Annals of the Romanian Society for Cell Biology

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

HEALTH STATUS, STRESS, AND FACTORS ASSOCIATED WITH THE QUALITY OF LIFE OF MONKS IN NONG KHAI, THAILAND

Phraratrattana longkorn1, Phrakhrubhavanadhammakosit2, Phramahajongyut Sundot3, Pradit Sararat4, Kris Khunluek5, Supat Assana6, Lampung Vonok7, Sutin Chanaboon8 , Kritkantorn Suwannaphant9 1,2,3 Nong Khai Monk Provincial Office, Thailand. 4,Nong Khai Provincial Public Health office, Thailand. 5Faculty of Science and Health Technology, Kalasin University, Thailand. 6,7,8,9 Sirindhorn College of Public Health, Khon Kaen, Thailand. 6Corresponding author; e-mail address: [email protected]

ABSTRACT

This study aimed to explore health status, stress, and identify the factors associated with the quality of life among monks in Nong Khai province, Thailand. 340 participants by systematic random sampling completed a cross-sectional analytical study. Questionnaires were administered for data collection from November 2019 to January 2020. Data were analyzed using descriptive statistics, and multiple logistic regression was fitted to identify associated factors. An adjusted odds ratio with a 95% confidence interval was conducted to determine the level of significance. The result showed that 69.71% of Maha Nikaya monks with an average age of 42.04+15.08 years have Dhamma Scholar Elementary level (89.71%) and were Buddhist monks (61.47%). More than half of the participants have no congenital disease (69.71%) and had a congenital disease such as Gastritis (9.12%), Diabetes Mellitus (7.65%), Hypertension (7.65%), and Bone and Joint diseases (6.47%). 77.65% consumed beverages; coffee (61.18%), energy drink (22.94%), and tea (17.65%). About 49.71% have a high level of stress, and 31.76% have a moderate level. The overall quality of life in each aspect was found at a moderate level; physical health (76.47%), environmental (75.88%), social relationship (66.47%), and mental health (65.88%), respectively. Factors associated with monks' quality of life: Ecclesiastical peerage; deputy abbot/assistant abbot and Buddhist monk (AOR.=3.93; 95 % CI: 1.19 to 12.92; p-value =0.016 and AOR =3.41; 95 % CI: 1.32 to 8.79; p-value =0.016), respectively. Level of stress; moderate and low (AOR=3.84; 95 % CI: 1.97 to 7.52; p-value <0.001 and AOR =5.56; 95 % CI: 2.33 to 13.29; p-value <0.001), respectively. Status as a religious leader and had the stress involves will affect the overall quality of life. Therefore, activities to promote physical health should be organized and mentally appropriate under the practice of the monks since it can promote the monks to have a good quality of life sustainably.

Keywords: Quality of life, Health status, Stress, Monks

I. INTRODUCTION The monks are Buddhist monks and novices. They are a religious leader who follows the teachings of the Buddha and teaches others according to the principles of Buddhism. Being in the ordination sex must follow the monks' rules or, according to the daily rituals different from the public (Phra Thep Pariyatti Moli (Tongdee Suratecho), 2010). as a result, adjustments must be made and faced with various problems (Chompunuch Singhamanee et al., 2018; Nitchawan Kerdcharoen et al., 2019; Pitinut Ratchapakdee et al., 2018). Most monks did not get annual checkups and received a low level of health promotion made them suffer from chronic disease (Attaworakun et al., 2019; Autchariya Poungkaew et al., 2018, 2018; Mintra Sararuk et al., 2017) as well as there are restrictions on the monks' exercise or outdoor sports. This directly affects monks' health condition and quality of life if there is no serious promotion of health care of monks from all sectors (PraKru Suvithanpatthanabandit et al., 2015).

