KKU Faculty of Public Health Journal of

Community Research

Volume 5, Spring 2017


 KKU Faculty of Public Health Journal of Community Research, Vol. 5 1

Table of Contents
Concerns, Uses, and Home Treatment of the Community Water Supply
System in Ban Tha Pho, Thailand .................................................................... 2
Hsa Hser Ku, Sara Mar, Abbey Marino

Risk Factors for Dog Biting and Owners’ Knowledge of Responsible Dog
Ownership ........................................................................................................ 10
Aja Beckham, Victoria Lai, Olivia Rainer

Strengths and Weaknesses of Farmers’ Health in Rural Thai Village:

Community Development of a Survey Instrument ....................................... 18
Cristeen Anyanwu, Brennan Torpey, Avanti Mohan
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 2

Concerns, Uses, and Home Treatment of the

Community Water Supply System in Ban Tha
Pho, Thailand

Hsa Hser Kua, Sara Mar b, Abbey Marinoc

a
College of Liberal Arts, Bethel University, Saint Paul, MN USA
b
School of Public Health, University of Washington, Seattle, WA USA
c
College of Arts & Sciences, The University of Tulsa, Tulsa, OK USA

Abstract. Aims: The objectives of this investigation were to identify common uses of the community water supply in the vil-
lage of Ban Tha Pho and to determine community members’ concerns and behaviors regarding the water supply. Methods:
One focus group and 30 semi-structured interviews were conducted. The participants in the focus group were sampled pur-
posefully, including the village headman, the headman assistant, head VHV, and one worker from the water treatment plant.
Participants for the semi-structured interviews were selected using stratified convenience sampling. Results: In Ban Tha Pho,
22 people (73.3%) stated the cleanliness of water was a concern, such as seeing dirt and dust in the water. Reports of foul-
smelling water, especially during the summer, was a concern for 12 participants (40%). At-home water treatment methods are
used by one-third of the villagers interviewed. The two methods used were alum and a cloth. The community water supply is
not used as a source of drinking water. Rainwater was the most common drinking water source (75%), followed by the weekly
water truck. Conclusion: Increasing knowledge of water treatment methods may be beneficial in addressing community mem-
bers’ concerns about the water supply quality in Ban Tha Pho.

Keywords: water supply, water treatment, alum, rainwater

 KKU Faculty of Public Health Journal of Community Research, Vol. 5
1.0 Introduction
Water contamination is a major environmental
problem in Thailand that is exacerbated by the
growing population and booming industrial sector
(Singkran, 2017). Increases in land clearing and
farming practices has contributed to soil erosion in
agricultural areas which has negatively impacted the
water quality. Elevated levels of suspended solids in
the water from erosion affects the turbidity, thus
limiting its usages and decreasing the water quality
(Sthiannopkao, Takizawa,Homewong, & Wirojana-
gud, 2006). Furthermore, agricultural runoff is a
concern in rural communities, especially during
times of heavy rainfall. The water may be contami-
nated by pesticides, fertilizers, and fecal material
from nearby animals (Krupa, Tate, Kessel, Sarwar,
& Linquist, 2011). Rural communities surrounding
polluted water sources are left with water that is
often not safe for drinking, showering or cleaning
purposes. Such populations are forced to employ
their own water quality assurance methods and are
becoming increasingly reliant on bottled water
(Kruawal, Sacher, Werner, Muller, & Knepper,
2004).
1.1. Rural Water Supply in Developing Countries
In many developing countries, surface water, such
as rivers and creeks, can be used as a water supply
source (Singkran, 2017). Surface water is an easily
accessible source for many rural communities and is
often employed for other purposes such as irrigation
(Bordalo, Nilsumranchit, & Chalermwat, 2001).
However, the water quality of river and creeks do
not always meet specified standards for human
health and safety. A study conducted in Thailand
found that major rivers contained high levels of fe-
cal coliform bacteria and suspended solids (Singkran,
2017). Erosion and land runoff were major contrib-
uting factors to this decrease in water quality. The
presence of fecal coliforms suggests that there are
pathogenic bacteria in the water, which is especially
concerning for human health (Singkran, 2017). Ad-
ditionally, there are seasonal variations in surface
water quality which tends to decrease during the dry
season as indicated by factors such as high turbidity
(Bordalo et al., 2001).
Rainwater is another commonly used source of
potable and non-potable water in rural communities
(Kwaadsteniet, Dobrosky, Deventer, Khan & Cloete,
2013). Rainwater collection is a low-cost method
3
and is used in rural areas of Northeastern Thailand
for domestic purposes. Due to seasonal heavy rains,
villagers can collect large quantities of water to last
through the dry season given proper storage and
collection methods (Pinfold, Horan, Wirojanagud, &
Mara, 1992). Rainwater quality is a concern, as it
can be contaminated with organic material, chemi-
cals from atmospheric deposition, and fecal material
from animals who defecate around the storage tanks
and on rooftops (Kwaadsteiniet et al., 2013).
1.2. Water Treatment Technologies in Developing
Countries
Water contaminants can be removed by a variety
of techniques. In rural communities, water treatment
methods are chosen based on accessibility, afforda-
ble cost, and the required level of maintenance. One
treatment technique common in rural communities is
slow sand filtration (SSF). SSF is a low-cost method
that is effective at removing microorganisms from
the water as long as turbidity is low (Gottinger,
McMartin, Price, & Hanson, 2011). However, this
could pose a problem in rural communities where
high turbidity of the reservoir water is an issue. SSF
requires minimal maintenance, namely regular
cleaning to clear the biological material that can
build up over time. Additionally, SSF can be modi-
fied for improved effectiveness, such as adding peb-
bles to remove suspended solids or adding granular
activated carbon to remove organics and pesticides
(Gottinger et al., 2011).
A second option is a conventional Water Treat-
ment Plant (WTP) which employs clearing, coagula-
tion, filtration, and chlorination techniques (Babayan,
Sakoyan, & Sahakyan, 2017). In developing coun-
tries, these WTP’s tend to be unsanitary, unhygienic,
and have out-of-date technology (Babayan et al.,
2017).
Treatment of rainwater is recommended by the
WHO because of the high probability of biological
and chemical contamination. There are many meth-
ods for rainwater treatment, the most basic one be-
ing using a screen or filter to prevent debris from
entering the collection container. Additional treat-
ment options include SSF, the usage of chlorine for
disinfection, and granular activated carbon
(Kwaadsteiniet et al., 2013).
If water treatment techniques are insufficient,
there are human health risks associated with ingest-
ing contaminated water. The purpose of this re-
search was to identify the top concerns about the
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 4

water supply in a rural community, and to discover
the most common home treatment techniques em-
ployed to clean the water.
2.0 Methods and Materials
pond that is shared among multiple villages in the
area including Ban Tha Pho. Water from the pond
then flows into the pump house where it is trans-
ferred to the water treatment plant (Fig. 1).

