Next Normal of Health Service System among the Elderly in Trang Community

Abstract

Background and Rationale: The development of health service systems that effectively address the specific needs and challenges of older adults, by fostering multisectoral community participation in elder care, is fundamental to enhancing their quality of life. This study employed the PARiHS (Promoting Action on Research Implementation in Health Services) framework, which integrated empirical evidence, contextual factors, and facilitation processes, as a guiding approach to develop a community-based health service system tailored for older adults in Trang province. The framework ensured alignment with evidence-based practices, local context, and appropriate facilitation mechanisms.

Methodology: This action research utilized the PARiHS framework to analyze the current situation, develop and implement the health service system, and evaluate its outcomes. The study involved 156 participants, including 3 sub-district health promoting hospital directors, 3 professional nurses, 60 village health volunteers, and 90 older adults with their caregivers. Data collection tools comprised demographic questionnaire, reflective journal, and health-related quality of life survey for older adults. Data were gathered through interviews, focus group discussions, and document reviews. Quantitative data were analyzed using frequency distribution, percentages, means, and standard deviations, while qualitative data underwent thematic content analysis.

Results: Key findings supporting the health service system’s implementation in the next normal era included: (1) utilization of digital technology, such as the LINE application, for effective and convenient health status monitoring and communication; (2) provision of holistic care encompassing physical, psychological, and social dimensions to promote comprehensive well-being among older adults; (3) capacity building and active involvement of families and communities in sustainable elder care; and (4) systematic support ranging from medical services and counseling to motivation at all levels. Follow-up evaluations revealed 100% satisfaction among older adult participants, consistent with high overall health-related quality of life scores (mean = 117.52, SD = 4.58).

Conclusion and Recommendations: The PARiHS framework facilitated an in-depth understanding and enhancement of critical factors influencing access to and delivery of health services for older adults. Emphasizing evidence-based approaches within community contexts, consideration of environmental and stakeholder readiness, and continuous support from community networks strengthened the integration of community participation in elder care systems. This integration is vital for reinforcing the resilience and sustainability of local community-based healthcare services in the next normal era.