Nong Khai province has 556 Maha Nikaya temples and monasteries, with 3,497 Maha Nikaya monks, 72 Dhammayutika temples and monasteries with 686 Dhammayutika monks. The temple's total was 603 temples, 4,183 monks, and novices (Nong Khai Provincial office of Buddhism, 2018). Nong Khai Provincial Public Health Office had a health screening of monks from 2016 to 2019. They were found that monks were at a higher www.turkjphysiotherrehabil.org 9940

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X health risk of increasing every year; diabetes 1.91%, 3.72%, 3.53% and 7.74%, hypertension 1.67%, 4.62%, 6.01% and 7.24%, and obesity, 9.23%, 13.79%, 14.99%, and 17.78%, respectively. From the health examination results, it was found that monks had congenital diseases increased from 22.00% in 2018 to 30.97% in 2019: Gastritis 10.00%, Bone and Joint disease 6.77%, and heart disease 3.55% (Nong Khai Provincial Public Health Office, 2019). This shows the trend of health problems among monks at risk of developing chronic communicable diseases and suffering from a congenital disease, including other health problems that continued to increase.

From the problem mentioned earlier, Nong Khai Province has established a project to develop a model of monk health promotion under the spirit of the Monks Health Constitution of 2017 to promote and support monks to receive comprehensive health promotion in all dimensions of health care. The project effectiveness was measured and assessed in various areas to cover the processing of a survey of health status, stress, and factors associated with the quality of life of monks. That will reflect the results and the monks' quality of life to use as a database for planning to improve monks' health in Nong Khai province and other provinces of Thailand.

II. METHODOLOGY 1. Objective 1. To explore the health status and stress of monks in Nong Khai, Thailand and identify the factors associated with the quality of life among monks in Nong Khai, Thailand

2. Studied population The population was 4,183 monks belonging to the temple according to the registration of the office of Buddhism Nong Khai Province, which were selected by a systematic random sampling method. Furthermore, to calculate the sample size for Multiple logistic regression (Hsieh et al., 1998), the target number of participants was estimated at 340 and collected data from November 2019 to January 2020

3. Research Instrument Questionnaires were administrated for data collection. Consisting of 3 parts as the following:

Part 1 General information contains 7 items; a sect, age, Buddhist lent, the highest level of education, the level of academic scripture education, the level of the Pali scholar, and Ecclesiastical peerage.

Part 2 Suanprung Stress Test-20 (SPST-20) (Suwat Mahatnirunkul et al., 1997) contains 20 items weighed on a 5-point Likert scale ranging from "1" (never) to "5" (very often). The total scores were classified into four levels: 0 to 24 as mild, 25 to 42 as moderate, 43 to 62 as high, and more than 63 as severe stress.

Part 3 The World Health Organization Quality of Life Brief – Thai (WHOQOL-BREF-THAI) (Mahatnirunkul et al., 1998) contains 26 items rated on a 5-point Likert scale. The instrument is divided into four domains: physical, mental, social relationships, and environmental. Scores were calculated for each domain and summarized to present overall QOL. The overall QOL is classified into three levels: 26 to 60 as poor, 61 to 95 as moderate, and 96-130 as good.

Quality Assessment Tool

Verify the quality of the questionnaire; it was evaluated by three experts using the Item-Objective Congruence Index (IOC) to ensure the content and construct validity and appropriateness. The IOC presented between 0.67 to 1.00. A questionnaire was brought to trial by the monks in Udon Thani province, Thailand and measuring internal consistency by Cronbach's alpha coefficient. The reliability was at 0.85.

Collecting data The research team collected the data with the consent of the provincial ecclesiastical governor and coordinated with the abbot to request cooperation in collecting data according to the number of participants determined by explaining the questionnaire method and then letting the participants full fill the questionnaire themselves. Furthermore, to protect research participants' information, no information was made publicly.

4. Data analysis This study analyzed using a packaged program as the followings. www.turkjphysiotherrehabil.org 9941

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

1. Descriptive statistics describe the general information and characteristics of a data set by measures of central tendency and variability.

2. Both bivariate and multiple logistic regression were fitted to identify associated factors.

3. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.

