Skip Navigation
Skip to contents

RCPHN : Research in Community and Public Health Nursing

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > J Korean Acad Community Health Nurs > Volume 33(2); 2022 > Article
Original Article Risk Perceptions of Noncommunicable Diseases among Cambodian Adults: A Cross-Sectional Study
Sung Heui Bae, Ok Nam Hwang, Ji Eun Jeong, Young Ran Yang

DOI: https://doi.org/10.12799/jkachn.2022.33.2.259
Published online: June 30, 2022
1Associate Professor, College of Nursing ․ Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
2Project Manager in Cambodia, Korea Association of Health Promotion, Seoul, Korea
3Graduate Student, Graduate School, Clinical and Public Health Convergence, Ewha Womans University, Seoul, Korea
4Professor, College of Nursing ․ Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
  • 1,017 Views
  • 58 Download
  • 1 Crossref
  • 0 Scopus

Purpose
In Cambodia, noncommunicable diseases (NCDs) account for 64% of all deaths. A lack of risk perception of NCDs leads to poor measures of their prevention and management. This study aimed to investigate Cambodians’ risk perceptions of NCDs based on the health belief model. Methods A cross-sectional design was used, and using convenience sampling, participants included 200 Cambodians aged 40 years or older. A face-to-face administered structured questionnaire was used to assess demographic characteristics, health behaviors, and risk perceptions of NCDs. Results Of the constructs of NCD risk perception, perceived severity (88.2%) and benefits (86.3%) were high, but relative to these, perceived cues to action (64.1%), barriers (63.5%), and self-efficacy (58.1%) were low. Conclusion It is important to improve perceived self-efficacy in government health promotion, outreach, and improvement programs and to reduce perceived barriers through medical tests either by facility-based delivery or via outreach health services in Cambodia.


J Korean Acad Community Health Nurs. 2022 Jun;33(2):259-268. English.
Published online Jun 30, 2022.  https://doi.org/10.12799/jkachn.2022.33.2.259
© 2022 Korean Academy of Community Health Nursing
Risk Perceptions of Noncommunicable Diseases among Cambodian Adults: A Cross-Sectional Study
Sung-Heui Bae,1 Oknam Hwang,2 Jieun Jeong,3 and Youngran Yang4
1Associate Professor, College of Nursing · Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea.
2Project Manager in Cambodia, Korea Association of Health Promotion, Seoul, Korea.
3Graduate Student, Graduate School, Clinical and Public Health Convergence, Ewha Womans University, Seoul, Korea.
4Professor, College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.

Corresponding author: Yang, Youngran. College of Nursing, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea. Tel: +82-63-270-3116, Fax: +82-63-270-3127, Email: youngran13@jbnu.ac.kr
Received January 18, 2022; Revised May 30, 2022; Accepted June 01, 2022.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

In Cambodia, noncommunicable diseases (NCDs) account for 64% of all deaths. A lack of risk perception of NCDs leads to poor measures of their prevention and management. This study aimed to investigate Cambodians’ risk perceptions of NCDs based on the health belief model.

Methods

A cross-sectional design was used, and using convenience sampling, participants included 200 Cambodians aged 40 years or older. A face-to-face administered structured questionnaire was used to assess demographic characteristics, health behaviors, and risk perceptions of NCDs.

Results

Of the constructs of NCD risk perception, perceived severity (88.2%) and benefits (86.3%) were high, but relative to these, perceived cues to action (64.1%), barriers (63.5%), and self-efficacy (58.1%) were low.

Conclusion

It is important to improve perceived self-efficacy in government health promotion, outreach, and improvement programs and to reduce perceived barriers through medical tests either by facility-based delivery or via outreach health services in Cambodia.

Keywords:
Cambodia; Health belief model; Noncommunicable diseases; Risk perception
INTRODUCTION

In 2021, noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes, and chronic lung disease, were responsible for almost 70% of deaths worldwide. Nearly three-quarters of all NCD deaths occur in low- and middle-income countries. The epidemic of NCDs poses devastating health consequences for individuals, families, and communities and threatens to overwhelm health systems [1].