2.1 Study Design and Site Description

This descriptive, cross-sectional study was con-

ducted in the community of Ban Tha Pho, which is
located in the Nam Phong district of the Khon Kaen
province in northeast Thailand. Ban Tha Pho is a
small rural village with a population of approximate-
ly 1,200-1,300 people within 200 households. Ban
Tha Pho is a tight-knit community situated next to
the Nam Phong River. Research was conducted
from April 24th, 2017 to April 26th, 2017. The
study used a focus group, stratified convenience
Figure 1: Reservoir pond that is the source of
sampling, and semi-structured interviews.
Ban Tha Pho’s non-potable water and the pump
The community of Ban Tha Pho obtains its non-
house (lower right of photo)
potable water from a reservoir behind the Ubonrat
Dam in Northeastern Thailand. Water from Ubonrat
Dam flows into irrigation canals, one of which fills a

Figure 2: Schematic of Water Source, Distribution, and Treatment Process

 KKU Faculty of Public Health Journal of Community Research, Vol. 5
The water treatment plant in Ban Tha Pho uses
alum as a coagulant followed by a series of 20 baf-
fles. The water then proceeds to a settling tank be-
fore entering a sand and gravel filter. Chlorine is
added to the filtered water, piped into a storage tank
and then stored in the water tower before being dis-
tributed to community homes (Fig. 2). Maintenance
of the water treatment plant occurs once every three
months. Common maintenance activities include
removing the dirt that collects in the settling tank
and washing the baffles.
2.2 Participants and Sampling Strategy
The participants in the focus group were sampled
purposefully, including the village headman, the
headman assistant, head VHV, and one worker from
the water treatment plant. The target population for
the semi-structured interviews was 30 households in
Ban Tha Pho and were selected using stratified con-
venience sampling. Researchers divided the com-
munity into three zones and sampled approximately
10 households from each zone. One of the village
health volunteers led researchers through the com-
munity to find participants for the semi-structured
interviews. The target participants of the semi-
structured interviews were the heads of the house-
holds. Inclusion criteria for participation were (a)
household tap water came from the reservoir, (b)
lived in Ban Tha Pho for at least five years, (c) can
read, write, and understand Thai, and (d) were at
least 18 years old.
2.3 Instruments and Data Collection
A focus group was conducted with the village
headman, the headman assistant, head VHV, and
one worker from the water treatment plant. The fo-
cus group lasted approximately 45 minutes and was
used to gather information about the overall com-
munity perspectives about the water supply. Addi-
tionally, the focus group defined coding responses
for some of the semi-structured questions.
Semi-structured interviews were held to collect
information about how community members use the
reservoir water, their concerns about the water sup-
ply, and any actions they take to remediate the prob-
lem. Each interview lasted approximately 10
minutes. Questions for the interview were developed
prior to the community visit and refined after infor-
mation was obtained during the focus group (Table
1). Questions were presented in an open-ended for-
5
mat and translated to community members in Thai
using a translator.
Table 1. Sample of Semi-Structured Interview Questions
1 How do you use your tap water?
1a What do you not use your tap water for?
2 How often do you (a) shower, (b) wash
clothes, (c) wash dishes, (d) wash produce,
(e) cook with the tap water?
3 What source of water do you use for
drinking water?
4 Do you have any concerns about the tap
water? If so, what are the concerns?
4a Do you think this causes any problems? If
so, what?
5 Do you do anything to try and make the
tap water cleaner? If so, do you think it is
effective? Why or why not?
6 Are you aware of the upcoming change to
the community water supply?
6a What do you think about the change?
2.4 Data Analysis
Data collected from the semi-structured inter-
views was analyzed using qualitative content analy-
sis. After all the interviews were completed, catego-
ries for coding and coding units were defined based
on recurring themes and responses. Data was ana-
lyzed using descriptive statistics in Microsoft Excel
to determine the frequency of responses. Additional-
ly, thematic analysis was used to report the focus
group and interview responses in a narrative format.
2.5 Ethics
Translators were employed to gain verbal consent
from each participant at the commencement of each
interview and focus group. Participants were aware
that the study was completely voluntary and all of
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
Figure 3: Community Concerns about the Water Supply (n=30)
their responses would remain confidential and anon-
ymous. Furthermore, they understood that all infor-
mation gained from the study would only be shared
amongst the researchers. Participants then signed an
informed consent form that stated their understand-
ing of their rights as a volunteer participant in this
study.
3.0 Results
3.1 Views about the Community Water Supply
The water supply system is very important to the
community because it gives them better access to
the water. From the focus group, community leaders
expressed concerns that the water from the water
supply is not very clean, and they do not always
have enough water to provide for all community
members. The piping system that distributes water
to community homes is at least 26 years old. The
head of the village health volunteers reported that
there are cases of rashes from the use of water from
the water supply system. Community leaders and
members are in the process of adding another water
source for the water supply to try to address water
quality and occasional shortages. The community is
currently 90% complete with a project that will draw
water from the Nam Phong River which will then go
through the water treatment plant and to community
homes.
6
3.2 Uses of Tap Water
Common uses of the tap water as identified dur-
ing the semi-structured interviews were showering,
washing clothes, washing dishes, washing produce,
watering gardens, and cooking. All 30 interview
participants reported they take a shower about 2-3
times a day with the tap water. Many participants
wash their clothes using tap water almost everyday,
while some wash clothes 2-3 times a week. As for
washing dishes, all 30 participants reported that they
use tap water everyday to wash their dishes, and
they do this up to 3 or 4 times a day. Some partici-
pants have small gardens, where they plant vegeta-
bles and herbs. They water these plants with tap
water twice a day, 3-5 times a week. Participants
reported avoiding using tap water for cooking and
washing produce.
3.3 Community Members’ Concerns about the
Water Supply
Of the 30 participants interviewed in Ban Tha
Pho, 22 people (73.3%) reported cleanliness of wa-
ter was a concern (Fig. 3). Community members
described seeing dust and dirt in their tap water.
Additionally, many expressed that they felt the wa-
ter was generally unclean. Complaints about smell
were common as well, especially during the summer.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
The presence of worms and insects in the water sup-
ply was a concern for six villagers (20%).
Rash development and itchiness after showering
were concerns expressed by four community mem-
bers. There were also reports that after doing laun-
dry, their clothes would come out dirtier than before.
Other community members reported a mental health
effect from frequent paranoia because they were
uncomfortable with using the water supply knowing
that it was unclean. Some worried about the invisi-
ble contaminants within the water, namely that there
may be bacteria in the water that could cause disease.
Participants also expressed that the reservoir is
not sufficient for meeting community water needs,
as it has been known to run out. When asked about
how they felt about the water supply switch to the
Nam Phong River, most people said they thought
the water would be cleaner because the water is reg-
ularly tested and compared to a national standard.
Furthermore, villagers believed using the Nam
Phong River would meet the demands of all the sur-
rounding villages who use this source and address
the problem of water quantity.
3.4 At-Home Water Treatment Methods
Only 33% of participants reported using some
form of at-home water treatment. Of these treat-
ments, alum usage was the most common with 7
participants (24%) using this method. Another three
participants (10%) filter their water through a cloth.
All participants who use these forms of water treat-
ment believed they were effective and better than
using no treatment at all.
Figure 4: At-Home Water Treatment Methods
(n=30)
7
3.5 Drinking Water Sources
Of those interviewed, no families reported using
the reservoir water for drinking. The most common
source of drinking water was from rainwater collect-
ed at their homes. 21 participants, or 75%, use this
source (Fig. 5). The other 25% purchase their drink-
ing water from the water truck that comes every
week.
Figure 5: Drinking Water Sources (n=28)
4.0 Discussion
Community members’ concerns about the water
supply reflected that turbidity is the main issue with-
in this community water supply. Turbidity in itself is
not a significant public health concern; however, it
is very observable which can cause distress among
users about the water’s usability. Furthermore, high
turbidity can decrease the effectiveness of water
treatment methods (Gottinger et al., 2011). The re-
ports of worms and insects present in the water were
a surprising result. These contaminants should be
removed during the sand and gravel filtration pro-
cess at the treatment plant, but their presence sug-
gests they may be entering the water through the
distribution system’s pipes due to a lack of mainte-
nance.
Based on the focus group and prior discussion, re-
searchers assumed rashes and itchiness after shower-
ing would be the main water-related health concern.
Unexpectedly, there were only four reports of these
complications. However, based on the many uses of
tap water identified during the interviews such as
showering, washing dishes, and washing clothes,
dermal exposure is still a concern.
Less than half of participants employed at-home
water treatment methods, yet they expressed concern
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
with the water’s cleanliness. Generally, community
members were unaware of possible at-home meth-
ods and those that did treat at home were uncertain
of the effectiveness. Many community members
believe switching the tap water source to the Nam
Phong River will be beneficial to the community,
despite knowledge of pollution from upstream facto-
ries. This demonstrates how the risk perception of
the water quality is largely based on what is “known”
to the community. Community members would ra-
ther draw their tap water from the river because they
know it is tested by the Pollution Control Depart-
ment and thus believe it meets a standard that is safe
for their health. However, should the water not meet
the standard, it is unclear how quickly the problem
could be resolved.
Research was conducted from different house-
holds representing three areas of the community.
Researchers were able to meet with community
leaders and water treatment employees to gain a
broader understanding of the treatment system and
general community perspective. Some of this per-
spective, however, was lost in translation.
The language barrier presented an issue during
the interviews, as there were moments when English
translations were exceptionally shorter than the an-
swers given in Thai. The sampling scheme was also
not completely random in each of the three areas, as
the snowball effect was often employed. Research-
ers were led to homes filled with groups of neigh-
bors and families who were working together. At
these homes, multiple interviews were conducted
within the same area, allowing participants to hear
interview questions and others’ answers long before
it was their turn to answer. Community members
were engaged and willing to help with this process,
but there was one Meh specifically who accompa-
nied researchers to interviewees’ homes. Meh would,
at times, join in the questioning process. She would
offer suggestions for answers that converted some
open-ended questions into leading questions. Thus,
these influences may have introduced bias into the
results.
5.0 Conclusion
Research reflected community members’ con-
cerns regarding water quality, including turbidity,
insects, and other particulates often found in their
tap water. These particulates should have been re-
moved in the water treatment process, which leads
community members to assume particulates re-enter
8
the water supply through the unmaintained distribu-
tion pipes. Some community members take the initi-
ative to treat their tap water at home using cloth fil-
tration and alum, but in general most participants do
not self-treat their water. The results suggest a gap
in understanding the community water treatment and
supply system. Increasing knowledge of methods for
at-home water treatment may be beneficial in ad-
dressing community members’ concerns about the
water supply quality in Ban Tha Pho.
6.0 Acknowledgements
This research would not have been possible had it
not been for the community members of Ban Tha
Pho who graciously welcomed us into their homes,
introduced us to the Isaan way of life, and were in-
credibly willing to share their knowledge with us.
We would specifically like to thank Ban Tha Pho’s
Headman, Headman’s Assistant, and the many Vil-
lage Health Volunteers for the hours spent in focus
groups, interviews, and on tours of the water treat-
ment plant. We would also like to thank our transla-
tor, Ban Ban, for interpreting our conversations,
striving for answers, and maintaining positivity
throughout all phases of this research project. Lastly,
we are incredibly appreciative to all of our CIEE
faculty, specifically Ajaan Toon and Ajaan Anthony
in the Faculty of Public Health for a semester of
guidance, input, and support.
7.0 References
Babayan, G. H., Sakoyan, G. A., &
Sahakyan, G. A. (2017). Assessing the
Quality of Water from Surface Sources
of Drinking Water Supply to Towns of
South Armenia. Electronic Journal Of
Natural Sciences, 28(1), 3-9.
Bordalo, A. A., Nilsumranchit, W., &
Chalermwat, K. (2001). Water Quality
and Uses of the Bangpakong River
(Eastern Thailand). Water Research,
35(15): 3635-3642.
Gottinger, A. M., McMartin, D. W., Price,
D. & Hanson, B. (2011). The
effectiveness of slow sand filters to
treat Canadian rural prairie water.
Canadian Journal of Civil Engineering,
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 9

