{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:47Z","timestamp":1772168987225,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.26599.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000}}],"reference-count":23,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T00:00:00Z","timestamp":1649808000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>\n                    <ns3:bold>Background:\u00a0<\/ns3:bold>\n                    This study aimed to determine the effectiveness of 36 hospital learning centers for the continued education of sick children using electronic distance learning television (eDLTV), parents\u2019 attitudes toward their child\u2019s illnesses and education, and service satisfaction of the centers.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Methods:<\/ns3:bold>\n                    The sample included 4,430 children aged 4-18 years old with common illnesses, chronic illnesses and developmental disorders, as well as 4,430 parents who had taken care of the child for at least 6 months. The methods included attitude surveys, which were analyzed using chi-square tests and t-tests.\n                    <ns3:bold\/>\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Results:<\/ns3:bold>\n                    \u00a0 The factors associated with education continuation of the children were illness types (parents were less worried about children with common illness and more concerned about education of children with chronic diseases and children with disabilities), distance from home to school, transportation type, parents\u2019 education level, marital status, and family income. About 99.8% of patients with common illnesses continued their education, followed by 99.3% of disabled children, and 95.9% of chronic patients. Satisfaction score towards the services at the learning centers were high (mean scores: 4.28 and 4.43 respectively, out of 5 = strongly satisfied).\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Conclusion:<\/ns3:bold>\n                    After completing an education program through eDLTV at a center, a total of 97.7% of children continued their education and\n                    <ns3:bold\/>\n                    were highly satisfied with the service at the center. Parents had positive attitudes towards their child\u2019s illnesses and education.\n                  <\/ns3:p>","DOI":"10.12688\/f1000research.26599.2","type":"journal-article","created":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T11:30:07Z","timestamp":1649849407000},"page":"1446","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of 36 hospital learning centers in Thailand: continuation of child patient education, parent attitudes toward child\u2019s illness and service satisfaction"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2315-5833","authenticated-orcid":false,"given":"Adidsuda","family":"Fuengfoo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"Sakulnum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumitra","family":"Owjinda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2022,4,13]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"386-91","DOI":"10.1097\/DBP.0b013e3181132074","article-title":"Examining the effects of maternal chronic illness on child well-being in single parent families.","volume":"28","author":"R Annunziato","year":"2007","journal-title":"J Dev Behav Pediatr."},{"key":"ref-2","first-page":"112-25","article-title":"Model of continuing care foe chronically ill children.","volume":"26","author":"T Atheros","year":"2011","journal-title":"Thai Journal of Nursing Council."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1002\/bimj.4710370610","article-title":"Daniel, Wayne W.: Biostatistics \u2013 A Foundations for Analysis in the Health Sciences. 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\n<i>Posted: 29 Mar 2022<\/i>; \n<b>1. This is a single-group interventional study. Here are areas for improvement: The abstract and also the paper should make the design much more clear. Is this a longitudinal one-arm intervention (designed by authors) or is this a natural experiment designed by a system and the authors just conducted the evaluation?<\/b>  This research was conducted in a form of&nbsp;\n<i>natural experimental<\/i>&nbsp;study in which variables are influenced by nature or factors outside of the researchers\u2019 control. A cross-sectional design has been implemented in this study where a group of the population is selected based on the inclusion criteria set for the study: types of illnesses, patient\u2019s and parent\u2019s demographic information in order to measure the effectiveness of the project and to examine the factors correlating with continuing education of children under HSH project, patient\u2019s attitudes and patient\u2019s satisfaction towards HSH project. However, a limitation of a cross-sectional study is that it is difficult to identify causal effects and only describe associations between variables.  \n<b>2. The result is not just about attitudes. Many other factors such as socioeconomic status predict child educational success, but the title only mentions attitude.<\/b>  Assessment of the Learning Center in Hospital Program was assessed on the function and effectiveness of children with health problems participating in the Learning Center in Hospital Program. Another angle, besides taking into account accuracy, should also consider preferences along the way. Therefore, it is assessed in various dimensions, such as assessing the perspectives of service users in terms of parental attitudes and the satisfaction of sick children participating in the Hospital Learning Center project, which is a secondary objective of this research and is discussed in the information found for the purpose.  \n<b>3. One major problem is that all samples are analyzed together. However, some of these children have physical health problems and some have disabling developmental challenges. These two groups are qualitatively different and cannot be combined. Just controlling for this type as a nominal variable (0\/1) does not solve the problem. I think at least for sensitivity analysis, all results should be replicated in a stratified fashion, separately for each of the groups mentioned.