Theme I: Vhv’s Self-directed Learning Abilities
In Thailand, a VHV works under the Ministry of Public Health through which the public health system is settled and centralized. The line of command is directed through a top-down communication system from the Ministry of Public Health to Tambon (sub-district) Health Promoting Hospitals where the Provincial Health Office is the operational node in each province. This administrative line is constructed to oversee all health promotion actions from central to provincial level. The VHVs bridge the gap from the sub-district level to villages and communities . When the COVID-19 outbreak started, VHVs took a crucial role as a prime resource in supervising individuals’ mobility, tracing roster records, carrying out household visits for temperature measurement, identifying people who needed home quarantine, and communicating necessary health messages pertaining to COVID-19 to every single household in their supervision area. They also stretched their role to help health professionals and to make sure that their community members adhered to the state measures and protocols of COVID-19 prevention.
Focusing on the self-directed learning process, the findings reflect different scenarios that show how the VHVs took initiatives and made attempts to improve their own learning. Prior to the outbreak, VHVs developed their knowledge and expertise to perform their duties through formal training and a vertical line of command. This formal training included activities such as meetings, workshops, and on-the-job training and was set by health authorities. However, face to face activities and prior scheduled training were completely disrupted when the number of infected cases rose in Thailand. Instead, self-directed learning through media platforms and online applications became central to enhancing their knowledge and skills necessary for working under the pandemic situation.
Acquiring Needed Information Across Media Platforms
Most VHVs revealed that they were actively exposed to different mass media channels for finding more up-to-date information relating to the national and global pandemic situation. Due to the insufficient and delayed provision of information from official sources, mass media became the most accessible information outlet for the VHVs. Some of them endorsed the significance of using mass media to broaden their knowledge of COVID-19 for more efficient interaction with their community members.
“I also watch TV news, which reports extensively about COVID-19 news all day. It’s a must for us (VHVs) to update ourselves about what is really going on so we could relate to the real situation and know what and how to respond to our villagers.” (Participant 3)
“I gain a wider view on the national situation by watching the news every day. News from the television is quite responsive. The up-to-date information keeps me in the loop and guides proactive work”. (Participant 29)
For those who were familiar with online platforms before the COVID-19 outbreak, the use of online searching was mentioned as being important. Some of them reflected on the use of their autonomous learning abilities to screen out less reliable or suspicious information. Others who were unable to decide whether certain pieces of information were accurate, took a collaborative learning method. They shared, discussed, and evaluated the information together.
“When the information given (by officials) is not enough or if I want to catch up with the situation, I will surf the internet. Google search is one of the ways, but you need to be very careful with what you find.” (Participant 7)
“We can’t rely only on the official source. Situations change quickly. I usually use Google and social media such as Facebook. Most of the time when I get new information or news, I will check first whether it’s true or not.” (Participant 2)
“There has been a massive amount of fake news on the internet since the beginning of the pandemic. Also, there was fake news about COVID-19 vaccines which made people fearful of getting jabs. Regularly, I discuss the news with my peers, and we are very cautious on selecting information only from reliable sources for communication with others.” (Participant 6)
These statements show not only the extent to which participants are an active audience of the media, but also the way they consume media information with critical views. Such a skill is particularly crucial in alleviating chaos during an infodemic of disinformation and misinformation. Importantly, it reflects their coming out of their comfort learning zones and the incorporation of group-learning. The VHVs have thus become active learners, instead of relying solely on what has been packaged and provided by the state.
Making Proactive Efforts To Learn Online Applications
More reflections on the VHVs’ attempts to learn can be seen through their utilization of unfamiliar technologies. The two new media platforms referred to by the participants in this new normal environment were the Line application and the Smart Or Sor Mor (or smart VHV) application. Line is an instant messaging application which can be used via smart phones, tablets, and personal computers. It allows for the exchange of texts, images, and audio and video, and for free calls. Thai VHVs have been encouraged to use Smart Or Sor Mor’s official Line account and the Smart Or Sor Mor Application for formal uses in sending and receiving formal documents and information from provincial health promotion units and the Ministry of Health since 2018 . In the pre-COVID-19 period, the participants admitted that they all knew about the availability of the official Line account and application, but they preferred meeting or talking in person and rarely deployed these tools. However, once the outbreak started, the use of the official Line account and application was unavoidable. Most participants recalled their frustration using these unfamiliar applications at the beginning.
