1. KHON KAEN UNIVERSITY 1
The Effect of Community Risk Perception on
Type-2 Diabetes Mellitus Screening Patterns of
Adults in Ban Nonsang Moo 10, a Rural Village in
Northeast Thailand
Aaron Hedquist1
, Rosa Keller2
, Josh Kumin3
, Carly Freeman4
, and Sydney Silver5
Abstract—The purpose of this investigation was to examine
the effect of risk perception on screening participation for Type-2
Diabetes Mellitus (T2DM) among adults in Ban Nonsang Moo 10,
a rural village in northeast Thailand. Methods and observations
were broken into three phases. The first phase was an initial com-
munity needs assessment. The second phase was a concentrated
study on nutrition knowledge and T2DM. Phase three narrowed
the focus on T2DM screening and risk perception of developing
the disease. Records from the Health Promoting Hospital (HPH)
were obtained to calculate prevalence and screening patterns of
the community. Interviews, participant observation, and surveys
were used to identify risk perceptions and knowledge of nutrition.
It was calculated that the prevalence of T2DM in adults over
age 45 was 12.8% compared to the population under age 45
which was only 0.7%. Screening percentages followed a similar
pattern with 22.2% of adults over age 45 screened compared
to the population under age 45 with only 6.3% being screened.
Less than half of the population had awareness of the Ministry
of Public Health daily dietary recommendations. It was also
noted that biological determinants of developing T2DM were
emphasized over behavioral determinants. It was concluded that
there potentially exists an undiagnosed population of T2DM
patients in Ban Nonsang Moo 10 because of a misguided risk
perception caused by lack of nutritional knowledge.
I. INTRODUCTION
TYpe-2 Diabetes Mellitus (T2DM) is one of the most
prevalent chronic diseases in Thai society with an es-
timated prevalence of 6.9% in individuals 15 years of age and
older as of 2009 (Deerochanawong 2013). Specifically, the
northeast region of the country is disproportionately affected
by the disease. According to the Ministry of Public Health
(MoPH), this region faces the highest mortality rate of diabetes
in Thailand with 19.2 per 100,000 individuals (MOPH, 2009)
coupled with the lowest rates of awareness in the country
(Aekplakorn 2007).
Risk perception is defined as the general risk assessment
for developing T2DM. Perception of risk varies among in-
dividuals, but this assessment will focus on the balance of
assessing biological and behavioral determinants of T2DM.
Both behavior and genetic factors lead to the development of
T2DM. However, lifestyle choices, namely dietary practices,
dictate the prevention and management of the disease.
This investigation exclusively focuses on family history and
Affiliations: 1The George Washington University,2Oregon State University,
3Villanova University, 4Tulane University, and 5Occidental College.
age as biological determinants. Diabetic patients in a rural
village in northeast Thailand expressed the belief that genetics
caused their ailment. When one family member was diagnosed
with T2DM, other family members believed their likelihood
of developing the disease increased regardless of lifestyle
choices (Nakagasien et al., 2008). In accordance with Buddhist
principles, many Thais understand the greater likelihood of
developing diabetes with age. Buddhist beliefs accept illness
as an inevitable element of the natural birth-and-death cycle
(Sowattanangoon et al., 2009).
This report focuses on the behavioral determinants of
T2DM, namely the consumption of nutritious foods and ap-
propriate portion sizes as defined by the MoPH. The ministry
recommends a balanced consumption of food groups to ensure
adequate intake of essential nutrients to sustain good health
and prevent non-communicable disease.
Correlated to changes in lifestyle, T2DM is developing in
younger age groups (UCSF, 2007). T2DM screening strategies
should be revised to compensate for these changes in the at-
risk population. This investigation will examine the effect of
risk perception on the participatory rate of varying age groups
in voluntary screening sessions for T2DM in Ban Nonsang
Moo 10, a small village in northeast Thailand.
This study hypothesizes that lack of knowledge of recom-
mended portion sizes leads community members to overem-
phasize the biological determinants for developing T2DM.
