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López BNS, Adell MDB, Cabrera LS, Padilla YGS. Beliefs, attitudes and feelings about work among healthcare workers and teachers during the fifth wave of COVID-19. J Int Med Res 2023; 51:3000605231206276. [PMID: 38000012 PMCID: PMC10676073 DOI: 10.1177/03000605231206276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To compare the beliefs, attitudes and feelings about work of healthcare professionals (HCPs) and teachers living in the Canary Islands (Spain) during the COVID-19 pandemic. METHODS The study had two parts. In Part 1, the Delphi technique was used to adapt a questionnaire. Part 2 was a cross-sectional, comparative study, performed from August 31st to October 25th, 2021 using the questionnaire online distributed to samples of HCPs and teachers. The questionnaire had three dimensions each separated into three sections (i.e., beliefs [coping ability, prevention and organisation]; attitudes [risks, commitments, and obligations]; feelings about work [burnout, support and work satisfaction]). RESULTS In total 1423 questionnaires were available for analysis, 640 from teaching staff and 783 from HCPs. Significant differences were found in eight of the nine sections. HCPs had a more positive attitude towards work compared with teachers, but had more negative beliefs and feelings about work. In addition, by comparison with teachers, HCPs were more committed to their work, more predisposed to take risks and fulfill their obligations, even though our sample of teachers felt more supported and satisfied at work. CONCLUSIONS Our results show that the pandemic caused a greater negative impact on job satisfaction of HCPs compared with teachers because they felt less supported by their superiors, which had a greater impact on their psychological health.
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Affiliation(s)
- Borja N Santana López
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Spain
- Universitat Jaume I, Castelló, Spain
- Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | | | - Luciano Santana Cabrera
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas, Spain
| | - Yeray G Santana Padilla
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas, Spain
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Zhang H. Technostress, Academic Self-Efficacy, and Resistance to Innovation: Buffering Roles of Knowledge Sharing Culture and Constructive Deviant Behavior. Psychol Res Behav Manag 2023; 16:3867-3881. [PMID: 37745271 PMCID: PMC10516214 DOI: 10.2147/prbm.s424396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023] Open
Abstract
Aim Scholarly works have primarily found a negative relation between technostress and individual performance outcomes. Nevertheless, there needs to be more empirical research that casts light on the underlying causal mechanism. The current study hypothesizes that technostress affects students' resistance to innovation through the mediating role of academic self-efficacy. Further, the study proposes innovation as a salient goal as a meta-level moderator. To capture this factor, the study investigates constructive deviant behavior and knowledge sharing culture as the buffering agents stimulating these links. Methods On a sample of 412 Chinese university students, the authors assess the structural model guided by the social cognitive theory to examine the predictive capability of the hypothesized relationships. Results The study found that technostress diminishes students' self-efficacy, which in turn augments resistance to innovation. Besides, constructive deviant behavior and knowledge sharing culture significantly moderate the direct association between technostress and self-efficacy and the indirect relationship between technostress and self-efficacy and then resistance to innovation. Discussion The study offers several meaningful theoretical and practical implications related to the critical role of technostress in deteriorating students' self-efficacy beliefs and enhancing resistance to innovation.
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Affiliation(s)
- Hua Zhang
- College of Educational Science, Nanyang Normal University, Nanyang, 473061, People’s Republic of China
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Solís P, Lago-Urbano R, Real Castelao S. Factors That Impact the Relationship between Perceived Organizational Support and Technostress in Teachers. Behav Sci (Basel) 2023; 13:bs13050364. [PMID: 37232601 DOI: 10.3390/bs13050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
In the last two years, the obligatory use of technologies due to the COVID-19 pandemic has increased the technostress suffered by education professionals. This study investigates the relationships between technostress and perceived organizational support and the influence of certain socio-demographic variables. An online survey was administered to 771 teachers working in different educational stages in various autonomous communities in Spain. Perceived organizational support was found to be significantly correlated with technostress. Women tend to experience more technostress in general and significant gender differences were also found in the dimension of anxiety. The analyzed data also suggest that perceived organizational support is higher in private schools. In urban centers, teachers' technostress increases in higher educational stages, such as secondary education and baccalaureate. Further work is needed to develop school policies that address the needs of teachers and provide support for those at risk of technostress. In addition, there is a need to design coping strategies and prioritize the most at-risk sectors to improve their overall health and well-being.