38, 455-463.
Krupa, M., Tate, K. W., Kessel, C., Sarwar,
N. & Linquist, B. A. (2011). Water
quality in rice-growing watersheds in a
Mediterranean climate. Agriculture,
Ecosystems and Environment, 144,
290-301.
Kruawal K, Sacher F, Werner A, Muller J,
Knepper TP. (2004). Chemical water
quality in Thailand and its impacts on
the drinking water production in
Thailand. Science of the Total
Environment. 340: 57-70.
Kwaandsteneit, M., Dobrowsky, P. H.,
Deventer, A., Khan, W., & Cloete, T. E.
(2013). Domestic Rainwater Harvesting:
Microbial and Chemical Water Quality
and Point-of-Use Treatment Systems.
Water Air and Soil Pollution, 224, 1629.
Pinfold, J. V., Horan, N. J., Wirojanagud,
W., & Mara, D. (1992). The
Bacteriological Quality of Rainjar
Water in Rural Northeast Thailand.
Water Research, 27(2): 297-302.
Singkran, N. (2017). Determining overall
water quality related to anthropogenic
influences across freshwater systems
of Thailand. International Journal of
Water Resources Development, 33(1):
132-151.
Sthiannopkao, S., Takizawa, S., Homewang,
J., & Wirojanagud, W. (2006). Soil
erosion and its impacts on water
treatment in the northeastern provinces
of Thailand. Environment International,
33:706-711.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 10

Risk Factors for Dog Biting and Owners’

Knowledge of Responsible Dog Ownership
Aja Beckhama, , Victoria Laib and Olivia Rainerc
a
Social Work, University of Illinois, Chicago, IL, USA
b
Public Health & Health Equity, Mills College, Oakland, CA, USA
c
Biology, Wofford College, Spartanburg, SC, USA

