Development of Practice Guidelines for Village Health Volunteers in Screening and Counseling Electronic Cigarette Users in Samut sakhon Province

Abstract

Results of the development and pilot testing of an operational manual for Village Health Volunteers (VHVs) regarding the screening of and provision of advice to e-cigarette users in Samut Sakhon Province (Objective 2):
The developed manual led to statistically significant improvements in the knowledge, attitudes, and skills of the VHV experimental group compared to both their pre-intervention levels and the comparison group, with large effect sizes observed across all three variables (η²p = .361–.663).
These results can be attributed to the manual’s design, which was based on empirical data from Phase 1 and integrated the 5A's, TTM, and MI frameworks with practical, hands-on experience involving e-cigarette users in the community.
1) Knowledge: Knowledge scores increased post-intervention and continued to rise through the follow-up period. This finding aligns with Lu et al. (2025), who found that community health personnel's knowledge increased following the C.H.A.N.G.E. training program and was sustained at the 1- and 6-month follow-up points; it also aligns with Garcia-Sierra et al. (2026), who observed increased knowledge among over 150 personnel following training. This aligns with the findings of Sadaengsan et al. (2025) regarding the impact of a capacity-building program for Village Health Volunteers (VHVs) on knowledge and attitudes concerning hypertension. However, the follow-up period in this study was shorter (three weeks post-experiment), and the follow-up scores approached the maximum possible (19.98 ± 0.16 out of 20), indicating a "ceiling effect." Additionally, given that the same test was administered three times over an eight-week period, the improvement observed at follow-up may have been partly attributable to familiarity with the test items (a "testing effect").
2) Attitudes: Attitudes emerged as the variable with the largest effect size between groups (η²p = .663), and this effect persisted through the follow-up period. This result is consistent with the manual’s design—which prioritized attitude adjustment based on findings from Phase 1—and aligns with Garcia-Sierra et al. (2026), who found that attitudes, motivation, and confidence in assisting service recipients improved following training. However, the post-experiment mean score of 54.75 out of 75 (an item mean of 3.65) remained at a moderate level according to the study's criteria, and only 42.50% of participants held positive attitudes—even though negative attitudes had been eliminated. This suggests that reducing stigma requires more time and sustained activities beyond the scope of this experimental period.
3) Operational skills Skills improved in a statistically significant manner, consistent with Nguyen et al. (2020), who found that village health workers in Vietnam increased their history-taking, advice-giving, and assistance to smokers following training. The findings also align with Evins et al. (2023), confirming that community health workers who adhere to established guidelines can enhance the effectiveness of smoking cessation interventions. However, the results differ from Nguyen et al. (2020) in two respects: first, Nguyen et al. measured actual practice at the 12-month mark, whereas this study utilized a self-assessment at 8 weeks; second, 75.00% of the Village Health Volunteers (VHVs) demonstrated only a moderate level of skill, with only 25.00% reaching a high level. This indicates that Motivational Interviewing (MI) counseling skills require repeated practice and ongoing supervision, consistent with the recommendations of Foo et al. (2025) regarding follow-up frequency.
4) Comparison with the control group: Prior to the experiment, the control group had higher rates of prior training on e-cigarettes (65.00%) and prior screening of users (47.50%) compared to the experimental group (22.50% and 17.50%, respectively). However, post-experiment results showed lower scores for the control group after adjusting for baseline scores. This finding supports the conclusion drawn by Tan et al. (2023) that general training is insufficient. The curriculum must be specifically designed for the work context of community personnel. However, the two groups were not selected via random sampling and differed in several fundamental characteristics, such as educational background and experience. Since the ANCOVA analysis controlled only for pre-test scores, other confounding variables may still have influenced the results.