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Affiliation(s)
- Patricia Solís
- Faculty of Education, Universidad Internacional de La Rioja, 26006 Logroño, Spain
| | | | - Sara Real Castelao
- Centro de Ponferrada, Universidad Nacional de Educación a Distancia, 24400 Ponferrada, Spain
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Santana-López BN, Bernat-Adell MD, Santana-Cabrera L, Santana-Cabrera EG, Ruiz-Rodríguez GR, Santana-Padilla YG. Attitudes and Feelings towards the Work of Teachers Who Had a School Nurse in Their Educational Center during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3571. [PMID: 36834273 PMCID: PMC9959088 DOI: 10.3390/ijerph20043571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to analyze the influence of the availability of a health professional on the beliefs, attitudes, and work feelings of teaching staff when facing the COVID-19 pandemic. This is a two-phase study: In the first one, the Delphi technique was used to update an instrument used by the authors in a previous investigation in 2020. The second phase was a cross-sectional, descriptive, and comparative study, carried out through an electronic questionnaire distributed among the teaching staff of the Autonomous Community of the Canary Islands (Spain), during the first two months of the 2021/22 academic year, in the midst of the fifth wave of COVID-19. Data were analyzed using Pearson's chi-squared test and the linear trend test. The reasons for advantages were analyzed and the dimensions of the questionnaire were compared between the groups studied (with or without a healthcare professional in the center). Out of 640 teachers in the study, 14.7% (n = 94) stated that they had a reference professional with health training in their educational center (a school nurse) for the management of possible cases of COVID-19. Significant differences were found in five of the nine dimensions studied between the groups of teachers analyzed. Teachers who had a health professional, specifically a nurse, during the pandemic indicated that they felt safer in their educational center, as they perceived that they had more personal protective equipment (OR = 2.03, [95% CI: 1.23-3.35]; p = 0.006). They were also more committed (OR = 1.89, [95% CI: 1.04-3.46]; p = 0.038) with their educational work and assumed more obligations (OR = 1.87, [95% CI: 1.01-3.44]; p = 0.045) and risks (OR = 2.82, [95% CI: 1.13-7.07]; p = 0.027). In addition, they presented fewer feelings of burnout (OR = 0.63, [95% CI: 0.41-0.98]; p = 0.041). These results indicate that having nurses in educational centers improves teachers' ability to cope with a pandemic situation.
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Affiliation(s)
- Borja Nicolás Santana-López
- Intensive Care Unit, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain
- Nursing Department, Universitat Jaume I, 12006 Castellón de la Plana, Spain
| | | | - Luciano Santana-Cabrera
- Intensive Care Unit, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | | | | | - Yeray Gabriel Santana-Padilla
- Emergency Surgery Unit, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
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Santiago ISD, dos Santos EP, da Silva JA, de Sousa Cavalcante Y, Gonçalves Júnior J, de Souza Costa AR, Cândido EL. The Impact of the COVID-19 Pandemic on the Mental Health of Teachers and Its Possible Risk Factors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1747. [PMID: 36767110 PMCID: PMC9914333 DOI: 10.3390/ijerph20031747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Objective: The objective was to analyze the development of psychiatric pathologies/burnout syndrome and their possible risk factors in teachers in the context of the COVID-19 pandemic. (2) Methods: A qualitative systematic review was carried out, according to the PRISMA protocol, in the PubMed, Scopus, and Web of Science databases using a combination of the following descriptors [MeSH]: "mental health", "mental disorders'', "covid-19" and "school teachers''. Articles selected were written in English, Portuguese and Spanish, published between November 2019 and December 2022. (3) Results: The most common psychiatric pathologies were generalized anxiety disorders and depression. Burnout syndrome was also quite prevalent. Of the 776 articles identified, 42 were selected after applying the eligibility criteria. Although there is variability among the analyzed studies, the risk factors most correlated with increased morbidity in teachers were: (i) being female; (ii) age below the fifth decade of life; (iii) pre-existence of chronic or psychiatric illnesses before the pandemic; (iv) difficulty in adapting to the distance education model; (v) family/work conflicts; (vi) negative symptoms caused by the pandemic. (4) Conclusions: Therefore, the COVID-19 impact on mental health appears to be more common in female teachers in their fifth decade of life and with pre-existing psychiatric comorbidities. However, prospective studies are needed to better map this situation.