According to the Ministry of Health in Cambodia, NCDs accounted for 64.0% of all deaths in Cambodia in 2018, and it is increasing by year along with double burden of infectious disease. About one in every four Cambodians (23.0%) dies prematurely, before the age of 70 years, from one of the four main NCDs: cardiovascular disease (24.0%), cancer (14.0%), chronic respiratory disease (4.0%), and diabetes (2.0%)[2]. The four main NCDs share common risk factors: tobacco use, excessive alcohol use, unhealthy diet, indoor air pollution, and physical inactivity. Currently, two million Cambodians use tobacco, with 42.5% of adult males smoking cigarettes. Over 8 in 10 do not eat enough fruit and vegetables to protect them from NCDs. Moreover, 1 in 5 Cambodian adults have high cholesterol, and 1 in 10 have high blood pressure due to a diet that is too high in saturated fats and salt [3].

Reducing the major risk factors for NCDs-tobacco use, physical inactivity, unhealthy diet, and excessive use of alcohol-is the focus of the WHO’s work to prevent deaths from NCDs [1]. It means that behavior change is well received in dealing with NCDs related to lifestyle. To prevent escalating the burden of NCDs as well as the treatment, the Ministry of Health in Cambodia identified the major interrelated causes or multiple causes for an individual and defined a number of multisectoral strategies: controlling tobacco and alcohol use, raising awareness of unhealthy food in the diet, maintaining health through physical activity, providing effective screening and treatment, and palliative care and promotion [4].

The health belief model (HBM) is one of the most effective health behavior-change models. It comprises six constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) explaining why an individual may or may not adopt preventive measures against the disease of interest [5]. Perceived susceptibility is the perception of the risk of acquiring an illness or disease. Perceived severity refers to a person’s feelings on the seriousness of contracting an illness or disease. Perceived benefits are the perception of the effectiveness of various actions available to reduce the threat of illness or disease. Perceived barriers refer to an individual’s feelings on the obstacles to performing a recommended health action. Perceived cues to action is the stimuli needed to trigger the decision-making process to accept a recommended health action. Lastly, self-efficacy is the level of a person’s confidence in their own ability to perform behaviors [6]. According to the HBM, individual beliefs about health and health conditions play a role in determining health-related behaviors. Therefore, the HBM is widely applied to health-related studies that examine health behaviors and health-risk behaviors in an individual.

A previous cross-sectional study found that perceived barriers and self-efficacy showed the most significant impact on NCD-related behaviors [7]. Another study found that HBM constructs were associated with participants’ exercise behavior [8]. A similar finding was reported in a study conducted in Saudi, which showed that the perception of the seriousness of obesity influenced physical activity [9].

About two decades ago, emerging global health issues may have shaped the current focus on communicable diseases, but the global burden of disease has changed to NCDs. Changing the patterns of personal health behaviors is the best way to prevent NCDs; the change can arise through education, advertisement, or advocacy activities. Society and governments also have a responsibility to create environments wherein individuals are made aware of, and can practically make, life choices that protect their health [10].

Risk perception is defined as interpretations and other subjective judgments about risks [11]. Risk perceptions are critical determinants of health with regards to making decisions such as practicing healthy behaviors [12]. NCD risk perception is important for promoting the adoption of healthy lifestyle and NCD prevention. Low level of perceived risk lead to risky behavior [13]. Despite the importance of NCD risk perception in lifestyle changes, studies related to the relationship among personal perceptions of NCDs based on the HBM are rare. One study conducted in South Africa found differences in the risk perceptions of NCDs by age groups such that young adult groups had poorer risk perceptions than middle-aged and older-aged adults, resulting in poor practices in regard to following NCD health recommendations [5]. Moreover, few studies related to the personal perceptions of NCDs have been conducted in the Asian regions.