Abstract. Aims: This study aimed to identify potential risk factors that induce dog bites and to assess villagers’ knowledge of
dog ownership and how this relates to dog bite prevention in Ban Sam Ran. Methods: Students conducted 10 semi-structured
interviews with dog bite victims to identify potential trends that provoke dog biting. To qualify dog ownership in the village,
13 semi-structured interviews with dog owners were given, including three of the 10 dog biting victims who owned dogs. Re-
searchers conducted in-depth interviews with representatives from the Health Promoting Hospital and Municipality to gather
records on number of dog biting incidents and existing programs and policies. Results: Two of the 13 dog owners interviewed
had been bitten by their own dog. Most bites were delivered to the extremities and did not cause severe injury. Out of the 13
dog owners, 10 let their dogs freely roam during the day; this may be a factor in that 8 out of 10 victims were bit by dogs
owned by another community member. Conclusion: There is a deficit in community members’ knowledge of risky situations
that can lead to a dog bite injury. Students will host a community meeting with a vet to increase education and awareness of
risky situations that may result in a dog bite injury.

Keywords: dogs, dog training, rabies vaccination, veterinary health

 KKU Faculty of Public Health Journal of Community Research, Vol. 5
1.0 Introduction
Dog bites pose a variety of health impacts, includ-
ing physical trauma, possible disfigurement, psycho-
logical trauma, and bacterial infections (Tanzin et al.,
2011). Approximately 17-18% of dog bites injuries
receive medical attention, while only 1-2% require
hospitalization (Overall and Love, 2001). Physical
deformities and trauma are more likely to happen
with children; because of their height, children are
more likely to be bitten on their face and neck (Bro-
gan et al., 1995). In comparison, adults usually re-
ceive bite injuries to the extremities. Although dog
bite wounds are considered a public health epidemic,
fatalities attributed to bites are relatively low: about
1 death per 5 million dogs (Callaham, 1980). Bacte-
rial infection may occur if the dog bite wound is not
treated properly. Human behavior can be a factor in
determining the severity of a dog bite, therefore it is
important for owners to be educated in proper treat-
ment and housing of their dogs.
1.1 Rabies Situation in Thailand
Rabies virus is an infectious disease usually
spread from dogs to humans via saliva from bites or
scratches. The virus is in the family of bullet-shaped
Rhabdoviridae that infect many hosts including ver-
tebrates; Lyssavirus is the particular genus that
commonly infects humans. Incubation time is typi-
cally 1-3 months during which the virus invades the
central nervous system causing a wide variety of
nonspecific symptoms; mortality rate is 100% after
clinical symptoms appear (Rupprecht, 1996). Mor-
tality from rabies is highest in Asian and African
countries where domestic dogs roam freely. As a
result, the Ministry of Public Health in Thailand has
successfully promoted mass rabies vaccination cam-
paigns for dogs. Human deaths from rabies has de-
creased from 370 in 1980, to 75 in 1996
(Mitmoonpitak, Tepsumethenon, & Wilde,1998),
and to fewer than 20 cases in 2003 (Denduangbor-
ipant et al., 2005).
1.2 Dog Bites and Associated Health Risks
Although less than 20 people died from rabies in
2003, over 400,000 people required rabies post-
exposure prophylaxis that year (Denduangboripant
et al., 2005). While transmission of the rabies virus
is relatively controlled, the high frequency of dog
11
biting is still a public health issue. Dogs harbor
many pathogens that can be harmful when intro-
duced via the bite wound. Bacteria can be trans-
ferred from the mucosa in the dog's mouth, for ex-
ample Pasturella canis, Capnocytophaga canimor-
sus, and Leptospirosis or from the outside of the
victim's skin, including Stapylococcus MRSA and
MRSP (Damborg et al., 2016). The aforementioned
bacteria from the mucosa can worsen soft tissue
damage inflicted by sharp teeth, and if left untreated,
causes septicemia and shock (Bongyoung, et al.,
2016). Staphylococcus aureus, Pasteurella multo-
cida, E. coli, Moraxella species, Pasteurella canis,
and Enterobacter cloacae were found to be the pre-
dominant bacterial species infecting a dog bite
wound (Kasempilmoporn et al., 2003).
If a dog bite wound is deep or dirty, it may be in-
fected with tetanus. Clostridium tetenai is anaerobic
bacteria that can thrive in deep wounds where oxy-
gen is lacking. The bacteria are more likely to enter
a wound from the environment than from a dog’s
mouth (Radjou, Hanifah, & Govindaraj, 2012). Of-
ten rabies prevention through vaccination is the
main focus when treating a dog bite wound, howev-
er tetanus also poses severe health risks.
1.3 Risk Factors for Dog Bites
Most dog bites are inflicted on children less than
15 years old (Kizer, 1979). Human behavior factors
into how much damage is done by a dog bite. For
example, children's jerky movements can be unpre-
dictable to a wary dog, and their shrill shrieks can be
interpreted as prey (Overall and Love, 2001). Pet
owners are more likely to be bit by their own dogs,
or neighborhood dogs, more likely than by strays
(Moss and Wright, 1987). In 1974, data collected
from 1,724 bite injuries and found that “owned dogs
delivered more bites, were larger, bit more victims
on the head and neck, delivered more bites needing
medical treatment, and, in short, were more danger-
ous than strays” (Harris et al., 1974). However, this
may not be the case for less developed countries
where stray dogs still roam in relatively high popu-
lations. Dogs are more likely to bite in the summer
and during the evening (Kizer, 1979).
1.4 Existing Policy and Practice in Thailand
Local municipalities in Thailand are responsible
for monitoring the local dog population. In accord-
ance with chapter 5 of the Animal Welfare law, the
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
owner must provide appropriate measures to ensure
the wellbeing of their pet, and will receive a fine or
jail time if they unlawfully abandon their animal.
Additionally, through the national rabies program,
Thailand has started a national responsible pet own-
ership campaign. This campaign has four main ac-
tivities: dog population survey and registration,
mass vaccination campaign, dog population control,
and public relation and parade campaign (OIE,
2014).
1.5 Education and Prevention
Raising awareness and increasing education may
be the easiest ways to decrease dog biting incidences.
For example, knowing how to interpret dogs behav-
iors can be learned even by preschool children and
can be a useful tool to incorporate into prevention
programs (Lakestani and Donaldson, 2015).
Thailand has seen dramatic improvements in the
rabies epidemic, such that many villages report no
issues with rabies. Still, dogs pose health risks par-
ticularly from bite wounds. The objective of this
research was to identify the trends that may provoke
dog biting in a semi-urban community of Northeast
Thailand with a large dog population. A community
action plan to increase awareness and education on
risky situations will be implemented after analyzing
the data.
2.0 Methods and Materials
2.1 Study Design and Study Setting
This study took place in Ban Sam Ran, a semi-
urban village in Northeast Thailand with a popula-
tion of 373 people. This village is located in Ban
Sam Ran sub-district, Muang district of Khon Kaen
Province.
2.2 Participants and Sampling Strategy
A list was obtained from the HPH that included
the names and addresses of people who reported
being bitten by dogs during the previous year. Con-
venience sampling was used to select ten partici-
pants to be interviewed. Researchers used the list to
find the homes of the patients, and then asked who-
ever was home if they were available to participate
in the interview.
In addition, two in-depth interviews were con-
ducted to inform researchers about vaccination ef-
12
forts, enforcement of related laws, and about general
practices of community dog owners. The first inter-
view was conducted with a local practicing veteri-
narian. The second interview was conducted with an
officer from the Ban Sam Ran Municipality, who is
responsible for monitoring the dog population.
Another 10 participants were selected using pur-
posive sampling. The participants had to be a dog
owner whose dog had never bitten anyone. Because
most residents arrived home late in the evening be-
tween 6:00 and 10:00 p.m., it was difficult to ar-
range interviews with some dog owners. Research-
ers then, used snowball sampling to ask if partici-
pants’ neighbors who owned dogs were available to
be interviewed. Additionally, if dogs were gated
within a home, researchers went to that home to
interview the dog owner. Also, if there were free-
roaming dogs in the community, researchers asked
neighbors who owned the dog and went to interview
the dog owner.
All participants needed to be at least 18 years of
age, current residents of the community, and able to
communicate in Thai.
2.3 Instruments and Data Collection
Three in-depth interviews were conducted to in-
form researchers about existing programs and poli-
cies in place to address the risk factors associated
with dog biting. The first interview was conducted
with a representative at the HPH, who kept record of
the number of annual dog biting incidents. The se-
cond interview was conducted with an officer from
the Ban Sam Ran Municipality, who is responsible
for monitoring the dog population. Additionally,
researchers interviewed a practicing vet who works
at a clinic in Udon Thani Province. A Thai translator
translated the interview questions for the HPH and
Municipality into Thai. The vet spoke English and
researchers asked questions in English without an
interpreter present.
Semi-structured interviews with community
members lasted approximately 10 minutes. Re-
searchers collected information about participants’
knowledge of dog training, how care for their dogs,
and dog biting incidents (Table 1). A Thai translator
translated the interview questions from English to
Thai. Additionally, clarifying and follow-up ques-
tions were also translated.
KKU Faculty of Public Health Journal of Community Research, Vol. 5 13