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Affiliation(s)
| | | | | | | | - Jucier Gonçalves Júnior
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Angélica Rodrigues de Souza Costa
- Programa de Pós-Graduação em Desenvolvimento Regional Sustentável (PRODER), Federal University of Cariri (UFCA), Juazeiro do Norte 63048-080, Brazil
| | - Estelita Lima Cândido
- School of Medicine, Federal University of Cariri (UFCA), Barbalha 60430-160, Brazil
- Programa de Pós-Graduação em Desenvolvimento Regional Sustentável (PRODER), Federal University of Cariri (UFCA), Juazeiro do Norte 63048-080, Brazil
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Chen X, Ren K, Shen Y. The effect of perceived organizational support on the prohibitive voice behavior of knowledgeable talents during the COVID-19 pandemic: Exploring moderating role of the digitalization level. Front Psychol 2022; 13:1020263. [PMID: 36507046 PMCID: PMC9728141 DOI: 10.3389/fpsyg.2022.1020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
This study focuses on the effect of perceived organizational support on the prohibitive voice of knowledgeable talents and on the factors influencing that voice during the COVID-19 pandemic in China. Grounding our research in social exchange theory and the Chinese sociocultural background, we collected data from 714 questionnaires from universities in Zhejiang Province and analysize by linear regression and found, first, that perceived organizational support significantly increased the prohibitive voice of knowledgeable talents and, second, that in the relationship between perceived organizational support and the prohibitive voice of those talents, the level of digitalization level of an organization has a positive the effect of perceived organizational support on prohibitive voice behavior. This study enriches the theory of voice behavior, helps universities understand the behavioral patterns of knowledgeable talents and guides the cultivation of an atmosphere with prohibitive voice behavior.
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Affiliation(s)
- Xiao Chen
- Talents Office, Zhejiang University of Technology, Hangzhou, China
| | - Kangjun Ren
- School of Management, Zhejiang University of Technology, Hangzhou, China
| | - Yan Shen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, China
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Porru A, Dicataldo R, Leo I, Roch M, Lucangeli D. Back to School: Italian Teachers' Perceptions of the Impact of COVID-19 on Personal and Social Well-Being and Teaching Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811652. [PMID: 36141916 PMCID: PMC9517635 DOI: 10.3390/ijerph191811652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 06/02/2023]
Abstract
During the COVID-19 pandemic, continuous closing and reopening of schools may have had an impact on teachers' perception of the risk of contracting SARS-CoV-2 and of the effectiveness of health measures introduced to limit the spread of the virus, with consequences on teaching methods and relational bonds within schools. By means of an online survey, we measured: teachers' stress, job-satisfaction, self-efficacy and emotions at work, risk-perception of contracting SARS-CoV-2, perception of effectiveness of health measures, teaching methods and social relationships. Participants were 2446 teachers (2142 women and 304 men) all engaged in the four educational stages. Most of the respondents were aged 50 or older (45%), followed by a group aged 41-50 (31%) and by a group aged <40 (24%). We used path analysis to test the impact that COVID-19 had, according to teachers, on teaching methods (Model 1) and social relationships (Model 2). In both models, teachers' stress was positively directly associated with risk-perception of contracting SARS-CoV-2 (Model 1: β = 0.10; p < 0.001; Model 2: β = 0.09; p < 0.001). Additionally, we found an indirect path between teachers' stress and risk-perception of contracting SARS-CoV-2 on the one hand, and perception of effectiveness of health measures on the other hand (Model 1: β = 0.02; p < 0.001; Model 2: β = 0.02; p < 0.001). These results suggest that, in emergencies, risk perception level, emotional regulation, and teachers' stress levels were all key factors affecting teaching methods and relationship quality in schools.
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Sigursteinsdottir H, Rafnsdottir GL. The Well-Being of Primary School Teachers during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11177. [PMID: 36141464 PMCID: PMC9517649 DOI: 10.3390/ijerph191811177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/18/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
This study examines the self-rated health and well-being of Icelandic teachers just before and over a year after COVID-19 first appeared. We ask, what was the stress level in 2021 compared to 2019 and the impact of mental and physical health and health symptoms on perceived stress? Were there any changes in self-assessed mental and physical health? Were there any changes in self-assessed mental and physical health symptoms? The study is based on an online survey conducted in 2019 and 2021. A total of 920 primary school teachers answered the questionnaire in part or in full, after three reminders. The main findings show increased stress, worsening mental and physical health, and increasing mental and physical symptoms in 2021 compared to 2019. The results also show a higher percentage of women than men reporting high stress, with women scoring higher on the PSS scale, but the gender patterns for mental and physical health are less clear. The results show that the COVID-19 pandemic had negative consequences on the health and well-being of the teachers. The study demonstrates the importance of school authorities keeping an exceptionally watchful eye on the welfare and well-being of teachers in the wake of the COVID-19 pandemic.
