Determinants of Primary Healthcare Utilization among Border Residents in Thailand: A Cross-Sectional Study
Abstract
Objective: To examine the demographics, attitudes, subjective norms, and perceived behavioral control (PBC) associated with the intention to seek and utilize primary healthcare in Thailand’s border areas.
Materials and Methods: A cross-sectional study was conducted from July to September 2025 among primary healthcare users in six border districts of Ubon Ratchathani Province. Using multistage sampling, 580 participants were recruited. Data were collected through a structured questionnaire assessing sociodemographic characteristics, Theory of Planned Behavior (TPB) constructs, intention to use primary healthcare (PHC) services, and self-reported utilization. Data were analyzed by using descriptive statistics, chi-square tests, negative binomial regression, and multivariate linear regression.
Results: Most participants were female (82.1%) and covered under the Universal Coverage Scheme (UCS) (90.9%). PBC had the highest mean score among TPB constructs (4.10±0.76) and was significantly associated with both past PHC utilization (IRR=1.27, 95%CI=1.01–1.60, p-value=0.043) and future PHC intention (β=0.27, 95% CI=0.52–1.59, p-value<0.001). Chronic disease status and shorter travel time were also significantly associated with past utilization. In addition, ages 40–59 years, marital status, and insurance type were associated with future PHC intention. Beneficiaries of the UCS reported a higher intention to seek care at sub-district health-promoting hospitals (p-value<0.001).
Conclusion: PBC, travel time, and chronic disease were associated with PHC utilization. These findings suggest that improving accessibility, strengthening primary care pathways, and supporting confidence in PHC services may be relevant for PHC utilization among border residents, including working-age and married groups.
Keywords
Full Text:
PDF (Early Version)References
Hone T, Macinko J, Millett C. Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? Lancet 2018;392(10156):1461–72.
Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, et al. Primary health care as a foundation for strengthening health systems in low- and middle-income countries. J Gen Intern Med 2017;32(5):566–71.
Kringos DS, Boerma WGW, Hutchinson A, Saltman RB, editors. Building primary care in a changing Europe: Case studies [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2015. [cited 2025 Nov 17]. Available from: https://pubmed.ncbi.nlm.nih.gov/29064645/
World Health Organization. Primary health care: closing the gap [Internet]. Geneva: WHO; 2021 [cited 2025 Nov 17]. Available from: https://iris.who.int/server/api/core/bitstreams/4ac41cc1-efce-41b6-ada9-eb965f94c303/content
Kruk ME, Gage AD, Arsenault C, Gureje O, Hirschhorn LR, Kruk ME, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018;6(11):e1196–252.
United Nations. Goal 3: Fast Facts [Internet]. New York: United Nations; 2023 [cited 2025 Nov 17]. Available from: https://www.un.org/sustainabledevelopment/wp-content/uploads/2023/09/Goal-3_Fast-Facts.pdf
Chaitiang N, Satyasomboon T, Tunsuchart K. Primary Health Care System Development According to Thailand’s Health Policy. PH.PL 2024;10(3):655-66.
Sumriddetchkajorn K, Shimazaki K, Ono T, Kusaba T, Sato K, Kobayashi N. Universal health coverage and primary care, Thailand. Bull World Health Organ 2019;97(6):415–22.
Quashie NT, Pothisiri W. Rural-urban gaps in health care utilization among older Thais: The role of family support. Arch Gerontol Geriatr 2019;81:201-08.
Rojjananukulpong R, Ahmad MM, Saqib SE. Disparities in Physical Accessibility among Rural Thais Under Universal Health Coverage. Am J Trop Med Hyg 2021;105:837-45.
Phankitiya S, Luvira V. Self-Referral to the University Hospital Resulting in Unnecessary Patient Expenses: A Prospective Descriptive Study in a Super-Tertiary Hospital. Indian J Community Med 2021;46:295-99.
Primary Health Care Performance Initiative. Improving geographic and financial access to care & strengthening primary care in Thailand. [Internet]. 2022 [cited 2025, Nov 17]. Available from: https://www.improvingphc.org/thailand-access-0
Kanthawee P, Markmee P, Muangin T, Suwannarong K. Border health system management along Thai-Laos border; a case study at communities with temporary check point in Wiang Kaen District, Chiang Rai Province. Dis Control J 2020;46(4):579-94.
