The results showed that the literacy of drug use following labels and understanding of medical terms among VHVs in a municipal hospital in Thailand was at good level. Since VHVs have responsibility for providing health education and advice to people in community, using medicines following the indications and instructions on the drug labels should be the expertise of most VHVs. A study by Komwong and Sangkhawat found that the VHVS in Bo Kwang Thong sub-district, Bo Thong district, Chonburi province, had a good level (mean score of 82.8%) of drug use behavior including correct drug use (14). Furthermore, the above-mentioned tasks of VHVs made them familiar with many medical terms such as calories, cholesterol, virus, drug allergy, as well as drug terminology, e.g. steroids, amoxicillin, and antibiotics. Therefore, high number of correct responses to the questions of medical terms was observed in this study.
However, considering the questions relating to antibiotic or antimicrobial drugs, fewer number of participants answered these questions correctly than the questions about drugs and other health products. Similar results were reported in a study by Wattanakul et al; VHVs in Don Kaeo sub-district, Mae Rim district, Chiang Mai province, had moderate level of knowledge of the rational antibiotic use (15). Also, other studies have reported low to moderate levels of knowledge about antibiotics among VHVs (16, 17).
With regard to the aspect of drug purchasing and using, participants in this study had moderate level of knowledge (mean score of 66.20%). Unlike these results, a previous study found that most of VHVs in Ban Khai district, Rayong province, had a high level (mean score of 58.0%) of knowledge about using drug safely and appropriately. Also, the behavior of using drug safely and appropriately was at high level (mean score of 69.14%) (18). It should be noted that, however, the mentioned study used different questionnaire and criteria for level classification, which might result in differences in the conclusion from this study.
The aspect that the repondents received the lowest scores was media assessment literacy with th average score of 33.42%; meaning is might not be familiar with evaluation of the advertised information of health products. According to the study by Tachavijitjaru and colleagues, all VHV training courses in Thailand were performed as ready-to-use knowledge to memorize and there was no sesstion to practice critical thinking skills of the trainees (19). Therefore, skills in application of the acquired knowledge to real situations might not be developed in the trained VHVs. In addition, the average age of the participants in this study was over 51 years, consequently slow learning ability and less memorizing ability (16). These factors might contribute to the lack of advertising media assessment skills among VHVs.
Based on the results from this study, over 80% of participants were previously informed and searched for information about drugs and other health products. The information was mostly obtained from health professionals by either informed or searching because VHVs had to work closely to medical staff to provide health information publicly. Furthermore, healthcare professionals were highly reliable source, so most VHVs chose to consult them for health information. It is worth to mention that 52.6% of the respondents had searched some health information via online because access to the internet was more convenient than contacting medical staff. However, in case if the receivers had lack of skills to assess the reliability of the received online information, there was a high risk that they would achieve fraud or incorrect information (20). Because of the low level of media assessment literacy among the respondents, the awareness of getting health information from the internet should be raised among all VHVs in Thailand.
There were some limitations that should be discussed in this study. Firstly, this study were performed in VHVs in only one setting with small sample size, so the results might not be able to be applied on VHVs in other areas in Thailand. However, according to the previous studies (14, 15, 18), the literacy of most VHVs in Thailand should be at moderate level. Secondly, this study did not aim to find an association between the literacy of VHVs and their characteristics. Indeed, some characteristics such as highest education and number of training course might correlate to the knowledge of respondents, thus further studies should consider these factors.