“The application is new to me. It took me a while to learn to operate it. After I got used to its interface, my work became easier. I don’t need to visit the hospitals to get the information I need anymore”. (Participant 9)
“Before the outbreak, I was not good at using Line or Smart Or Sor Mor Application. I just started using them after the outbreak began. At first, it was a bit confusing. I asked for help from my peers and grandchildren. I may be old, but I’m ready to learn. Now I’m getting better”. (Participant 22)
In addition to the use of the official Line account and application, the VHVs created their own Line chat groups to organize their informal surveillance network in communities, exchange information, communicate with individuals, and monitor the community members’ health daily. This method replaced the traditional approach of door-to-door arrangements and meetings in person.
“We opened a Line group chat to pull together staff from different levels to exchange
messages and keep up with what’s going on. For the households, we also called and texted them to monitor their health conditions and give advice so as to avoid the traditional means of house visits.” (Participant 23)
“I use Line to coordinate with other networks such as local authorities, public health officials, community enterprises, vendors, and local interest groups. We tried to chat and meet in the distance instead of meeting in person.” (Participant 11)
“During this new wave, more villagers are getting infected. We use a chat application to monitor their conditions; however, sometimes we must go visit the quarantine areas or screening tents in person. For VHVs’ daily work report, we send it via the application. Document reports are required only on a half-month basis”. (Participant 30)
The need for the VHVs to make use of self-directed learning became even more vital when the pandemic situation worsened. They had to be able to make the full use of existing application features such as location pinning to locate field hospitals and quarantine and screening stations, and video meeting applications for new normal regular meetings.
“Since the spread of COVID19, I have learned to use many new applications and features to make our work possible. For example, I recently learned how to use the location pinning feature because we need to send the location of field hospitals to those involved.” (Participant 10)
“Most of the VHVs are seniors. We are not keen on technology, but we need to learn. Now I know how to use several more applications. Lately, I learned to use Zoom to conduct VHV regular meetings, so we no longer need to meet in person.” (Participant 17)
Despite their struggles, most participants expressed their willingness to learn and embrace these new communication technologies. When facing technical difficulties, they did not hesitate to ask for help from their peers and young family members. Being able to use these technologies enhances the VHVs’ self-directed learning capability as well as their knowledge and skills in the fields of health promotion and disease control.
“Knowing how to use new technologies has helped me a lot. I can learn COVID-19 related-knowledge, give and receive advice, report cases, and coordinate with others via Line and other applications much more easily”. (Participant 8)
“We set up a Line group to monitor the situation with community staff such as provincial officers, VHVs from nearby villages, and health practitioners from provincial health hospitals. Our communication is very rich and active. We receive information simultaneously from the center. We use the application not only for COVID-19 prevention purposes, but also for referring chronic patients to hospitals.” (Participant 19)
“We (VHVs at Mooban/village level) connect and have conversations every day. We also connect with VHVs of other villages (at Tambon/sub-district Level). When other villages experience new or complicated cases, they will share their cases in Line groups and we can all learn from each other.” (Participant 25)
Notably, the research findings also suggested that what lies beneath the VHVs’ self-directed learning practices was their intrinsic value of “doing good deeds” and their desire to help others. Most participants similarly echoed that the volunteering service brought them pride, joy, and happiness because they could contribute to their community's safety and well-being.
“Being VHVs especially during this pandemic is very difficult but I don’t mind. I believe we were born to help others. Doing good deeds makes us worthy of being human.” (Participant 18)
“Since the cases began to rise sharply, we’re working harder, and I feel so burnt out. But when I brought survival kits and medicines to the villagers and heard them say something like – thank you, or please come again - I felt so good. It brings me joy and pride to help others and work for our society.” (Participant 26)
Theme II: The Influence of Collective power on VHVs’ Working Process
Unlike other previous health promotion activities that mostly aimed at empowerment through health knowledge provision, the COVID-19 prevention activity entailed a degree of imposition on community members to strictly follow the state control measures. However, the fact their volunteer positions did not give them authoritative power made this facet of the work a challenge. This study revealed that the VHVs employed collective power - a cultural factor that influences health promotion practices in the Thai community - to strengthen group collaboration and to mobilize collective action in order to tackle this challenge. The power was found in two aspects: in-group and inter-group power.
Articulating Significance Of In-group Power
Most participants articulated that collective power enhanced their capacity to perform this challenging activity and provided them with moral support. Particularly, the VHVs’ efficiency in enforcing the COVID-19 prevention measures among villagers was claimed as a result of their collective action at a group level.