5. Research Ethics This study was approved by the Human Research Ethics committee, Sirindhorn College of Public Health Khon Kaen, Thailand. (Ref. No. HE 6320012)

III. RESULTS 1. General information 69.71% was the Maha Nikaya sect, and 30.29% was the Dhammayutika sect, with an average age of 42.04+15.08. 44.41% having a Buddhist lent less than five years. The highest education was secondary and diploma (44.41%). Most of them have Dhamma Scholar Elementary Level (89.71%) and have not to study Pali scholar (62.06%). The Ecclesiastical peerage; Buddhist monks (61.47%), The Abbot (26.47%), and Deputy Abbot or Assistant Abbot (12.06%). (Table 1)

Table 1 General Information (n=340) Variables Frequency Percentage Sect Maha Nikaya 237 69.71 Dhammayutika 103 30.29 Age(year) Less than 40 161 47.35 40-60 137 40.29 More than 61 42 12.35 x ± S.D.: 42.04 ± 15.08, Median (Min: Max) 40(13: 84) Buddhist lent (years) �Less than 5 151 44.41 5 - 10 75 22.06 More than 11 114 33.53 x ± S.D.: 10.60 ± 12.33, Median (Min: Max) 5(1: 59) Education Uneducated� 19 5.59 Primary 82 24.12 Secondary/Diploma 151 44.41 Bachelor's degree or higher 88 25.88 Dhamma Scholar Unenrolled 35 10.29 Elementary level 96 28.24 Intermediate level 32 9.41 advanced level 177 52.06 Pali Scholar Unenrolled 211 62.06 Level 1-2 65 19.12 Level 3 or higher 26 18.82 Ecclesiastical peerage Abbot 90 26.47 Deputy abbot/Assistant abbot 41 12.06 Buddhist monk 209 61.47

2. Health status, stress, and quality of life Health status: More than half of the participants have no congenital disease (68.53%) and had a congenital disease such as Gastritis (9.12%), both Diabetes Mellitus and Hypertension (7.65%), Bone and Joint diseases (6.47%), heart disease (3.53%). 77.65% consumed beverages; coffee (61.18%), energy drinks (22.94%), tea

www.turkjphysiotherrehabil.org 9942

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

(17.65%), and nutritional drinks (16.47%). 62.35% of them are non-smoking, and it found that amount 37.65% are smoking. (Table 2)

Table 2 Health status, beverage consumption and the smoke of the monk. (n=340) Health status Frequency Percentage No congenital disease 233 68.53 Having a congenital disease 107 31.47 Gastritis 31 9.12 Diabetes Mellitus 26 7.65 Hypertension 26 7.65 Bone and Joint 22 6.47 Heart disease 12 3.53 Chronic obstructive pulmonary disease 9 2.65 Others (Asthma, CKD, Allergy, Kidney Stones) 18 5.29 Beverage consumption Not consumed 76 22.35 consumed 264 77.65 Coffee 208 61.18 Energy drink 78 22.94 Tea 60 17.65 Nutritional drink 56 16.47 Smoke Non-smoking 212 62.35 Smoking 128 37.65 The Stress: Almost half of them had a high (49.71%), moderate (31.76%), and mild stress (10.00%), respectively. (Table 3)

Table 3 Level of stress (n=340) Level of stress Frequency Percentage Mild (0 to 23) 34 10.00 Moderate (24 to 41) 108 31.76 High (42 to 61) 169 49.71 Severe (62 or moreover) 29 8.53 Mean ± S.D 44.79±15.39, Median (Min, Max) 47 (20, 99), Total 100 score.

Quality of life The overall quality of life was moderate (77.94%), good (18.24%), and poor level (3.82%), respectively. (Table 4) In each aspect was found at a moderate level; physical health (76.47%), environmental (75.88%), social relationship (66.47%), and mental health (65.88%), respectively. (Table 5)

Table 4 The overall quality of life of monks(n=340) Quality of Life Frequency Percentage Good (96 to 130) 62 18.24 Moderate (61 to 95) 265 77.94 Poor (26 to 60) 13 3.82 Mean± S.D: 83.77±13.58, Median (Min, Max) 83 (34,119), Total 130 score.

