Environmental Management for Opisthorchis viverrini and Cholangiocarcinoma Prevention in a High-Risk Area of Thailand: The KALMeFS Model.

Objective: Despite the Ministry of Public Health's initiative to involve local governments in waste management through the establishment of sewage treatment ponds aimed at disrupting the life cycle of Opisthorchis viverrini (OV), the majority of areas still lack adequate sewage treatment facilities. This action research sought to develop an environmental management model (EMM) to prevent OV and cholangiocarcinoma (CCA) in a high-risk region of Thailand.

Methods: The study identified two primary target groups: a process development group comprising 20 participants and an evaluation group comprising 32 participants. Research tools involved structured interviews using questionnaires and focus group discussions. Quantitative data were analyzed using descriptive and inferential statistics, with a paired t-test employed for specific comparisons. Qualitative data were examined through content analysis.

Results: The findings were categorized into three key aspects: (1) The contextual factors and challenges related to OV and CCA were analyzed using an epidemiologic triangle framework. (2) Model development: The Appreciation-Influence-Control (A-I-C) method facilitated several activities, including knowledge dissemination, raising awareness among local administrators, training environmental surveillance volunteer leaders (ESVL), developing public relations materials, conducting food waste management training, and constructing a sewage treatment system. (3) Model evaluation: Significant improvements (p<0.05) were observed in participants' knowledge, attitudes, behaviors, and health beliefs regarding OV and CCA prevention. The outcome of these efforts led to the creation of a new model, termed the "KALMeFS Model," which comprises K=Knowledge; A=Authority (raising awareness among administrators); L=Leader (establishing ESVLs); Me=Media development; F=Food waste management; and S=Sewage management.

Conclusion: The initial steps toward establishing an effective EMM for OV and CCA prevention involved comprehensive planning, knowledge dissemination, standard-setting, and implementation. Monitoring and evaluation are critical to ensuring the long-term success of CCA prevention efforts in Thailand.