<\/b>  The research team would like to accept and appreciate the advice that is very helpful. In the issue of data analysis should be separated into groups, diseases because each group of diseases has a different nature and affects learning. The researcher, therefore, brought this issue to further improve in the analysis of the data to separate the groups into three groups: common disease children, chronic disease children, and children with developmental problems, as shown in the table.  \n<b>4. SES and social determinants of health are root causes of health and well-being. The paper, however, does not mention these concepts despite that it measures them.<\/b>  Socioeconomic status is a very important part of healthcare and is the foundation for proper health management and lifestyle. It is a valuable recommendation when further analyzed separately. The disease group found that social socioeconomic status affecting admission to continuing education after discharge from the hospital was associated with all disease groups. When analyzed, it was found that there was still a relationship between chronic disease and chronic disease groups with developmental problems because it is a long continuous treatment, and with costs that depend on severity, complexity, and advances in technology, children with chronic and developmental diseases have a better chance of living longer.  \n<b>5. Overall, I think the data are much stronger than the discussion section. Many more areas could be discussed which are left untouched. <\/b>&nbsp;  The researcher agreed and used the data for further analysis, separating the disease groups. We have added more discussion on factors that remained related to children's continued return to school when analyzing disease groups: parents' education, socioeconomic status, family income, number of siblings, etc.  \n<b>6. These children are educationally heterogeneous. This includes children at kindergarten to much higher levels. Progress in educational programs is highly dependable on the workload required. So, simply controlling for the educational level does not solve this problem. Overall, the high heterogeneity of the sample is a major problem here.<\/b>  We agree on the issue of diversity in the classroom as one of the limitations of education in nature experimental study. In a future study, we will include prospective follow-up studies and segmented samples for cross-sectional study to&nbsp;reduce such limitations.  \n<b>7. S<\/b>\n<b>ex\/gender is beyond a control variable. Parents may differently invest in their boys and girls (gender norms). Similarly, a child may get different attention and investment depending on the number of siblings. Thus, more attention is needed on the composition of the household beyond marital status.<\/b>  Since gender is an uncontrolled variation, the researcher has selected the factors that are more likely to affect the continuation of children which are the number of siblings and family income. After analyzing separately, the study found that parents with more than 2 children are likely to discontinue education of the child with chronic diseases or with developmental problems. At the same time, families with a monthly income lower than 5,000 baht considered stopping further education of the sick child. With economic constraints, parents may need to think about the cost-effectiveness of sending their child to school. It must be decided that delivering a child without chronic illnesses or developmental delay may be more cost-effective than children with chronic illnesses or developmental delay since education cost is not the only expense under parents\u2019 responsibility, but also healthcare costs or medication costs for the sick child. In contrast, the study found that the number of siblings and hospital length of stay do not correlate with&nbsp;children without chronic illnesses or developmental delay&nbsp;to further education because the normal school system allows them to go back to school after they recover.  \n<b>8.&nbsp;<\/b>\n<b>Another important area in this paper is poor eligibility. These poor selection criteria have made it very difficult to know who was in the study. I think the authors need to replicate their findings in groups of patients with more homogenous conditions.<\/b>  It is a valuable suggestion that gives the researcher a clearer perspective. Therefore, the researcher has divided the groups to select the pediatric patients by separate disease groups and analyze the factors affecting admission to further education in order to create more homogeneous conditions as shown in the table.  \n<b>9. More information is needed on the variation of the adherence to the curriculum across learning centers. How do various centers do their job? Was there any effect on centers?<\/b>  Hospital Learning Centers for sick children use a standardized curriculum established by the Ministry of Education applicable for children at all education levels: pre-kindergarten, primary, secondary, tertiary levels, as well as vocational education. This curriculum is a collaboration between MOU partners: the Ministry of Education, Ministry of Public Health, and Ministry of Science and Technology.  All of the operational processes need to follow the Clinical Practice Guideline (CPG) and pass an external audit from a third party to ensure that the education that is delivered to sick patients in every hospital learning center meets the standard.  \n<b>10.&nbsp;<\/b>\n<b>Participants were nested to centers so they are not independent samples. Please discuss your solution to address this data challenge.<\/b>  The selection of a sample in this study was a voluntary response sample from all 36 learning centers in Hospitals across Thailand. That is, after the instruction was given to the participants, they were able to participate in the study voluntarily. If the number of participants was more than the expected population, a random sample selection would be implemented. In order to access the data, permission from the Human Ethics Committee of the Ministry of Public Health that oversees all 36 network hospitals must be approved.","URL":"https:\/\/f1000research.com\/articles\/9-1446\/v2#referee-comment-8020","order":2,"name":"referee-comment-8020","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.123004.r304892, Banchaun Benjasuwantep, Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, 16 Aug 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/9-1446\/v2#referee-response-304892","order":3,"name":"referee-response-304892","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}