Consequently, less than 10% of adults under the age of 45
participate in screening sessions, therefore, no one under the
age of 45 is being diagnosed for T2DM in Ban Nonsang Moo
10.
II. METHODS
The study took place in Ban Nonsang Moo 10 in Nampong
District, Khon Kaen Province, Thailand. The village consists
of 513 people and is located in the northeast region of the
country.
Statistical Methods Phase One
The study was conducted in three phases. This report is
composed of results gathered during phase two and phase
three. The data collected in phase one guided the focus
of this investigation. In phase one, an initial community
needs assessment was conducted to identify demographic

2. KHON KAEN UNIVERSITY 2
Fig. 1. Conceptual Framework for Research
and health information in order to determine potential health
concerns. Since this was the first time our organization had
visited the community, this phase was also used to establish
rapport. From this assessment, it was noted that the majority
of the community practices Buddhism. The primary source
of income in the community is agriculture, with 76.6% of
the population working in the industry. The most prominent
level of education is Prathom 4-6, encompassing children
ages 9-11. Informal observations displayed a disproportionate
consumption of rice-starchy foods over other core food
groups such as fruits and vegetables. Based on this, the focus
of research for phase two was concentrated on nutritional
knowledge.
Phase Two
Phase two was an in-depth analysis of the community0
s
knowledge of portion sizes relative to the recommended
dietary guidelines set forth by the MoPH. In addition, food
sources were identified and eating practices were observed.
Quantitative and qualitative tools were used for data
collection. The quantitative data was collected through
surveys distributed to adults ages 15 and older. 60 surveys
were distributed throughout the day, both in the community
and surrounding rice fields. Community volunteers and one
translator assisted in distributing the survey. The survey
consisted of 28 questions which focused on three topics:
demographics, food frequency, and knowledge of healthy
nutrition practices. General demographic information entailed
age, gender, occupation, and education level. Food frequency
questions asked for a 24 hour recall of food consumption
and were divided into the core food groups identified by the
MoPH nutrition flag (see appendix) with an added section for
snacks and sugary drinks. Portion sizes were estimated using
a standard hand guide (see appendix). This tool was chosen
because it was easy to visualize and requires no additional
measuring tools. These results were interpreted into standard
serving sizes. For the food group rice-starchy foods, serving
size was represented by number of plates of rice consumed per
day where one plate was equivalent to three serving spoons.
The 1,600 calorie daily dietary intake recommendation was
used for comparison because it was the appropriate diet for
working women and men aged 25-60 as determined by the
MoPH. The third topic focused on knowledge of healthy
nutrition practices assessed by awareness of the nutrition flag
and knowledge of a healthy daily dietary intake. Data was
analyzed using standard descriptive statistical methods, which
will be discussed further in the Statistical Methods section.
Participant Observation
During phase two, participant observation was recorded
of two voluntary host families. Compensation was provided
to cover all accommodations and meal costs. Participant
observations followed the entire food preparation and
consumption process. First, participants accompanied host
families to observe what food was being purchased and
where. The food preparation process was observed in order
to investigate supplementary ingredients such as sugar, oil,
salt, and MSG. Once food was prepared and ready for
consumption, participants shared a meal with host families;
eating behaviors and portion sizes were noted. General food
consumption throughout the day was observed and recorded.
Observations were compared to the recommended portions
provided by the MoPH.
Interviews
Four interviews were conducted to determine cultural
factors of nutrition, knowledge of nutrition, food sources
and access, and T2DM. Key informants for the topics
were selected as interview participants: the head Village
Health Volunteer (VHV), the headman, a rice farmer, and
a vegetable farmer. A translator was present during all
interviews to clarify responses from participants and ensure
the investigation remained culturally appropriate.