Therefore, the purpose of this study is to (i) examine the relationships between the general characteristics of individuals and the risk perceptions of NCDs and (ii) assess the distribution of risk perceptions of NCDs according to the general characteristics of individuals. The findings of this study could inform the Cambodian government and aid in its decision-making process on public health policy and plans to prevent and manage NCDs.

METHODS

1. Study Design

A cross-sectional design was used in this study.

2. Participants and Data Collection

The study participants comprised 200 Cambodian adults 40 years or older who currently resided in communities in Kandal, a province located about 27 miles from Phnom Penh. G*Power version 3.1.9.7 estimated the sample size at 185, considering a maximum of 5 number of groups, a level of significance of .05, statistical power of.80, and a small effect size of .26 [14]. They were recruited using convenience sampling between December 2020 and January 2021. A pilot study among 30 adults in Kandal Province was carried out to examine the extent of understanding of each question, measure the time to answer all questions, and test the appropriateness of the translation into the local language, Khmer. Participants in the preliminary survey understood all questions well and did not report any discomfort, and the survey took about 30 minutes.

Four local senior college students conducted the data collection under a local survey supervisor who understood the purpose of the study. Training workshops were held by the primary investigator to provide local survey supervisor and each interviewer with one-on-one practical training via an online meeting. Before the survey, the local survey supervisor provided details of the study aims and methods to each village leader and obtained permission to survey the village. The interviewers visited house by house and introduced the study; the survey was initiated once the written consent was obtained. In cases for which the participant had difficulty answering the questions on their own because of illiteracy, the interviewers helped with reading questions but did not provide explanations. The interviews followed social distancing and the national guidelines for Covid-19 prevention. All survey personnel wore masks and used hand sanitizer prior to home visits. If any survey personnel had respiratory symptoms such as cough or fever, they were not allowed to participate in the survey.

3. Measurements

The study used a structured questionnaire composed of information about general characteristics (sex, age, marital status, education, occupation, perceived health status, medical check-ups, and diagnosed disease), health behaviors (drinking alcohol, smoking, exercising, eating fruits and vegetables, drinking energy drinks, and consuming salts), and the risk perception of NCDs.

The risk perceptions of NCDs were assessed based on a previous study by Kaba and et al. [5]. In their study, perceived susceptibility was measured by 5 items (e.g., Obese/overweight will lead me to getting NCDs), perceived severity by 5 items (e.g., Having an NCD will have major effects on my life and family), perceived benefits by 7 items (e.g., Not having an NCD is beneficial), perceived barriers by 7 items (e.g., Very little can be done to prevent NCDs), perceived cues to action by 6 items (e.g., I eat a well-balanced diet), and perceived self-efficacy by 5 items (e.g., I am confident about how to prevent chronic diseases). Each item was checked by using a 5-point Likert scale (strongly disagree, disagree, neutral, agree, and strongly agree), and the answers were integrated: “agree” and “strongly agree” were integrated as “agree,” and “disagree,” “strongly disagree,” and “neutral” were integrated as “disagree” among each item response. The validity of the risk perception of NCD items was confirmed in their study, evidencing that the questions were suitable within the constructs of the HBM, and Cronbach’s α coefficient for all constructs was recorded between .78 and .89 [5]. In this study, the Cronbach’s α coefficient ranged from .58 to .84 for each construct of the HBM (susceptibility: .58, severity: .65, benefit:.69, barriers: .60, cues to action: .58, efficacy: .84).

The questionnaire was translated from English into Khmer (the Cambodian language), and the Khmer version of the questionnaire included all questions and was pilot-tested among 30 Cambodians who were later excluded from the main study based on the guidelines “translating from one language to another” [15] to improve reliability and validity.

4. Statistical Analysis

Data analysis was carried out using SPSS version 21 (IBM Corp.). Descriptive statistics (n, %) were used for general characteristics, health behaviors, and the risk perception of NCDs. Differences in the NCD perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy according to general characteristics were analyzed according to participants’ general characteristics using a t-test, a Welch test in the case of unequal variance, and a Scheffé test for post-hoc.