“We worked together even more closely to support each other. We had to boost each other’s strength to overcome physical and mental fatigue caused by the demands of this task. It was so intense and stressful.” (Participant 25)
Importantly, all participants similarly echoed that the in-group power helped them to get through the feelings of discouragement and despair caused by resistance and hostile reactions from some of their community members. The group strength also helped a few VHVs get through the stress due to their families’ disapproval of doing this health service at the cost of their personal health risk.
“During the first wave, some villagers didn’t understand our work. We faced some resistance. However, after a while the situation escalated and through our endeavors to communicate, we received better cooperation”. (Participant 14)
“We faced complaints from some villagers at the beginning of the pandemic. They said we were so annoying and too nagging with the measures. I was a bit discouraged. But my peers said - we just need to keep explaining. Once they understand the situation, they will appreciate what we do”. (Participant 24)
“My family was displeased and worried about my health; they did not want me to do the service at all. The thing that kept me going was the support from my peers”. (Participant 10)
This in-group power was underpinned by kinship and kinship-like relationships among the VHVs. Some of them were relatives. Most were born and have been living in their communities for generations. Not only were they close personally, but their families also knew each other very well. As a result, having compassion for each other and a willingness to support one another came naturally.
“We are all related in a way. Some are my relatives and family friends. My parents also used to be VHVs, so I knew the nature of the work and some senior VHVs before taking the job”. (Participant 16)
“All of us are more like siblings. We know each other very well so everybody was willing to stick together to keep COVID-19 out of our communities”. (Participant 20)
“Our team has worked together for more than 10 years. We know each other very well. We know the strengths and weaknesses of each other. Therefore, we are willing to fill in for what is lacking for our peers and to give support when needed”. (Participant 5)
Strengthening Community Networks Through Inter-group Power
Similar scenarios of close-knit relationships among community members also contributed to the collective action at a community level. Many participants explained that the community members also took part in monitoring the movement of people inside and outside their communities and informed VHVs. This active participation stemmed from their strong sense of ownership which made them willing to be the “eyes and ears” of their VHVs.
“People in our community were very cooperative. They became our eyes and ears, keeping us informed about the flow of people going in and out of our community.” (Participant 22)
“Most villagers were locals, born here and living here. We (VHVs and villagers) are acquainted. We (VHVs) usually know what is going on, like who has been born and who has died. Working in a community would not be any problem to us. Especially during this pandemic, we received quite good cooperation”. (Participant 27)
Cohesive collaboration between VHVs, local people, and authorities in managing disease control checkpoints was also found in all communities. Even though each party took a different role - the police and village headman set up the check point system, VHVs and local health officials took turns to help the police, and community members provided food and refreshments - they all worked toward the same goal. Particularly during the third wave, the inter-group collaboration extended to the referral system of those being identified as risk groups or infected.
“We worked together and synthesized our efforts as a unit to prevent the spread of COVID-19 in our communities. We did whatever we could at the screening tents.” (Participant 13)
“We worked closely with sub-districts, local hospitals, and temples (designated as community isolation units) to deal with the spreading situation in our area. We provided meals for those in home quarantine and coordinated with doctors to follow-up on their condition on a daily basis.” (Participant 30)
Another aspect of collective action was evident in the establishment of help centers established by and for people in several communities. The help centers were mostly located in “Wat” (Buddhist temples), sacred places that function beyond religious rituals to unite people from various organizations to provide primary assistance. The centers signify the utilization of community strength and the value of group commitments which are particularly high when everyone’s risk is shared.
“Our community set up a help center at a temple. The center acted as a go-between among members aiming to help those in need.” (Participant 15)
“We also collaborated with Buddhist meditation centers and temples in order to give the villagers assistance and distribute necessary commodities for COVID-19 prevention and control”. (Participant 1)
In addition to the collaboration among both health-related and non-health-related subgroups in the community, networking with other communities and social units - a common practice in local communities - was clearly reinforced during the pandemic. The VHVs’ extensive interactions with different levels of networks became a source of power that facilitated and supported their COVID-19 prevention and control activities.
“One reason for our success in managing the situation in this community is because we networked with other groups in other villages. They helped us to distribute preventive measures to their networks and individuals in their area.” (Participant 21)
“Before COVID, we coordinated with schools, community co-ops, housewives’ clubs, senior citizen groups, and local authorities as part of our work, so it was easy to unite our actions and help each other even more during COVID.” (Participant 12)