Table 1. Abbreviated List of Interview Questions

2.4 Data Analysis

Responses from the semi-structured interviews

1 Do you own a dog? were coded and entered into a database using Mi-
crosoft Excel 2013. Trends among owners with bit-
2 Do you own a dog that allegedly bit some- ing dogs were compared to trends among owners
one? with non-biting dogs.

3 How many dogs do you own? 2.5 Ethical Considerations

4 Have you gone to Vaccination Day?
5 What vaccinations did your dog receive?
6 How many times did your dog have a bath
in the past month?
7 How much do you spend time with your
dog?
8 Is your dog trained?
9 Where do you keep your dog during the
day/night?
Translators were employed to gain verbal consent
from each participant prior to the interview. Partici-
pants were aware that the study was completely vol-
untary and their responses would be confidential and
anonymous. The participants were informed that
their responses would only be shared amongst re-
searchers.
Consent was documented with a signature by the
participant on a printed informed consent sheet. The
interpreter assisted those who were unable to physi-
cally write their signatures on the consent sheet,
with the verbal consent from the participant.

10 How many hours is your dog caged last

3.0 Results
week?
3.1 Dog Bite Incidence
11 How many times do feed your dog(s)?
The HPH reported that the number of dog biting
12 What type of food do your dogs eat? incidents have become reported more frequently
because there is an increase in community aware-
13 Has your dog ever bitten someone? ness about health outcomes that result from contract-
ing rabies. An average of about 24 people were bit-
14 Where did this occur? ten annually. The number of people bitten shows an
increasing trend.
15 Describe the situation.

16 Was it severe enough for you to go to the

HPH for a vaccine?

17 Have you changed how you handle your

dog since the incident?

18 If your dog bites someone, who is responsi-

ble?

19 Are there any consequences for the owner?

20 Should there be any consequences?

21 What should the consequence be? Figure 1. Number of dog bite victims that re-
ceived the PEP vaccine per year.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
3.2 Municipality’s Perspective
The Municipality reported that people are not ed-
ucated about how to identifying risky dog behaviors
such as how to stop a dog fight, looking under their
cars for dogs before approaching it, and general dog
safety precautions. They think the community would
benefit from having a vet come to educate commu-
nity members about safety involving dogs.
3.3 Dog Bite Victims
11 out of the 13 of the participants had dogs that
have not bitten anyone. Of the 10 participants who
were bitten, two participants reported being bitten
by their own dog. All dog owners in this study re-
ported that their dog was vaccinated.
3.4 Dog Care
3.4.1 Dog Enclosures
None of the owners kept their dogs on leashes
regularly, nor did the owners keep any of them
caged. Most dog owners allowed their dogs to freely
roam the village during the day; however, many
would keep their dogs at home with the gate locked
during the night (Figure 3). Owners that kept dogs
behind a locked gate live near a busy road or owned
dogs aggressive towards other dogs. Those that kept
dogs in the house owned smaller dogs with no
guarding purpose.
Figure 3. Dog enclosure environment
3.4.2 Food and Hygiene
The frequency of bathing varied greatly among
the dog owners (Figure 4). Owners usually bathed
their dogs with human shampoo or only with water
and no shampoo. Some owners stated that their dogs
would go “bathe” themselves on their own by going
14
into the water of the rice fields. Big dogs were usu-
ally never bathed in comparison to smaller dog.
All owners provided their dogs two meals a day,
in the morning and at night. Most owners gave their
dogs leftovers including liver, chicken, sticky rice.
Figure 4. Frequency of dog bathing
3.4.3 Time with Dog
Villagers generally reported that they would be
outside the front of their homes with the dog nearby.
For them, this was considered interaction time with
their dog(s). Some households reported that their
children would run around with the dog(s). Big dogs
would usually roam freely in the community for
large parts of the day. The few people that interacted
with the dog all day kept the dog in the house.
Figure 5. Interaction time between dog and owner.
3.4.4 Dog Training
When asked if their dog was trained, owners re-
sponded in hesitation. Rarely would the dog obey
the command of its owner. Usually the dog would
acknowledge the owner but not move or not
acknowledge the owner at all. Owners said the
dog(s) obeys when food is present. Around a quarter
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 15

(23.1%) of the dogs were trained to some capacity.

