District-Level Health Governance for Disease Prevention and Control in Thailand: A Cross-Sectional Study of District Health Board Performance and Associated Factors
Woraphon Reangchan, Wutthichai JariyaObjectives
Within a decentralized health system, District Health Boards (DHBs) serve as district-level health governance mechanisms for coordinating multisectoral action in local disease prevention and control. Despite their importance, empirical evidence on DHB-specific performance remains limited. This study aimed to assess DHB performance in disease prevention and control and identify its associated factors.
Methods
A cross-sectional study was conducted from December 2025 to April 2026 among 441 DHB members in Health Region 2. Data were collected using a self-administered online questionnaire. Descriptive statistics were used to summarize respondent characteristics and performance scores. A multivariable linear mixed-effects model with a district-level random intercept was used to identify factors associated with DHB performance while accounting for clustering of members within districts.
Results
Overall DHB performance in disease prevention and control had a mean score of 4.09 ± 0.54 (95% CI: 4.04–4.14). Monitoring systems and the use of evaluation data remained areas for improvement. The multivariable linear mixed-effects model identified that seven factors were significantly associated with DHB performance: community participation (β = 0.289, p < 0.001), task delegation (β = 0.232, p < 0.001), communication (β = 0.148, p = 0.002), management skills (β = 0.126, p = 0.001), adequacy of DHB members (β = 0.107, p = 0.002), teamwork (β = 0.092, p = 0.048), and length of DHB membership (β = 0.060, p = 0.024). The model had a marginal R 2 of 0.757 and a conditional R 2 of 0.768.
Conclusions
DHB members perceived their overall performance in disease prevention and control as generally favorable. The findings suggest that strengthening community participation, clarifying task delegation, improving communication, developing management skills, ensuring adequate DHB membership, building teamwork, and retaining experienced DHB members may enhance disease prevention and control at the district level.