Moonpanane K, Pitchalard K, Thepsaw J, Singkhorn O, Potjanamart C. Healthcare service utilization of hill tribe children in underserved communities in Thailand: barriers to access. BMC Health Serv Res 2022;22:1114.
Haque MN, Alam MA, Saha S, Panthumas S, Clara AA, Sharif MPI. Vaccine Adherence and Behavioral Changes of Adults Regarding Prevention of COVID-19: A Community Survey Using the Theory of Planned Behavior. JPSS [internet]. 2023 Oct [cited 2025 Nov 15];32:160-9. available from: https://so03.tci-thaijo.org/index.php/jpss/article/view/267459
Cheraghalizadeh H, Adib-Rad H, Pasha H, Chehrazi M, Nasiri-Amiri F, Omidvar S. Effectiveness of face to face and virtual education to promote breast self-examination based on the theory of planned behavior: a randomized controlled trial study. BMC Cancer 2025;25:548.
Siripipatthanakul S, Limna P, Sriboonruang P, Kaewpuang P. Applying the TPB and the UTAUT Models Predicting Intentions to Use Telemedicine Among Thai People During the COVID-19 Pandemic. Int J Comput Sci Res 2023;7(1):1362–84.
Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011;26(9):1113-27.
Cochran WG. Sampling techniques. 3rd ed. New York: John Wiley & Sons; 1977.
Department of Provincial Administration, Ministry of Interior. Population Statistics by Registration (Monthly). In: Registration Statistics System [Internet]. Bangkok: Department of Provincial Administration; [cited 2025 Nov 21]. Available from: https://stat.bora.dopa.go.th/stat/statnew/statMONTH/statmonth/#/mainpage
Srisa-at B. Preliminary research. 10th ed. Bangkok: Suviriyasan Company Limited; 2017.
Office of the National Economic and Social Development Council. Poverty and Inequality Report 2023 [Internet]. Bangkok: NESDC; 2024 [cited 2026 Jan 8]. Available from: https://www.nesdc.go.th
National Statistical Office. The 2023 Household Socio-Economic Survey: Northeastern Region [Internet]. Bangkok: NSO; 2024 [cited 2026 Jan 8]. Available from: https://www.nso.go.th/nsoweb/official_stat/province/er#gsc.tab=0
Gao M, Zhu X. Rural residents’ willingness to utilize primary care and its influencing factors in the context of graded diagnosis and treatment: a study in Deqing, China. Front Public Health 2024;12:1478686.
Pourmand G, Doshmangir L, Ahmadi A, Noori M, Rezaeifar A, Mashhadi R, et al. An application of the theory of planned behavior to self-care in patients with hypertension. BMC Public Health 2020;20(1):1290.
Limwattananon S, Neelsen S, O’Donnell O, Prakongsai P, Tangcharoensathien V, van Doorslaer E, et al. Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand. J Public Econ 2015;121:79-94.
Patcharanarumol W, Panichkriangkrai W, Sommanuttaweechai A, Hanson K, Wanwong Y, Tangcharoensathien V. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand. PLoS ONE 2018;13(4):e0195179.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457-502.
Hughes D, Leethongdee S. Universal coverage in the land of smiles: lessons from Thailand's 30 Baht health reforms. Health Aff (Millwood) 2007;26(4):999-1008.
Limwattananon S, Tangcharoensathien V, Tisayaticom K, Boonyapaisarncharoen T, Prakongsai P. Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care? BMC Public Health 2012;12(Suppl 1):S6.
Kane S, Joshi M, Desai S, Mahal A, McPake B. People's care seeking journey for a chronic illness in rural India: Implications for policy and practice. Soc Sci Med 2022;312:115390.
Srivastava AK, Gupt RK, Bhargava R, Singh RR, Songara D. Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India. BMC Health Serv Res 2023;23(1):387.
Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S. Women’s preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health 2009;99(9):1666–72.
Lilford RJ, Daniels B, McPake B, Bhutta ZA, Mash R, Griffiths F, et al. Supply-side and demand-side factors affecting allopathic primary care service delivery in low-income and middle-income country cities. Lancet Glob Health 2025;13(5):e942-53.
Joung IM, Stronks K, van de Mheen H, Mackenbach JP. Health behaviours explain part of the differences in self reported health associated with partner/marital status in The Netherlands. J Epidemiol Community Health 1995;49(5):482-8.
Bracke PF, Colman E, Symoens SA, Praag LV. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study. BMC Public Health 2010;10:224.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.