The remaining (76.9%) were not. Table 2. Summary of Dog Bite Incidents
Characteristic Percent (%)
3.4.5 Dog Care after Dog Bite Incident Body Part Bitten
Most villagers did not change the way that they Leg 50%
trained or interacted with their dog after the dog bite Ankle/Heel 20%
incident. One villager noted that because her small Hand 10%
dog had previously bit a visitor, she now keeps the Shoulder 10%
dog in the house when guests come to her home. Butt 10%
Season
3.5 Dog Bite Incidents Cool 40%
Hot 30%
Most participants reported that the bites were nips Rainy 10%
to the ankle and calf area (Table 2). Victims that had No Data 20%
a dog bite an extremity: the leg, ankle, or hand, were Category of Dog Bite
typically involved with a startled or defensive dog. Aggressive dog 40%
Incidents occurred while dogs were not seen sleep- Accidental encounter 30%
ing under a car and were startled when someone Defensive dog 30%
approached and bit the person, usually on the lower
Location of Incident
extremities. People who were bitten by aggressive
Work 40%
dogs were bitten on the shoulder or butt. Some other
House 30%
incidents were because mother dogs were defensive
Motorcycle/Road 20%
of their newborn puppies. An electrician reported
Market 10%
being bitten multiple times after entering homes to
fix appliances. One woman was bit on her shoulder 4.0 Discussion
when at a friend’s home who owned a puppy mill.
She was taken to a hospital outside the village and
The increase in dog biting incidents was a con-
was not on the original list of HPH patients.
cern expressed in the community. This number may
People were bit at relatively the same frequency
still be an underestimate of the true number of dog
during the hot and cool seasons. Only one person
bites because a participant in the study reported go-
was bit in the rainy season. The question was not
ing to a hospital outside of the community and the
asked in two interviews.
incident was not reported to the local HPH.
Situations that qualified as accidental involved
The results show that although dog biting inci-
dogs that were stepped on or startled, a person was
dents are increasing most incidents are accidental or
bitten when trying to stop a dogfight, or when a dog
because the dog was being defensive of its newborn
was involved in a road accident. Defensive dogs bit
puppies. Those who reported that dogs were aggres-
because their puppies were nearby. Dogs identified
sive towards humans said the dog had bitten many
as aggressive bit motorcyclists, were unprovoked, or
people, which may indicate that there are a small
bit owners who were attempting to keep their pets
number of community dogs that are aggressive to-
from biting a stranger.
wards humans.
All participants went to the hospital after being
The Municipality hosts an annual free Vaccina-
bitten. All participants including the person bitten
tion Day program and Universal Health Coverage
and dog owners reported that it is the dog owner’s
provides free rabies vaccine to the HPH. Rabies is
responsibility to take the bitten person to the hospi-
controlled in the community. However, these pro-
tal. All participants who were bitten were taken to
grams may deter the community from wanting to
the hospital by the owner. No children were reported
learn about safety precautions to take with dogs be-
in this study because the HPH records report that
cause they can get a free vaccination if bitten. Addi-
children have not been involved in any dog biting
tionally, there is a low risk of rabies because most
incidents.
dogs have been vaccinated.
In regards to dog ownership, dog owners do not
have a strong relationship with their dogs because
53.4 percent of dog owners reported not interacting
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
with their dog. Additionally, most dogs were al-
lowed to free-roam for large parts of the day. Alt-
hough rabies is controlled, there are risks of expo-
sure to other infectious disease when a dog free
roams (Durr, 2017). The community may benefit
from a dog ownership program.
Research was conducted from different house-
holds within the community. Researchers gathered
information about the risk factors associated with
dog bites and the knowledge that dog owners have
about taking care of dogs.
One of the limitations of this study was that it was
difficult to interview the people on the HPH list be-
cause many people arrived home in the late evening.
It was challenging to find participants for the inter-
view. Thus, these factors may have limited our in-
sight to the risk factors associated with dog biting
and knowledge of responsible dog ownership
amongst community members.
5.0 Conclusion
This research highlighted some of the most com-
mon situations in which dog biting incidents oc-
curred, including aggressive, protective, and acci-
dental incidents. Increasing knowledge about safety
precautions with dogs may be beneficial. Addition-
ally, research reports highlight dog owners’
knowledge of dog ownership responsibilities. In
general, most dog owners do not take care of their
responsibilities to the pet. The community may ben-
efit from having a vet come educate the community
and distribute educational material.
6.0 Acknowledgements
This research would not have been possible with-
out the community members of Ban Sam Ran who
participated in interviews and helped provide re-
searchers with insight about the community. Thank
you specifically to the Ban Sam Ran Headman,
Headman Assistants, Head of the Health Promotion
Hospital, Head of the Village Health Volunteers,
and Village Health Volunteers. Also, thank you to
our translator for helping us interpret conversations
and better communicate with community members.
Thank you to Ajaan Anthony and Ajaan Toon for
helping guide our research project. Finally, thank
you to CIEE for providing students with the oppor-
tunity to study abroad in Thailand and learn in a new
environment.
16
7.0 References
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Brogan TV, Bratton SL, Dowd MD, et al. (1995).
Severe dog bites in children. Pediatrics; 96: 947-
950.
Callaham M (1980). Dog bite wounds. JAMA; 244:
2327-2328.
Denduangboripant et al (2005). Transmission dy-
namics of rabies virus in Thailand: Implications
for disease control. BMC Infectious Diseases.
Damborg P, Broens EM, Chomel BB, et al. (2016)
Bacterial zoonoses transmitted by household
pets: state of the art and future perspectives for
targeted research and policy actions. Journal of
Comparative Pathology; 155(1): s27-s40.
Durr, S., Dhand, N., Bombara, C., Molloy, S., &
Ward, M. (2017). What influences the home
range size of free-roaming domestic dogs? Epi-
demiology and Infection, 145(7),1339-1350.
Kasempilmoporn S, Benjavongkulchai M, Saengs-
eesom W, Sitprija V (2003). Oral bacterial flora
of dogs with and without rabies: a preliminary
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1162-1166.
Kizer KW (1979). Epidemiologic and clinical as-
pects of animal bite injuries. JACEP; 8: 134-141.
Lakestani N, Donaldson ML (2015) Dog Bite Pre-
vention: Effect of a Short Educational Interven-
tion for Preschool Children. PLoS ONE 10(8).
Mitmoonpitak C, Tepsumethenon V, Wilde H.
(2013) Rabies in Thailand. Epidemiology Infec-
tious; 120: 165-169.
Moss SP and Wright JC (1987). The effects of dog
ownership on judgements of dog bite likelihood.
Anthrozoos; 1: 95-99.
World Organisation for Animal Welfare (OIE).
“Benchmark Document: Rabies and Rabies-
Related Initiatives in ASEAN Member States
(2014).” (2014). Proceedings from the Workshop
on Relevant International Standard for Rabies.
Chiang Mai, Thailand, 11-13 June 2014.
Overall K and Love M (2001). Dog bites to humans
- demography, epidemiology, injury, and risk.
Journal of the American Veterinary Medical As-
sociation; 218(12): 1923-1934.
Radjou A, Hanifah M, Govindaraj V. (2012) Teta-
nus following dog bite. Indian Journal of Com-
munity Medicine; 37(3): 200-205.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 17

Rupprecht CE. (1996) Rhabdoviruses: rabies virus.

