship between settlement period and occupation and attitudes about the disease (p>0.05). Hypothesis 2 was therefore rejected. Hypothesis 3. Age, settlement period, educational attainment, occupation, and social class were significantly related to adoption of practices regarding LF prevention and control (p<0.05). Hypothesis 3 was therefore accepted. Hypothesis 4. Meeting/training/seminar attendance, participation in activities/exhibits, and information exposure through campaigns were significantly related to knowledge about LF (p<0.05). Hypothesis 4 was therefore accepted. Hypothesis 5. There was a significant relationship between knowledge about LF and attitudes toward LF (p<0.05). Hypothesis 5 was therefore accepted. Hypothesis 6. Chi-square tests revealed a significant relationship between attitudes toward LF and adoption of practices regarding its prevention and control (p<0.05). Hypothesis 6 was therefore accepted. 134

5 DISCUSSION In Hypothesis 1, the significant relationship between settlement period and knowledge about LF may be due to the fact that long settlement in the epidemic area gave more opportunity for the residents than those who settled later to receive more information on LF through various public relations media. On the other hand, no relationship was found between personal factors (such as age, educational attainment, occupation, and social class) and knowledge about LF. These results confirm the earlier findings of Vanikanukoon (2002) on knowledge, attitudes, and information exposure in relation to behavioral responses of people in Pathumthani province who were included in the Universal Coverage of Health Insurance Project. Vanikanukoon noted that people in Pathumthani province who joined the project and had different ages, educational attainment, and occupation shared the same knowledge about the project. Aside from this, no relationship was found between social membership and knowledge about LF. This might be because knowledge about LF is specific. This results from information exposure or direct experience. Thus, being members of the same or different social group had no effect on knowledge about the disease. With regard to Hypothesis 2, the significant relationship between personal factors (such as age, educational attainment, and social class) and attitudes toward LF confirms the earlier findings of Taesukawat (2001) in a case study of street food vendors in the Bangkok metropolis. Taesukawat found a correlation between public relations exposure about sanitary practice and knowledge, attitude, and participation in improving food cleanliness. The study also revealed a relationship between age, educational attainment, and attitude. This might be because attitude is a personal feeling and people who are old and/or have a high educational attainment are likely to have more knowledge and experience than those who are younger or who have a low educational attainment. This results in differences in attitude (Suppadit 2003). Besides, as Suppadit s study indicated, a relationship between social class and attitude might be due to the fact that social factors and social characteristics affect thought and values since people normally have a continuous relationship with other members of a social group. Also, as noted from a related study, there is a tendency to cling on to their society and rely on their society in order for them to make decisions on expressing their attitude and behavior (Chantanasamit 2003). On the other hand, the present study revealed no relationship between settlement period, occupation, and attitudes toward LF. This may be due to the fact that personal attitude arises from experiences (Chantanasamit 2003). These results confirm the earlier findings of Paengprasit (1994) on factors related to audience attitude toward the night news television program of MCOT (Channel 9), a case study of students and faculty members of the National Institute of Development Administration. Settlement period and occupation were found to have no relationship with attitude. Chi-square tests on Hypothesis 3 showed that personal factors related to adoption of practices regarding LF prevention and control were age, settlement period, educational attainment, occupation, and social class. These results confirm the earlier findings of Chaikan (2003) on the relationship between information exposure and knowledge, attitude and behavior among the plaintiffs of the Central Administrative Court. The demographic characteristics were age, educational attainment, and the period of filing a suit related to the behavioral samples of the administrative court. Chaikan s findings were also in accord with the study of Gatesuesaat (2001) on exposure, knowledge, attitude, and behavior of Bangkok drivers in using gasohol. It was also found that occupational variables and social class were related to the choice of using gasohol. Regarding Hypothesis 4, findings indicated that meeting/training/seminar attendance helped develop more knowledge about LF. These results confirm earlier findings on learning behavior. That is, the behaviors resulting from training or experiences caused the subconscious to be capable of responding to other stimuli after having been familiar with the previous learning process. Most of the behavioral responses that were concerned with the learning process (Tarapote 2002) were related to knowledge about LF. This indicates that participation in activities/exhibits on LF prevention and control practices imparted to the samples more knowledge about the disease. This is also in accord with the principle underlying selective perception whereby human beings perceive the information that they are interested in by adjusting the information for basic cognition (Sotanasathien 1990). Information perception, which is a campaign strategy in the practice of LF prevention and control, is related to knowledge of the disease. This indicates that information perception as a campaign strategy imparted to the samples more knowledge about LF. These results confirm the earlier findings of Varalaksna (1994) on exposure to mass and interpersonal communication regarding narcotics and their prevention among students of the lower secondary education in Muang district, Chiangmai province. Perception of information was found to be related to knowledge levels on drugs and their prevention. 135