5. Ethical Consideration

The study was approved by the IRB of Jeonbuk National University (IRB No. 2020-12-003-001).

RESULTS

1. Descriptive Characteristics of Study Participants

Table 1 presents the descriptive characteristics of study participants. A total of 200 respondents participated in the study. There were 58 male respondents and 142 female respondents. The age of the participants ranged from 40~49 to 70~85 years old, and the mean age was 56.96 (SD 11.86) years. Respondents were mostly married (74.0%), and a few participants had been married before (18.5%) or were never married (7.5%). Most of the respondents were likely to have a lower level of education; 15.5% were uneducated and 35.5% completed only elementary school. More than half of the participants were farmers (30.0%) or sellers/operators of small business (28.0%). Only 20% of respondents perceived their health status as good, while 64.5% and 15.0% perceived their health status as fair and poor, respectively. Seventy percent of all participants (70.5%) received medical check-ups for at least one item of blood sugar, blood pressure, or lipids within the last year. In addition, 52.5% of them were diagnosed with one or more diseases of hypertension, diabetes, or dyslipidemia by a doctor.


Table 1
Descriptive Characteristics of Study Participants (N=200)
Click for larger image

2. Health Behaviors of Study Participants

Table 2 shows the reported health behaviors of all study participants. A third (35.0%) of them reported drinking alcohol once or more than twice per month. Nine percent of the study participants reported that they smoked. However, only males reported a high use of alcohol and tobacco, 67.2% and 29.3%, respectively. Regarding eating habits, over 50% of participants reported they eat fruits one to three days a week or eat vegetables every day. Most of the participants reported they take energy drinks (65.0%), and 57.0% of them have three to five energy drinks a week. Participants have been drinking energy drinks for a long time, from two years to more than five years (data not shown). Lastly, 42.0% of participants added salt or salty sauce while preparing a meal at home. Twenty-three percent (23.5%) of the participants always eat (10.0%) or sometimes eat (13.5%) salty processed food. A few participants perceived that they consume too much salt (12.0%).


Table 2
Health Behaviors of the Study Population (N=200)
Click for larger image

3. The Perceptions of NCDs

The average of each item shows that perceived severity (88.2%) was the highest, followed by perceived benefits (86.3%), perceived cues to action (64.2%), perceived barriers (63.5%), and perceived self-efficacy (58.15%)(Table 3).


Table 3
Distribution of Risk Perceptions of Non-communicable Disease (NCDs) (N=200)
Click for larger image

In the perceived susceptibility, most of the participants recognized that being obese/overweight (70.6%), having unhealthy eating habits (80.0%), and physical inactivity (70.0%) were risk factors of NCDs. A few participants only considered family medical history (22.5%) as a risk factor of NCDs. In the perceived severity, the participants responded that having NCDs could make them crippled (93.0%) as well as scared (85.5%). They responded that NCDs also could impact their work and income (91.0%), and their life and family (85.5%), and could change their outlook (76.0%). In the perceived benefits, over 85.0% of participants agreed that not having NCDs is beneficial. They also agreed that physical activities (81.5%), a healthy lifestyle (84.0%), and managing body weight (81.0%) could prevent NCDs. Regarding health check-ups, 97.0% of participants agreed that health check-ups were beneficial and that NCDs could be detected early (82.0%). However, only 64.0% of participants agreed that not smoking prevents NCDs. Sixty-three percent (63.5%) of participants agreed that barriers to preventatives such as medical check-ups and healthy foods can make NCD prevention difficult to achieve. About 75.0% of them agreed that health check-ups are high-priced, and are time-consuming as well. Some of the participants responded that going for health check-ups was embarrassing (32.0%). Sixty-six percent of them also agreed that healthy food is costly, and that cooking healthy food is time-consuming. Regarding perceived cues to action such as prevention and treatment, about 60% of the participants agreed that very little can be done to prevent NCDs, and that no treatment will be effective in curing NCDs. To improve their health, most of the participants followed medical orders (80.5%). They also changed their eating habits, such as eating a well-balanced diet (64.5%), avoiding fatty foods (62.5%), and eating small-portion meals (41.0%). About half of the participants perceived self-efficacy to the risks of NCDs. Sixty percent of them responded that they were able to work on a healthy lifestyle activity; however, they did not have information on the means for preventing NCDs (51.5%).