Table 5 Quality of life of monks in each aspect. (n=340) Quality of Life Variables Poor Moderate Good n (%) n (%) n (%) 1. Physical health 11(3.24) 260(76.47) 69(20.29) 2. Mental health 28(8.24) 224(65.88) 88(25.88) 3. Social relationship 65(19.12) 226(66.47) 49(14.41) 4. Environmental 23(6.76) 258(75.88) 59(17.35) 3. Factors associated with the quality of life of monks in Ning Khai, Thailand www.turkjphysiotherrehabil.org 9943

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

To find factors associated with monks' quality of life in Nong Khai, Thailand, using Multiple logistic regression method selections called Backward Elimination. The study showed that two significant factors were associated with monks' quality of life. First, an ecclesiastical peerage, deputy abbot, or assistant abbot and Buddhist monks will have a 3.93, 3.41 times better quality of life than monks who are abbots (AOR=3.93; 95 % CI: 1.19 to 12.92; p-value =0.016, AOR=3.41; 95 % CI: 1.32 to 8.79; p-value =0.016), respectively. Second, a stress level, monks with moderate and mild stress will have a 3.84, 5.57 times better quality of life than monks with high to severe stress (AOR=3.84; 95 % CI: 1.97 to 7.52; p-value <0.001, AOR=5.56; 95 % CI: 2.33 to 13.29; p-value <0.001), respectively. (Table 6)

Table 6 Factors associated with quality of life (n=340) Variables n % QOL Crude AOR 95% CI P -Value Modera OR te to Good Ecclesiastical peerage 0.016 Abbot 90 6(6.66) 1 1 Deputy abbot/ assistant 41 8(19.51) 3.39 3.93 1.19 to 12.92 abbot Buddhist monk 209 48(22.97) 4.17 3.41 1.32 to 8.79 Stress level < 0.001 High to severe 198 18(9.09) 1 1 Moderate 108 30(27.78) 3.84 3.84 1.97 to 7.52 Mild 34 14(41.18) 7.00 5.56 2.33 to 13.29

IV. DISCUSSION The survey of health status, stress, and analysis of factors associated with monks' quality of life in Nong Khai, Thailand. The results were presented for discussion as follows:

1. Health status Monk health status Nong Khai Province found that 31.4% had a congenital disease: Gastritis 9.12%, Diabetes Mellitus 7.65%, Hypertension 7.65%, and Bone and Joint disease 6.47%, consistent with the results of the survey of monks' health status. Chiang Mai Province found that 39.50% of monks had a congenital disease, Diabetes Mellitus (9.60%), Hypertension (14.40%) (Wuttisaksakul, S., 2018), and in Bangkok, 34.10% of monks had a congenital disease, Diabetes Mellitus (33.33%), Hypertension (50.00%) (Autchariya Poungkaew et al., 2018). However, unlike Udon Thani Province's survey results, 66.60% of monks had a congenital disease. Most of them were Diabetes Mellitus and high blood pressure (Pitinut Ratchapakdee et al., 2018). Moreover, in Ranong Province, 62.70% of monks had a congenital disease, 16.40% were Diabetes Mellitus, and 20.90% were Hypertension (Sirorat Chotikasathit & Saovanee Pongpieng, 2010). There is a tendency to get sick with congenital diseases increased. More than 30 percent of the critical factors affecting non-communicable diseases among monks consume sweet, oily, salty foods and smoke. It was found that 61.18% of monks in Nong Khai province drank coffee, 22.94% drank energy drinks, and 17.65% drank tea, and 37.65% smoking. That is consistent with other research findings that factors affected health status and morbidity with non-communicable diseases caused by consuming sugary beverages and smoking. A survey found that 54.90% of monks in Khon Kaen Province drink Ovaltine, tea, and coffee daily 44.02% were smoking (Sarawin Phachan & Benja Muktabhant, 2015). Furthermore, in Ubon Ratchathani, 90.83% of monks drank energy drinks, 86.69% smoking, and 14.68% suffered from chronic diseases (Mintra Sararuk et al., 2017). Last, in Phayao province, 27.70% of monks were drinking sugary beverages 2-4 days/week; this indicates the risk posed by health behaviors that will affect the morbidity and health status of the monks. By regular consumption of sweetened beverages and smoking these factors, monks can avoid or modify their behavior on their own if given the right and appropriate advice.

