ArticleAsian Pacific journal of cancer prevention : APJCP2026
3Es-Based Program to Enhance Safety Behaviors Among Fermented Fish Producers in Northeast Thailand: Implications for Liver Fluke and Cholangiocarcinoma Prevention.
Article in Asian Pacific journal of cancer prevention : APJCP, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveConsumption of fermented freshwater fish is common in Northeast Thailand but increases the risk of Opisthorchis viverrini (OV) infection, nitrosamine exposure, and cholangiocarcinoma (CCA). This study evaluated a 3Es-based safety program designed to enhance knowledge, attitudes, behaviors, and to reduce ergonomic risks among informal fish processors.
methodsA quasi-experimental study was conducted with 100 participants from two fishing communities in Ubon Ratchathani Province. The experimental group (n = 50) received a 13-week safety program based on engineering, education, and enforcement (3Es), while the comparison group (n = 50) received routine health services. Data were collected through a structured questionnaire and an ergonomic assessment using the Rapid Upper Limb Assessment (RULA). Statistical analyses included t-tests and effect size estimation with Cohen's d.
resultsPost-intervention, the experimental group demonstrated significantly greater improvements than the comparison group in knowledge (mean difference = 2.09, p < 0.001, d = 2.69, very large effect), attitudes (mean difference = 0.39, p < 0.001, d = 3.88, very large effect), and behaviors (mean difference = 0.25, p < 0.001, d = 1.06, large effect). RULA scores also improved markedly, with fish sorting, drying, and packaging risk levels reduced from high to low, and cleaning and gutting reduced from very high to medium risk.
conclusionThe 3Es-based program significantly improved safety-related knowledge, attitudes, behaviors, and reduced ergonomic risks. Large effect sizes confirm that these gains are both statistically and practically meaningful, supporting integration into community health services and local policies for sustainable OV and CCA prevention.
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