6 Tests on Hypothesis 5 showed that knowledge about LF that was imparted to the samples developed better attitudes toward LF. These findings confirm those of Taesukawat (2001), as mentioned above. Knowledge was found to be related to attitudes toward sanitation and cleanliness. In an earlier study, Zimbardo (1977) stated that attitude changes depend partly on knowledge, that is, if people have some knowledge about something, they are likely to change their attitude. Results of testing Hypothesis 6 revealed that the attitudes toward LF which were imparted to the samples developed better behavioral responses to practices on LF prevention and control. These findings confirm those of Chaikan (2003), as mentioned above, who found that the attitudes of the plaintiffs toward the Central Administrative Court were related to the behavioral samples of the Central Administrative Court. In an earlier study, Zimbardo (1977) stated that behavioral changes depend partly on attitude, that is, if people have a good attitude toward something, they will probably change their behavior about it. CONCLUSIONS AND ECOMMENDATIONS Based on the information obtained from the evaluation of public relations and other factors influencing knowledge, attitudes and practices regarding prevention and control of LF, the following recommendations were sent to concerned government agencies responsible for improving public relations to help implement measures toward eradicating the disease: 1. Results of testing the 6 hypotheses in this study indicate the need to develop and improve public relations materials, techniques, and strategies for facilitating information reception through campaigns on the disease. Thus, knowledge about LF must be nurtured by encouraging attendance in meetings and training/seminar programs, as well as participation in activities/exhibits that promote adoption of practices regarding prevention and control of the disease. 2. Public relations should be conducted continuously. People should be encouraged to participate in public relations media production, and the information must be clear and easily understood. This can be done through the help of public health volunteers, television, radio, etc. The strength of public health volunteers is when information can be delivered directly and conveniently to people. Television is also an appropriate medium even for the illiterate, and radio can provide access to information even for people living in remote areas. Public relations that fit the target groups can raise their level of awareness and enhance participation of people toward goal achievement. 3. The development of public relations information must suit the target group since people living in some border areas have inadequate knowledge in general and many of them are illiterate. Hence, audio-visual media, like television and radio, can be employed effectively in these areas. Frequent and continuous public relations campaigns help urge people to receive information and knowledge about LF. Besides, brochures, cassette tapes, and CD recordings can help people understand the information presented better. 4. Audio-visual media can be used in lectures, meetings, and training/seminar programs. Motion pictures can serve as audio-visual aids in presentations by local resource persons to give lectures or share knowledge and experience to participants. Participants in meetings and training/seminar activities can be encouraged to sing in order to help them memorize the lyrics of songs that are used to convey the message intended. These media can be extended through news broadcasts, public health stations, schools, temples, etc. Audio-visual aids make information more accessible to target groups. Also, people are encouraged to participate and have better understanding and attitudes toward LF that will promote dissemination of information on the prevention and control of the disease. ACKNOWLEDGMENT The research team would like to thank the Department of Disease Control, the Ministry of Public Health, Thailand for financial support, and the graduate students from The Graduate Program in Environmental Management, National Institute of Development Administration (NIDA), for assistance in data collection. REFERENCES CHAIKAN C The relationship between information exposure and knowledge, attitude and behavior among the plaintiffs of the Central Administrative Court. [Master s thesis]. Bangkok, Thailand: Thammasat University. 143 p. (available at Thammasat University Library) 136

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