Head Village Health Volunteer
Within this community the head VHV is responsible for
the coordination of the VHV network. A VHV oversees the
primary care of 10 households on average. Primary care
encompasses maternal and child health, vaccinations, and
initial screening surveys. The head VHV in Ban Nonsang Moo
10 has strong knowledge of community nutrition practices,
health problems, and perceptions of disease related to poor
nutrition. Interview questions focused on gaining further
insight on overall community understanding of nutrition and
related disease. Through the interview, the head VHV shared
insight on the availability of current screening and diabetes
annual records, which will be discussed in the Statistical
Methods section.
Headman
The headman is an elected official who is responsible for
the civil society institutions of the community. The headman
coordinates various governing bodies of the community,
such as the community board, and manages the demographic
records of the village. Interview questions focused on
changing demographic information, noticeable disease-related
trends in the community, and community perception of T2DM

3. KHON KAEN UNIVERSITY 3
causes.
Farmers
Farmers have a significant presence in Ban Nonsang
Moo 10. Both rice and vegetable farmers were selected
because initial survey results indicated that a large portion
of community members bought or grew their own food
locally. The interviews focused on food access, food sources,
and the farmers0
perceptions of personal nutrition practices.
Questions were designed to understand farming practices,
their knowledge of nutrition, and the role their product plays
in the community.
Information gathered from phase two interviews were
compiled into a single mind map. A mind map (see appendix)
is an organizational tool used to draw connections and
understand overarching themes. The mind map was divided
into four components: cultural factors, knowledge of nutrition,
food sources and access, and T2DM.
Phase Three
The observation and data collected in phase two narrowed
the focus of research to T2DM screening and risk perception
of developing the disease. The first survey did not include
screening information for the community, therefore a four
question survey was developed. This survey was designed to
gather information on age, gender, screening participation, and
their perceived primary reason for T2DM screening. During
midday, 100 surveys were distributed with the assistance
from community volunteers and one translator. This data was
analyzed using standard descriptive statistical methods.
Nampong District Hospital Diabetes Clinic
Two interviews took place at the diabetes clinic at Nampong
District hospital. The majority of diabetes patients from Ban
Nonsang Moo 10 are treated at this facility, therefore, it plays
an important role in the health outcomes of the community.
In order to understand the screening process, a clinician and
medical practitioner were interviewed. Interview questions
focused on the screening process, diagnosis, and treatment
to understand the risk perception of developing diabetes and
discrepancies in screening rates.
Takraserm Health Promoting Hospital (HPH)
The HPH plays an important role in screening and is the
base of the VHV network of Ban Nonsang Moo 10. One
interview was conducted with the station nurse at the HPH to
gain insight on the logistical aspect of T2DM screening and
to further understand discrepancies highlighted by the district
hospital.
Annual records were obtained from the HPH with consent
from the head VHV and staff. Only case numbers were
recorded, and all records were kept anonymous. During phase
two, the HPH provided the 2014 Annual Record of all T2DM
patients in Ban Nonsang Moo 10. The records included
gender, age, household number, and the World Health
Organization International Classification of Disease (ICD)
with complications. During phase three, the HPH provided
the screening records of hypertension and diabetes from
2013-2014. These records included gender, age, household
number, as well as potential risk of developing the diseases.
The 2014 population information, provided by the HPH, was
also intended for use in prevalence calculations.
Surveys and records obtained from the HPH were analyzed
using descriptive statistical methods. These calculations
included prevalence, frequency, and percentage of population.
Microsoft Excel and SPSS Statistics software were used for
data analysis.
III. RESULTS
This study used both quantitative and qualitative research
methods to collect and analyze data.
Quantitative Results
HPH Records
The calculations found in figure one were obtained from
the most updated diagnostic and population records from
the HPH using Excel and SPSS Statistics. The prevalence
percentage was calculated for the population of each age
group in the community. The prevalence percentage of adults
35-44 was 3.5% and prevalence percentage of adults ages
35 and older was 11%. T2DM affected the 70-74 population
range the most, with 35.7% of that age group being diagnosed
with the disease. It was concluded that the prevalence of
T2DM in Ban Nonsang Moo 10 was 6.4%, with double the
amount of cases in women than men. When broken down
by population it was found that no one under age 40 was
diagnosed with T2DM. Therefore, the prevalence of diabetes
in the total population under age 45 was 0.7% compared to
12.8% in the population over age 45.