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Wilson AM, Ogunseye OO, DiGioia O, Gerald LB, Lowe AA. Barriers to COVID-19 Intervention Implementation in K-5 Classrooms: A Survey of Teachers from a District with Mask Mandates despite a Statewide Mask Mandate Ban. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148311. [PMID: 35886159 PMCID: PMC9316596 DOI: 10.3390/ijerph19148311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The study objective was to characterize K-5 teachers' risk perceptions and experiences with CDC COVID-19 classroom guidance in an Arizona school district with a mask mandate, conflicting with a statewide mask mandate ban. METHODS Public school teachers (n = 111) were recruited between 14 December 2021, and 31 January 2022, for an anonymous online survey with questions on seven important topics related to: (1) population demographics, (2) teachers' perceptions of COVID-19 in the workplace, (3) masks, (4) physical distancing, (5) surface transmission routes, (6) air flow, and (7) contact tracing protocols. Descriptive statistics were calculated, and statistically significant differences in categorical responses by grade level taught were investigated with Fisher's exact test. RESULTS There were 76 complete responses. No significant differences across grade levels were found. More than half (53%, 43/81) reported not feeling protected from occupational COVID-19 exposure. Lack of mask usage/enforcement was the most frequently listed reason (40%, 17/42). Physical distancing barriers included large student-teacher ratios. CONCLUSIONS Consistent mask guidance at state and local levels, increased financial support, and lower student-teacher ratios may improve the implementation of CDC guidance for classrooms. Conflicting statewide and district-level school mask policies may negatively impact teachers' risk perceptions.
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Affiliation(s)
- Amanda M. Wilson
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA;
- Correspondence:
| | - Olusola O. Ogunseye
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA;
| | - Olivia DiGioia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA; (O.D.); (L.B.G.)
| | - Lynn B. Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA; (O.D.); (L.B.G.)
- Asthma & Airway Disease Research Center, Tucson, AZ 85724, USA;
| | - Ashley A. Lowe
- Asthma & Airway Disease Research Center, Tucson, AZ 85724, USA;
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Psychological and Physical Changes Caused by COVID-19 Pandemic in Elementary and Junior High School Teachers: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137568. [PMID: 35805255 PMCID: PMC9265812 DOI: 10.3390/ijerph19137568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to determine psychological and physical differences in elementary and junior high school teachers during COVID-19. This questionnaire-based cross-sectional study was conducted among 427 teachers in Tokyo, Japan (between 15 and 30 October 2020). The questionnaire explored school type (elementary and middle schools), sex, age, and COVID-19 changes (psychological changes, physical changes, impact on work, and infection control issues perceived to be stressed). Post hoc tests for I cannot concentrate on work at all, found a significant difference for no change–improved and male teacher in elementary school female teacher in junior high school (p = 0.03). Regarding stress situation due to implementation of COVID-19 infection control, there were significant differences for disinfection work by teachers between male teachers in elementary school female teachers in junior high school (p = 0.04) and female teachers in elementary school female teachers in junior high school (p = 0.03). COVID-19 produced differences in psychological and physical changes between male and female teachers in elementary and junior high schools. Some experienced psychological and physical stress, whereas others showed improvement. Given that teachers’ mental health also affects students’ educational quality, it is important to understand and improve teachers’ psychological and physical circumstances and stress.
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Assavanopakun P, Promkutkao T, Promkutkeo S, Sirikul W. Perspectives and Factors Affecting the Preventive Behavior Pertinent to COVID-19 among School Employees in Chiang Mai, Thailand: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5662. [PMID: 35565063 PMCID: PMC9104893 DOI: 10.3390/ijerph19095662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
The school is one of the most challenging environments for management to prevent the spread of COVID-19 infection. School employees play important roles as the main practitioners of recommended preventive measures. Consistent application of preventive measures by school employees strengthens the school’s readiness to reopen for on-site education. The study objectives are (1) to assess school employee agreement and actions in accordance with the preventive measures and recommendations for COVID-19 prevention and control, (2) to assess the readiness of the school and employees for on-site education, and (3) to determine factors associated with consistent performance of these measures. A cross-sectional study was conducted via an online survey from 5 November 2021 to 25 January 2022. Self-reported online questionnaires were used to collect school employees’ data. The readiness of schools for on-site education was assessed using 44 indicators from the practical guidelines by the Thai Department of Health. Of the 402 study participants, the majority of participants had agreed to all measures and recommendations for COVID-19 prevention and control in school. High levels of concern and disagreement in school re-opening (aOR 3.78, 95%CI 1.04 to 13.70; p = 0.043) were associated with higher consistent performance of the measures and recommendations for COVID-19 prevention and control in schools. Male teachers (aOR 0.43, 95%CI 0.23 to 0.80; p = 0.008) and any disagreement with these measures and recommendations (aOR 0.03, 95%CI 0.01 to 0.23; p < 0.001) were associated with lower consistent performance. Our study findings can inform the stakeholders to decide on the re-opening and supportive strategies. School employees, especially in male employees, must be supported from the relevant sectors to decrease disagreement to the measures and enhance awareness of the pandemic situation before the school re-opening.
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Affiliation(s)
- Pheerasak Assavanopakun
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.A.); (T.P.)
| | - Tharntip Promkutkao
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.A.); (T.P.)
| | - Suchat Promkutkeo
- School of Economics, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.A.); (T.P.)
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
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