2. The Stress A survey on the stress of monks in Nong Khai Province found that the stress was at mild to moderate level (41.76%), high level (49.71%), and severe level (8.53%). On the other hand, the stress survey of monks in Bangkok showed that 70.70% of monks had mild to moderate stress, and 29.3% with high to severe stress (Nitchawan Kerdcharoen et al., 2019). In monks in Udon Thani Province, the overall stress was moderate (Pitinut www.turkjphysiotherrehabil.org 9944

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

Ratchapakdee et al., 2018). Due to stressful events, 53.00% of monks in Phayao Province will eat more or less food than usual (Chompunuch Singhamanee et al., 2018). Based on the survey results of monks' stress, the stress was at a high level to severe, indicating that the risk of mental health problems among monks is likely to increase if not addressed. The monks have limitations on the morality of the monks due to the status of monks must be religious leaders, being role models, and preaching Dharma principles for people to behave as good people. Monks, therefore, have different stresses from the general population. There is no channel for monks to seek advice or vent problems with other people conveniently, including the drug epidemic in Nong Khai province. It was found that every temple had to be tested for substance abuse among all monks. If substance abuse is detected, behavior modification activities are required if they are in high-risk and sick groups. There could be an important cause that results in the monks in Nong Khai have a high level of stress more than in other areas.

3. Factors associated with the quality of life The position of the monks associated with monks' quality of life in Nong Khai, deputy abbot, or assistant abbot, and Buddhist monks will have a 3.93 and 3.41times better quality of life than monks who are abbots. That is consistent with the study of health behaviors of monks in Phayao Province; most of them are monks who hold the position of an abbot (65.00%) and deputy abbot, or the assistant abbot and secretary (35.00%) had high-risk behaviors in food consumption (50.50%). Moreover, those monks who were in poor health and had congenital diseases were related to the increasing age (Chompunuch Singhamanee et al., 2018). The Ecclesiastical peerage that administrative position is the abbot, the deputy abbot, or the assistant abbot must perform duties in the Sangha administration to have peace and order in their area role. Besides, in contacting and coordinating with different departments about people outside the temple, including having to follow worldly and religious religions. Furthermore, according to the position of the monks at a higher level, it represents a more significant burden and responsibility accordingly that would affect the health status and overall quality of life of the monks as well.

In the case of stress, monks with mild and moderate stress will have 5.57 and 3.84 times, respectively, a better quality of life than those with high to severe stress. Those compatible with findings in Payao found that monks who had stress or problems from emotional behavior will affect the health status of monks (Chompunuch Singhamanee et al., 2018). The social change situation made the monks play a more secular role—the drug epidemic and expanding into the monks. As a result, monks must adapt to the changes that occur in every aspect. These cause the monks' stress to increase, including monks who have limited access to counseling for mental health problems, inaccessible to consulting with ease. Moreover, monks with higher ecclesiastical peerage positions will have different mental health according to the position of responsibility to encourage monks to have a good quality of life. Hereafter, well-being must be promoted physically, mentally, socially, and environmentally balanced in all aspects.

Consequently, monks need to adjust their health care behaviors. Supposing reduces the risks that will affect the illness with non-communicable diseases and other congenital diseases by regularly receiving health care advice and health screening and integrating holistic health care according to Buddhist guidelines. Plus, to be in line with the health care principles of the Ministry of Public Health that will help promote good health and succeed in monks having a good quality of life sustainably.

V. CONCLUSIONS Factors associated with monks' quality of life were ecclesiastical peerage and stress. Other factors that pose a risk to the health status of the monks is to have congenital diseases, consumption of sugary beverages, smoking; these factors must be modified in behavior to help encourage good health and quality of life of monks sustainably.

RECOMMENDATIONS 1. Mental health promotion activities should be designed to allow monks to have access to services simply, conveniently, and suitable for the position of the monks to reduce problems and impacts that will affect the health status and quality of life.

2. To raising monks' quality of life, holistic health must be promoted in the dimensions of physical, mental, social, and environmental health under the practice of the monks.