The calculations found in figure two were obtained from the
2013-14 diagnostic records and the most updated population
records from the HPH, which were calculated using Excel
and SPSS Statistics. The screening percentage was calculated
for the population of each age group in the community.
34.9% of the adult population aged 45-49 were screened for
T2DM, making them the most screened age group. It was
concluded that the percentage of screening for T2DM in Ban
Nonsang Moo 10 was 13.8% in the last two years. It was
found that 6.3% of the population under age 45 had been
screened compared to 22.2% of the population over age 45
being screened for T2DM in the last two years.
Nutrition Survey
During phase two, 58 nutrition surveys were administered.
When compared to HPH records for gender and age, the
data followed similar distributions. This suggests that this
data was an accurate representation for the demographics of
Ban Nonsang Moo 10. With a population size of 413 aged
15 and older, the error for the survey results was calculated
to be 12%. For the food group rice-starchy foods, average
consumed (2.60 plates), average recommended (2.60 plates),
and MoPH recommended servings (2.66 plates) were about
the same. The consumption of fruits and vegetables was low,
and the consumption of meat and dairy was higher than

4. KHON KAEN UNIVERSITY 4
Fig. 2. Number of T2DM Patients with Prevalence by Age Group and Gender
in Ban Nonsang Moo 10
recommended by MoPH. Only 49% of individuals surveyed
were aware of the MoPH nutrition flag.
Screening Survey
During phase three, 100 four-question surveys were
distributed to gather information on screening habits in
Ban Nonsang Moo 10. However, since the survey was
administered during midday, the population that was available
was primarily older and did not accurately represent the total
population. As well, community volunteers who assisted in
the administration of the survey misinterpreted the question
regarding the main reason to be screened for T2DM. Due to
these reasons the survey results were not relevant to the study
and were excluded from analysis.
Qualitative Results
Participant Observations
Results from both participant observations were closely
related, therefore reported as a single narrative. In both
households the mother was responsible for all meal
preparations. There were three stages of observation:
shopping at the local market, food preparation, and eating at
the home. While at the local market, locally grown vegetables,
tofu, and meat were purchased. During food preparation,
the households cooked a variety of dishes which included
ingredients such as tofu, bean sprouts, papaya, chillies, green
curry, leafy greens, chicken, fish sauce, MSG, sugar, soy
sauce, and oyster sauce. In household one, it was common
to add sugar to main dishes. Both white rice and glutinous
rice were provided at every meal. Once prepared, food was
Fig. 3. Number of Screened Individuals with Percentage by Age Group and
Gender in Ban Nonsang Moo 10
placed on a floor mat and eaten family-style in the home. In
household two, family members felt uncomfortable eating the
prepared meal with participants, therefore, observations of
food consumption and portions were consistently documented
throughout phase two.
It was observed that host family members did not use
plates. Households used large handfuls of glutinous rice as
utensils for grabbing food directly from the serving dishes.
As a result, there was a greater consumption of glutinous rice
over white rice. Glutinous rice was present in all communal
settings, leading to casual consumption throughout the day.
For example, at night villagers roasted glutinous rice, battered
in egg and fish sauce, over a fire and eaten communally.
Head Village Health Volunteer
The head VHV stated that nutrition education in Ban
Nonsang Moo 10 is derived from basic nutrition knowledge
acquired during early school years. While she had heard of
the nutrition flag, the VHV network had never utilized it
as a tool during nutrition education. She proposed that diet
changes, namely an increase in sugar intake over the last 20
years, can be linked to the increased prevalence of T2DM.
The increase of T2DM was tied to both diet and genetics,
according to the head VHV. She went on to state that diabetes
is largely related to diet more than genetics because a larger
number of individuals diagnosed with T2DM do not have a
family history of the disease.