Medical Microbiology, 4th edition; chapter 61.
Tenzin, Dhand NK, Gyeltshen T, Firestone S,
Zangmo C, Dema C, et al. (2011) Dog Bites in
Humans and Estimating Human Rabies Mortality
in Rabies Endemic Areas of Bhutan. PLoS Negl
Trop Dis 5(11).
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2014. Accessed via globalanimallaw.org
 KKU Faculty of Public Health Journal of Community Research, Vol. 5 18

Strengths and Weaknesses of Farmers’ Health

in Rural Thai Village: Community
Development of a Survey Instrument
Cristeen Anyanwua, , Brennan Torpeyb and Avanti Mohanc
a
College of Arts and Science, Georgetown University, Washington, DC, USA
b
School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
c
College of Arts and Science, Brandeis University, Waltham, MA, USA

Abstract. The purpose of this investigation was to determine strength and weaknesses in the lives of rural farmers in Northeast
Thailand. Methods. This study used a 6-person focus group to construct a Healthy Farmer Chart. This chart was then
disseminated in the form of 34 surveys to be completed by other rural farmers in the community. The farmers for the focus
group were sampled with the assistance of village health villagers. The 34 participants for the survey were selected due to their
occupation and availability during the day. Results: The main strengths listed by rural farmers were confidence/independence
(44%) followed by the ability to earn money, pride in work and pride in occupation as a farmer (38%). The main weaknesses
listed by rural farmers were their inability to earn enough money (73%), issues with aches and pains from farming (59%), and
poor physical health from using chemical fertilizer (56%). Farmers mentioned pride in their work as a family tradition but the
work ultimately takes a toll on their physical health while hindering their ability to earn enough income. Conclusion: Farming
for rural farmers in this village is met by many challenges. The first challenge is the falling rice prices, a major source of
income in this area, matched with increased burden of debt. The combination of low prices and high debt pushes farmers to
overextend themselves physically in the field, leading to a host of physical ailments.

