Abstract
This research is a quasi-experimental study with the objective to evaluate
effectiveness and analyze system-level driving factors of the “Integrated PsychosocialMedical Student Support System” or the “Kru Nang Fah system.” This research
collected data using mixed methods. Quantitatively, student health outcomes were
measured using the PHQ-A, WHO-QOL, and PWBS. Qualitatively, data were collected
using semi-structured focus group discussion with groups of teachers, peer support
students, and students who received care in the intervention schools, and then
analyzed using content analysis (content analysis).
The sample for the quantitative study had inclusion criteria: 1) being students
in Mathayom 1–2 (Grades 7–8), and 2) having PHQ-A scores between 5–19 points (the
research team emphasized to the intervention schools that if students with PHQ-A
scores greater than 20 points were found, they must be urgently referred to
healthcare professionals). From 6 schools participating in the research (3 intervention
schools and 3 control schools), there were 247 students who met the inclusion
criteria and had complete data, consisting of 105 students in the intervention schools
and 142 students in the control schools.
The sample for the qualitative study in each intervention school consisted of:
1) 4 teachers, 2) 4 peer support students, and 3) 10 students who received care.
Across the 3 schools, the total was 54 participants.
The quantitative results found that the Kru Nang Fah system was effective in
reducing depression among the students with statistical significance. The depression
scores (PHQ-A) of the intervention group decreased from a mean of 9.09 to 6.95
points (a decrease of 2.13 points; p < .001). When testing the difference in mean
change between the two groups using Welch’s independent t-test, it was found that
the intervention group had a greater reduction in scores than the control group with
statistical significance (t = 2.16, p = 0.032). This was especially evident among
students with moderate depression (yellow group), whose scores decreased by an
average of 3.93 points, and 71.4% had reduced levels of depression severity
(becoming green or blue group), while the control group improved by only 36.9%. In
addition, after controlling for baseline scores, the social relationships domain of
quality of life among students in the intervention group was significantly higher than
that of students in the control group (β = 0.61, p = 0.049).
In terms of implementation outcomes, it was found that the teachers and
peer support students had high satisfaction with the system (means of 4.72 and 4.51
out of 5, respectively). Classifying students into groups according to levels of
depression helped distribute teachers’ workload and facilitated appropriate care
according to students’ problem levels. The tool-box set was also appropriate and
helped provide clear operational direction (mean 4.70 out of 5 points). In addition,
teachers reported positive changes in both attitudes and skills in student care, with
increased confidence in providing counseling and improved ability to use
psychological skills such as deep listening and non-judgment. These findings are
consistent with data from students who received care, who reported good satisfaction
with the system (mean 3.87 out of 5) and felt that they could access support more
easily, were listened to, and had more people who understood their problems.
The findings reflect that key driving factors supporting successful
implementation include support from school administrators, the presence of teacher
change agents, integration into routine school work, and support networks from
external agencies. In conclusion, the Kru Nang Fah system demonstrates effectiveness
in reducing the risk of depression and promoting students’ mental well-being, as well
as feasibility for real-world implementation. For policy recommendations, it should
be supported for scale-up and developed into public policy on mental health care in
educational settings. The Kru Nang Fah system should be included in school
operational standards, and innovative financing models such as Social Impact
Partnership (SIP) and Pay for Success (PFS) should be used to scale up implementation
effectively and sustainably, in order to create an effective, accessible, and sustainable
student support system for Thai youth.