Headman
The headman reported population statistics of Ban Nonsang

5. KHON KAEN UNIVERSITY 5
Fig. 4. Comparison of Average Consumed and Persumed Healthy Servings
with MoPH Recommendations of Adults Aged 15 and older in Ban Nonsang
Moo 10
Moo 10 over the last three years. He noted that the population
remained consistent from 2012-2014. The main cause of
death during these years were diabetes complications (kidney
failure), cancer, liver failure, and old age. The headman
perceived the community0
s nutrition status to be adequate and
attributed this to the locally grown and accessible vegetables
and animal protein. When asked about nutrition issues related
to the high incidence of T2DM in the community, the
headman stated that the consumption of glutinous rice and
sugary foods contributed to these high numbers.
Vegetable farmer
The interviewed vegetable farmer primarily grew cucumbers
for the past six years. He believed many community members
over consume rice because it is the staple of Thai eating. The
vegetable farmer proposed that the consumption of sticky
rice and sugar led to diabetes. He shared the community0
s
commonly held perception that socioeconomic status plays a
role in access, and consequently consumption, of nutritious
foods.
Rice farmer
The rice farmer was interviewed in the rice field since winter
rice harvest season was ongoing. She shared that consuming
rice led to positive health but could lead to complications if
eaten in excess. When asked about the causes of T2DM, she
noted that genetics played the prominent role; she believed
she may develop health problems in the future because people
in her family had T2DM. She disclosed little understanding
of nutrition and also expressed that the community had basic
knowledge of nutrition. Despite this basic understanding,
community members still ate foods that attributed to
poor health. In addition, she believed that the community did
not eat healthy portion sizes, instead, eating until they felt full.
Clinician at Nampong District Hospital
At the Nampong District hospital, patients were offered
soy milk and rice porridge upon arrival. While waiting, a
clinician educated patients about portions and amounts of
ingredients in food. In addition to the biomedical services
provided to T2DM patients, traditional practices were offered
for complications. These services included: traditional foot
massage and foot soak in a mangosteen water bath. Meditation
practices were also promoted by clinicians as a means to
cope with the disease.
During the interview the clinician acknowledged behavioral
factors for developing T2DM, she believed that genetic
factors were the cause for the recent increase in prevalence.
She observed that T2DM patients attribute their diagnosis
with primarily with family history and old age. She expressed
gaps in the screening process and misrepresented diagnostic
rates for the under 45 population. She believed that 10-20%
of the Thai population goes undiagnosed.
Endocrinologist at Nampong District Hospital
The endocrinologist at Nampong District Hospital stated
that in Thailand, the lay people believe the main cause of
T2DM is related to genetics. The doctor expressed difficulty
in changing perceptions of genetics as the primary cause of
T2DM because this philosophy has been passed down from
generation to generation. This belief is still popular, regardless
of the fact that the most recent diabetes research by the
MoPH found lifestyle to be the greatest determinant of disease
development. The doctor stated the most referenced research
on T2DM is collected outside of Thailand, and about 95% of
research is done by the American Diabetes Association. Due
to limited resources, no doctors were present at the clinic0
s
mobile T2DM screening processes, so the procedure was
carried out solely by VHVs and nurses. When questioned on
the low participation rate of community members under the
age of 45 in screenings, the doctor attributed it to those under
age 45 underestimating their risk of developing T2DM and
the emigration of younger generation to larger cities looking
for work.
Health Promoting Hospital Nurse
The nurse expressed that a large number of people under 40
years old are undiagnosed. She attributed this to perceptions
of equating young age to good health and men, in particular,
not wanting to be confronted with the reality of having
T2DM. While there is a focus on the genetic determinants of
T2DM, the number of people in the community with genetic
predispositions is very small, and the majority of people
being diagnosed with T2DM are the first in their family.
