Development of a Model for Preventing Unintended and Low-Quality Pregnancy among In-School Adolescents in Phetchaburi Province, Thailand

Abstract

Adolescent pregnancy remains a significant public health concern in Thailand, with Phetchaburi Province identified as an area with a persistently higher prevalence of teenage mothers relative to the national average. Despite legislative reform through the Prevention and Solution of Adolescent Pregnancy Act B.E. 2559 (2016), evidence-based prevention models tailored to the sociocultural context of in-school adolescents in this region remain limited. This study aimed to identify factors influencing pregnancy prevention behavior and to develop a structured prevention model for in-school adolescents in Phetchaburi Province.

              Methods: A mixed-methods research design was employed across two sequential phases in Mueang District, Phetchaburi Province. Phase 1 utilized quantitative methods with a sample of 308 in-school adolescents aged 15–19 years, recruited through multi-stage random sampling. A structured questionnaire with a Cronbach's alpha of 0.87 was used to assess sexual health literacy, self-efficacy for pregnancy prevention, attitude toward pregnancy prevention, perceived social support, and pregnancy prevention behavior. Data were analyzed using descriptive statistics and multiple regression analysis. Phase 2 employed qualitative methods, comprising four focus group discussions and two brainstorming sessions with 45 key informants, to develop a prevention model based on the Phase 1 findings.

              Results: The multiple regression model was statistically significant (F(4, 303) = 53.47, p < 0.001) and accounted for 41.4% of the variance in pregnancy prevention behavior (R² = 0.414). Self-efficacy for pregnancy prevention was the strongest predictor (β = 0.42, p < 0.001), followed by sexual health literacy (β = 0.31, p < 0.001), attitude toward pregnancy prevention (β = 0.23, p < 0.001), and perceived social support (β = 0.18, p = 0.003). These findings informed the development of the KAS Model in Phase 2, comprising three core components — sexual health literacy (K), self-efficacy (A), and pregnancy prevention behavior (S) — and 12 structured activities. The model demonstrated high content validity (CVI = 0.91).

              Conclusion: The KAS Model offers a practical, evidence-based framework for preventing unintended and low-quality pregnancy among in-school adolescents. By leveraging existing community resources, including village health volunteers and LINE application networks, the model is designed for integration into primary care units and school health programs in Phetchaburi Province and may serve as a replicable framework for comparable settings across Thailand.