3. Encourage the integration of holistic health care according to Buddhist guidelines and health care guidelines of the Ministry of Public Health to be the same approach. Besides, to help promote the monks to receive comprehensive health care holistically in all dimensions of health care. www.turkjphysiotherrehabil.org 9945

Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X

DECLARATION OF CONFLICTING INTERESTS The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

REFERENCES 1. Attaworakun, S., Ngamdee, N., & Cherdsuntia, V. (2019). Monk’s health in urban area: The Problem that should be considered. Vajira Medical Journal : Journal of Urban Medicine, 63(Supplement), S177–S184. 2. Chotikasathit, S., & Pongpieng, S. (2010). Health Status and Self-health care behavior of Buddist Monks in Amphur Muang, Ranong. Lanna Public Health, 6(3), 297–307. 3. Hsieh, F. Y., Bloch, D. A., & Larsen, M. D. (1998). A simple method of sample size calculation for linear and logistic regression. Statistics in Medicine, 17(14), 1623–1634. https://doi.org/10.1002/(sici)1097-0258(19980730)17:14<1623::aid-sim871>3.0.co;2-s 4. Kerdcharoen, N., Naviganuntana, Y., & Wisitpongaree, C. (2019). Stress and Factors Affecting Level of Stress among Buddhist Monks in Bangkok. Vajira Medical Journal : Journal of Urban Medicine, 63(1) , 9–20. 5. Mahatnirunkul, S., Pumpaisanchai, W., & Tapanya, P. (1997). The Construction of Suan Prung Stress Test for Thai Population. Academic Psychiatry and Psychology Journal, 13(3), 1–20. 6. Mahatnirunkul, S., Tuntipivatanaskul, W., & Pumpaisanchai, W. (1998). Comparison of the WHOQOL-100 and the WHOQOL-BREF (26 items). Journal of Mental Health of Thailand, 5, 4-15. 7. Nong Khai Provincial office of Buddhism. (2018). The report of number of Temples and Monks in Nong Khai Province. The department of Administration and Sangha Affairs, Nong Khai Provincial office of Buddhism. 8. Nong Khai Provincial Public Health Office. (2019). The report of health check for Monks and Novices to support five precepts village in Nong Khai province. 9. Phachan, S., & Muktabhant, B. (2015). Nutritional Status and Food Consumption of Buddhist Monk in Mueng District, Khon Kaen Province. Srinagarind Medical Journal, 30(6), 552–561. 10. Poungkaew, A., Panitrat, R., Saneha, C., Na Ayuthdaya, K. S., & Sangkapong, T. (2018). Model development for promoting food consumption behaviors of monks: Monks’ perspectives. Journal of health science research, 12(1), 81–91. 11. Ratchapakdee, P., Srison, P., Sriwan, T., Phanphon, V., Chaleekul, K., Sachanasophon, N., Kunna, N., Phokongchai, P., & Phanmui, S. (2018). The Health Care Behaviors of Monk in Udon Thani Municipalloty Udon Thani Province. Udonthani Hospital Medical Journal, 26(3), 199–207. 12. Sararuk, M., Sangwalee, W., & Kampangsri, W. (2017). Prevalence and Factors Associated with Chronic illnessof Monks in Amphoe Warinchamrab, Ubon Ratchatani Province. Journal of Science and Technology, Ubon Ratchathani University, 19(1), 37–48. 13. Seemanee, S., Mattavagkul, C., Poomrittikul, P., Ditajorn, R., & Trangkasant, P. (2018). Factors Related Nutrition Consumption Behaviors of Monks and Foodstuff Dedication Behaviors to the Buddhist Monks of People in Phasicharoen District, Bangkok. Journal of Nursing, Siam University, 19(27), 22–38. 14. Singhamanee, C., Samerchua, W., & Satchasakulrat, S. (2018). Health Behaviors among Buddhist Monks in Phayao Province. Journal of MCU Nan Review, 1(1), 43–55. 15. Sratecho, T. (2010). Vocabulary: Dictionary for the study of Buddhism.(4thed.). Thammasapa. 16. Suvithanpatthanabandit, P., Daengharn, T., & Vapuchavitee, S. (2015). Model Development of Monk’s Holistic Health Care in Khon Kaen Province through The Network Participation. JOURNAL OF THE OFFICE OF DPC7 KHON KAEN, 22(2), 117–130. 17. Wuttisaksakul, S. (2018). Factors Related to Health Behaviors of Monks in Fang District, Chiangmai. Journal of Nurses Association of Thailand Northern Office, 24(1), 71–83.