Keywords: agriculture, Northeast Thailand, participatory research

 KKU Faculty of Public Health Journal of Community Research, Vol. 5
1.0 Introduction
Agriculture is one of Thailand’s top-grossing in-
dustries and has made significant contributions to
the country’s economic success. It has served as a
“social safety net, in terms of food security and as a
source of employment” (Jitsanguan, 2001). Much of
Thailand’s countryside remains populated largely by
farming communities with villagers leading rural
lifestyles.
1.1 Historical Context: Agricultural Sector
Thailand’s agricultural market has recently been
struggling to compete with comparative rice prices
in other ASEAN nations, such as Vietnam (Sirikan-
chanarak, 2016). As a result of this competition in
the international agricultural market, what was once
a safety net has become a conundrum for rural Thai
farmers who predominantly farm rice (Bhongmaka-
pat, 1990). Farmers feel pressure to produce larger
quantities of crops to earn enough income to make
ends meet, necessitating an increased application of
agricultural chemicals (Jitsanguan, 2001). Increased
used of pesticides damages fertile soil and causes
farmers to increase the amount and strength of the
fertilizer they must spray on crops (Thapinta et al,
2000).
1.2 Financial Difficulties of Farmers
While competition in the agricultural sector, spe-
cifically in international markets such as that of Vi-
etnam, has required increased fertilizer use, the need
to protect crops incentivizes fertilizer usage just as
much (Sirikanchanarak, 2016). Most Thai farmers
use fertilizers in order to facilitate production of
crops as well as ensure the quality of crops produced
(HSRI, 2005). Crops with the highest market value
contain the highest amounts of pesticides in
field/soil due to a shift away from low-value crops
and towards high-value crops in the agricultural
market (Poapongsakorn et al, 1998). As a result of
this shift, farmland used by rural Thai farmers has
compromised soil quality and has decreased crop
yields, which has been corroborated by Thai farmers
during a previous community needs assessment in
Ban Tha Pho. With all these factors being consid-
ered, farmers are confronted with a wide range of
challenges socially, financially, and in terms of their
own health.
19
1.3 Health Challenges of Farmers
As agriculture continues to remain a cornerstone
of Thailand’s economy and culture, the well-being
of Thai farmers, or lack thereof, can therefore direct-
ly impact the country’s economic prosperity. There-
fore, injuries resulting from the work of farmers
should be paid attention. Some of such physical
health ailments and injuries incurred include chronic
cases with mean durations of almost 6 years (Nop-
kesorn, 2011). Demographics such as age and gen-
der are influences that need to be taken into account
when discussing the health of rural farmers in Thai-
land. The older population, 65 and above, plays a
key role in farming, especially rice cultivation
(Poungchompu et al, 2012). For this population, the
strongest determinants of self-assessed health may
be seen in the presence of chronic diseases, func-
tional status, and/or psychosocial symptoms (Hassen
et al, 2010). These determinants can be used to help
better assess the strengths and weaknesses of Thai
farmers, specifically in the northeast region.
Given the decreasing price of rice and in turn
the decreasing income of many rural farmers in
Thailand, this study aimed to determine and assess
strengths and weaknesses of farmers’ health in Ban
Tha Pho.
2.0 Methods and Materials
2.1 Study Design and Study Setting
This descriptive study took place in Ban Tha Pho,
Moo 4, a small village in Northeast Thailand. This
village is located in the Tha Krasoem sub-district
and Nam Phong district in the Khon Kaen province.
2.2 Participants and Sampling Strategy
The focus group had six participants, five female
and one male. The survey had 34 participants, 12
males and 22 females. All participants actively farm
for profit and were contacted during hours conven-
ient to them. This study used convenience sampling.
Participants were at least 18 years of age, current
residents of this community, and at least half of their
salary supported by farming; participants were ex-
cluded if they did not fit the above criteria.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
2.3 Instruments and Data Collection
A 40-minute focus group established qualities of
a healthy and an unhealthy farmer. This discussion
was facilitated using guided questions regarding
physical, mental, and social health within the con-
text of their profession as farmers. Participants cre-
ated a “healthy farmer chart” to describe the
strengths and weaknesses of farmers in the village
with regards to physical, mental, and social health.
This collaborative activity included the opinions of
all participants and the focus group’s consensus
served as an accurate representation of criteria for
adequate versus inadequate health statuses of farm-
ers in Ban Tha Pho.
The “healthy farmer chart” was generated collab-
oratively with the community, and the definitions
were created by participants in the focus group (Ta-
ble 1).
Using Table 1, a survey was conducted where
farmers in the community were asked to identify
which three healthy qualities they relate to as
strengths and three unhealthy qualities they relate to
as weaknesses. This illustrated which strengths and
weaknesses, within the scope of mental, physical,
and social health, hold the most significance in the
farmer’s personal experience given the list compiled
in the chart.
A qualified translator familiar with the Isaan dia-
lect was used to translate questions and explanations
given by English-speaking researchers.
Table 1. Healthy Farmer Chart
20
2.4 Data Analysis
Quantitative data gathered from the survey was
entered and coded into a database using Microsoft
Excel 2013. Descriptive statistics, namely the mean
of participant’s ages and frequency of responses,
were calculated using Microsoft Excel.
The farmers in the focus group defined the
strengths and weaknesses used in the Healthy
Farmer Chart. Strengths were defined as characteris-
tics or qualities, which are beneficial to being a
well-rounded and strong farmer in this village.
Weaknesses were defined as characteristics, which
would negatively impact a farmer and/or is seen as a
quality of substandard farmer in the community.
Both strengths and weaknesses were defined by un-
der the broad term of health and were chosen by
participants in the focus group because of im-
portance to themselves, the farming lifestyle, and/or
the community. This allowed the community to
build the tool used in the surveys, rather than outsid-
ers without knowledge of the farming community to
define what are strong versus weak qualities of a
farmer in this village. The strengths and weaknesses
of a farmer were placed into the Healthy Farmer
Chart. During the survey, strengths and weaknesses
for the community were defined as responses with
the highest frequency. This conclusively brought the
standard for strong and weak qualities of a farmer
into the Healthy Farmer Chart, and then defined
what were strengths and what were weaknesses for
actual farmers in Ban Tha Pho.
.
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
2.5 Ethical Considerations
All participants voluntarily gave written or verbal
informed consent via a translator before participat-
ing in this project. Consent was documented using a
signature on a printed informed consent sheet. Re-
sponses remain confidential, and no responses were
or will be shared with any law enforcement or those
without a professional duty to the research. The data
has been and will continue to be securely stored with
a password only accessible to the researchers
3.0 Results
3.1 Demographics
Six farmers participated in the focus group, one
male and five females. All participants are rice or
vegetable farmers in Ban Tha Pho and helped collect
the data shown in Table 1.
Of the thirty-four participants who took the sur-
vey, 67% of participants were female, and 33% were
male. The average age was 55, and 91% were rice
farmers.
3.2 Strengths identified by farmers
Participants listed four major qualities as personal
strengths of being a farmer; 44% said they are con-
fidence/independence; 38% said they earn money;
38% said they take pride in continuing their family
tradition; and 38% said they are proud to be a farmer.
Other qualities from the Healthy Farmer chart were
chosen, but the frequencies of responses were fewer
than the four major strengths listed (Table 2).
3.3 Weaknesses identified by farmers
Qualities considered weaknesses with a high fre-
quency of responses were an inability to earn
enough money (73%); issues with aches and pains
from farming (59%) and poor health from chemical
fertilizer use (56%). Other qualities were listed, but
the frequencies of responses were fewer than the
three major strengths listed (Table 2).
4.0 Discussion
Results indicate that the majority of farmers in
Ban Tha Pho view confidence and independence as
a main personal strength and the inability to make
21
Table 2. Strengths and Weaknesses of Farmers (n = 34)
Strengths Number (%)
Confident & Independent 15 (44)
Earns Money 13 (38)
Proud of Work 13 (38)
Proud to Continue Family Tra- 13 (38)
dition
Weaknesses Number (%)
Doesn’t Earn Enough Money 25 (74)
Lots of Aches and Pains 20 (59)
Poor Health from Chemical Use 19 (56)
enough money as the main weakness. Based on the
Healthy Farmer chart generated by the community
and then grouped by theme and physical, mental, or
social health, mental health would be viewed as a
strength amongst farmers in this village because of
their resilience and appreciation for farming as cul-
tural trademark and family tradition.
Resilience and appreciation for farming are two
features, which make farming an honorable profes-
sion in this community. Yet, the work is detrimental
to their physical and social health. Aging is viewed
as a weakness due to the amount of energy a farmer
must exert in order to make enough money to sup-
port their family. Their lack of substantial income is
categorized as a quality of poor social health since
low income is a social determinant that can nega-
tively impact their overall health and lead to risky
health behaviors.
Mental health for a healthy farmer was broadly
defined by their ability to feel confident and inde-
pendent, free from stress, and proud of their work.
The majority of participants agreed that confidence
and independence are qualities that they deem as
strengths. On the survey, very few participants iden-
tified feeling stressed due to their occupation. Many
viewed farming as profitable work, but not lucrative.
It is not lucrative due to the rise and fall of crop
prices, particularly the steady decline of rice prices.
Many found that low rice crops made it hard to con-
tinue their family tradition of being rice farmers and
had to invest in other crops. The problem with di-
versifying crops is that farmers often have to take
out loans from the agricultural bank, compounding
this debt with previous debt from possibly accumu-
lated from buying fertilizers for crops or paying for
their children’s education. The continued depend-
ence on loans to sustain their trade as farmers make
it hard for be rid of debt. Such challenges cause a
 KKU Faculty of Public Health Journal of Community Research, Vol. 5
cascade of problems in their social and physical
health. Crop yield and income would be classified
under social health, which farmers characterized as
not only income but also community relationships
and personal life.
Physical health for a healthy farmer was broadly
defined by themes such as a pain and wellbeing.
Well-being is perceived as regularly exercising, be-
ing well rested, and healthy aging. The debt accu-
mulated by being a farmer disrupts a farmer’s ability
to engage in many healthy activities such as rest and
healthy aging. Many farmers found that as they were
aging their ability to sustain their farms decreased.
Participants seemed to prioritize their crops and in-
come over physical health, though it was a concern
of theirs. They would work through their back and
leg aches as well as any headaches in order to com-
plete necessary tasks for the day. Some farmers con-
sidered the act of farming as exercise while others
wouldn’t work at all if their pain were unbearable,
losing a day of income. It is reasonable to say that
physical health is an area in need of interventions.
An intervention that can teach farmers to prevent
injury could also help them decrease the number of
days they lose from injury and possibly help in-
crease their crop yield and income.
5.0 Conclusion
The results indicate that farmers in Ban Tha Pho
have (a) a strong perception of their mental health
and (b) a need for improvement in their physical and
social health. Mentally, farmers in Ban Tha Pho see
their work as a source of pride, which continues
their family and community tradition. Physically,
their work in the fields increases their aches and
pain and because their crops have a low financial
yield, they are at risk of many negative physical,
mental, and social health effects. While perceptions
of weaknesses highlight areas in need of support, it
is important that interventions are culturally relevant
and financially beneficial. Farmers would respond
well to programs that recognize pride in farming as a
culturally important quality for this agricultural
community. Educating farmers on proper techniques
for exercise and safer methods for increased crop
productivity are suitable interventions to improve
their health and possible areas for further research.
22
6.0 Acknowledgements
We thank the village of Ban Tha Pho for their
warm welcome, the community members who were
participants in our focus group and survey, and those
who cared for us during our stay. We thank our team
of translators and Maw Thoo and her team of village
health volunteers for their guidance. Lastly, we
thank both Dr. Anootnara T. Kuster and Anthony C.
Kuster for advising us throughout the course of the
research, which greatly helped our study.
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