IV. DISCUSSION
The initial hypothesis was that no one under the age of 45
had been diagnosed with T2DM. The HPH records disproved

6. KHON KAEN UNIVERSITY 6
this hypothesis, however, only two cases (0.7%) of T2DM
were diagnosed under the age of 45. As well, no one under the
age of 40 was diagnosed. This low percentage of prevalence is
surprising when compared to external literature. A study done
on the prevalence and management of diabetes in Thai adults
shows that 8.4% of the rural population had been diagnosed
with T2DM (Aekplakorn, et al. 2003). In Ban Nonsang Moo
10, 11% had been diagnosed. This suggests that the diabetes
rates in the community are significantly higher than its rural
counterparts. However, diagnostic percentages of adults 35-
44 was 4.9% in the InterASIA study, compared to 3.5% in
Ban Nonsang Moo 10. This indicates a possibility that there
are more diabetic patients under the age 45 than recorded.
The hypothesis that less than 10% of adults under age 45
not being screened was supported by the HPH records. The
investigation determined 6.3% of the population under 45 had
been screened. This small percentage of the under 45 adult
population being screened coupled with the low diagnostic
percentage, relative to the InterASIA study, suggests a possible
undiagnosed population.
The last hypothesis was that lack of knowledge of recom-
mended portion sizes leads community members to overem-
phasize the biological determinant for developing T2DM.
With less than half of the surveyed population aware of
the MoPH nutrition flag, this suggests community members
are not educated about recommended portion sizes. This
is highlighted by figure three, participant observations, and
interviews. Figure three illustrates the discrepancies in the
community0
s understanding of healthy portion sizes with
MoPH recommendations. There was an overemphasis on the
importance of meat and a lack of importance of fruits and
vegetables in a healthy diet. The lack of nutritional knowledge
is further evident in participant observations. Households
consumed glutinous rice consistently throughout the day and
were unaware of the amount consumed. Interviews highlighted
the significance of these observations on risk perception of
developing T2DM. Interviews with both farmers, the headman,
and the VHV indicated a knowledge that overconsumption
of glutinous rice is a behavioral determinant of developing
T2DM. However, some interviewees still expressed genetics
and old age to be more important risk factors in developing
the disease. Interviews suggest this emphasis exists because
of a lack of understanding of the severe role their diet plays
in developing T2DM. A previous study, in a rural village
in northeast Thailand, researched T2DM patient0
s perception
of disease development. It was concluded that patients were
aware of diet factors but overemphasized biological concerns
(Nakagasien et al., 2008).
The interviews with the clinician, endocrinologist, and HPH
nurse indicated that the overemphasis on biological determi-
nants led to younger populations choosing not to screen for
T2DM. The HPH nurse expressed that younger populations,
specifically under 40, are going undiagnosed because they
associate old age with illness, failing to comprehend the
impact of diet on developing T2DM. The endocrinologist
supported this observation. The perception of the importance
that genetics and age has in disease development derives from
family beliefs. These beliefs cause a decreased risk perception
among younger populations, consequently, discouraging them
from participating in screening sessions for T2DM. Therefore,
there potentially exists an undiagnosed population of T2DM
patients in Ban Nongsan Moo 10 because of a misguided risk
perception with an underemphasis on behavioral determinants
caused by a lack of nutritional knowledge.
V. LIMITATIONS AND FURTHER RESEARCH
This investigation encountered social desirability bias
through participant observations, communication with village
volunteers, and survey responses. First, both host families and
village volunteers were aware of the objectives of the research.
In an eagerness to satisfy these objectives, households made
an effort to eat healthier and were weary about eating during
meal times. This was alleviated by reframing the observation
period to the entire research phase. Village volunteers were
also eager to satisfy research objectives. While assisting in
surveying, volunteers pushed for more desirable answers.
In order to remain accountable, the investigation withdrew
analysis of the screening survey and decided to focus more
on other observations. Finally, survey respondents introduced
social desirability bias through self reporting of their dietary
habits. This potentially caused a similarity between consumed
servings and presumed healthy servings. This was mitigated
by comparing the presumed healthy servings with the MoPH
recommendations instead of comparing consumed servings
with the recommendations.
The results were influenced by recall bias when participants
of the nutrition survey were asked to recall all food consumed
in the last 24 hours. There was a discrepancy because Thai
style eating makes it difficult to record serving size. This
limitation was reduced by using the hand guide to portion
sizes because it gave a visual representation of dietary intake
which made it easier to recall consumption.
The language barrier during interviews was mitigated
through the use of a translator. However, participant observa-
tions were extended through the entirety of the research pro-
cess, therefore, one translator was not sufficient to understand
dietary habits fully. Also, through the process of translation,
information was lost because many of the observations were
meant to understand cultural habits and therefore did not have
an exact translation. This limitation was alleviated by com-
bining qualitative and quantitative results to fully comprehend
risk perceptions and dietary habits.
Further research for this topic should focus on measuring
the blood glucose levels of adults under the age of 45 to prove
that there is an undiagnosed population. As well, research
should be conducted on ways to change the emphasis on
genetic factors towards a more balanced risk perception.

7. KHON KAEN UNIVERSITY 7
VI. APPENDIX
Fig. 5. Nutrition Flag published by the Thai Ministry of Public Health
Fig. 6. Visual Representation of Serving Sizes
Fig. 7. Mind Map for Phase Two Interviews
REFERENCES
[1] Aekplakorn, W., Abbott-Klafter, J., Premgamone, A., Dhanamun, B.,
Chaikittiporn, C., Chongsuvivatwong, V., and Lim, S. S. (2007). Preva-
lence and Management of Diabetes and Associated Risk Factors by
Regions of Thailand Third National Health Examination Survey 2004.
Diabetes care, 30(8).
[2] Aekplakorn, W., Stolk, R., Neal, B., Suriyawongpaisal, P., Chongsuvivat-
wong, V., Cheepudomwit, S., Woodward, M. (2003) The Prevalence and
Management of Diabetes in Thai Adults. The International Collaborative
Study of Cardiovascular Disease in Asia. Diabetes care, 26(10).
[3] Aekplakorn, W., Bunnag, P., Woodward, M., Sritara, P., Cheepudomwit,
S., Yamwong, S., and Rajatanavin, R. (2006). A risk score for predicting
incident diabetes in the Thai population. Diabetes care, 29(8), 1872-1877.
[4] C. Deerochanawon, et al. (2013, March 14). Diabetes management
in Thailand: A literature review of the burden, costs, and out-
comes. Globalization and Health. Retrieved November 26, 2014, from
http://www.globalizationandhealth.com/content/9/1/11
[5] Ministry of Public Health (2009). Public health statistic A.D. 2008.
[6] Nakagasien, P., Nuntaboot, K., and Sangchart, B. (2008).
Cultural Care for Persons with diabetes in the community:
An ethnographic study in Thailand. Thai Journal of Nursing
Research, 12(2), 121-130. Retrieved November 28, 2014, from
http://thailand.digitaljournals.org/index.php/TJNR/article/view/2406
[7] Pongmesa, T., Li, S. C., and Wee, H. L. (2009). A survey of knowledge
on diabetes in the central region of Thailand. Value in Health, 12(s3),
S110-S113.
[8] Sowattanangoon, N., Kotchabhakdi, N., and Petrie, K. J. (2009). The
influence of Thai culture on diabetes perceptions and management.
diabetes research and clinical practice, 84(3), 245-251.
[9] UCSF. (2007). What is Type 2 Diabetes? Diabetes Teaching Center at
the University of California, San Fransisco. http://dtc.ucsf.edu/types-of-
diabetes/type2/understanding-type-2-diabetes/what-is-type-2-diabetes/
VII. ACKNOWLEDGEMENTS
Thank you to the Takraserm Health Promotion Hospital
for allowing access to the records necessary for prevalence
and screening calculations. And thank you to Siriwatchaya
Naowong for her wonderful translation service and dedication
to our research.