4. Differences in the Perceptions of NCDs According to General Characteristics

In perceived susceptibility, participants diagnosed with one or more diseases of hypertension, diabetes, or dyslipidemia had higher mean percent (66.6±25.6) than other participants who were not diagnosed with any diseases by a doctor, and the difference was statistically significant (p=.024). There were statistically significant differences in perceived barriers depending on the experience of medical check-ups (p=.007). The participants who were examined with at least one item of blood glucose, blood pressure, or lipids within a year had a lower mean percent (60.5±27.7) than other participants who were not examined with medical check-ups. A statistically significant difference was determined between the general character of individual occupation and “perceived benefits.” The seller or small business participants had the highest mean percent (90.6±17.2), followed by the farmer, civil servant, participant with no occupation, housekeeper, and others (F=2.75, p=.020). A statistically significant difference was determined between the educational status and “perceived self-efficacy”(F=2.46 p=.047). The mean percent of the farmer was 70.3±38.4, and it was found to be higher than other occupations (F=3.46, p=.005). However, the percent scores for perception of severity and cues to action were not statistically significant (Table 4).


Table 4
Differences in the Non-Communicable Disease (NCD) Perceptions According to General Characteristics (N=200)
Click for larger image

DISCUSSION

We examined the Cambodians’ health behaviors and the risk perceptions of NCDs, and also examined this risk perception of NCDs according to demographics and health-related variables among Cambodians. We used the risk perception based on the HBM with six constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived cues to action, and perceived self-efficacy). Several variables were related to these constructs. In Asian regions, few studies have assessed the risk perception of NCDs. This study contributes to finding evidence for significant factors related to the risk perception of NCDs. The risk perception of NCDs has been found to be related to preventive behaviors against NCDs [7, 8]. Thus, these factors can be used to promote the risk perception of NCDs in NCD prevention.

The prevalence of diabetes and hypertension is 9.6% and 14.2%. Because this study only included Cambodian aged 40 years or older, prevalence of self-reported disease diagnosed is relatively high (52.5%)[16]. Regarding the health behaviors of study participants, we found that there were fewer heavy episodic drinkers and fewer smokers compared to the findings of a national study in Cambodia [2]. According to the Department of Prevention Medicine of Cambodia, 22.1% of Cambodian are smokers in 2016. Among men 71.8% are current drinkers. 48.1% of Cambodian were having five or more daily servings of fruits and vegetables. Compared these numbers, participants of this study are less smoking and having more fruits and vegetables [16]. This might be because the study sample consisted of a high proportion of women. About 50% of the respondents reported that they intake processed foods high in salt, and 12% consumed very salty food. The intake of sodium of the Cambodians (5,615.9 mg) was three times higher than the WHO recommendation (2,000.0 mg), which is attributed to the additional seasonings during daily cooking, such as fish sauce, monosodium glutamate, and prahok (a locally made fish paste) [17]. In this study, the data also show the high levels of salt consumption among Cambodians. The consumption of high sodium has contributed to about 28% of deaths caused by cardiovascular disease [2]. In addition to smoking and drinking alcohol, high levels of sodium consumption need to be managed in Cambodia.

Another interesting finding is in regard to energy drinks. Sixty-five percent of the respondents reported they drink energy drinks regularly. About 22.0% started to drink energy drinks within one year previous to the study. More than half drink energy drinks 3 to 5 times a week. In Laohasiriwong et al.[18]’s study, men, those aged 31~59, those in a household of less than 5 family members, and those earning < $300/month were more likely to consume soft drinks. In the beverage industry, they are the fastest-growing type of product [19]. A review study found that energy drinks trigger adverse events, including insomnia, stress, and depressive mood. It is recommended not to drink energy drinks frequently (no more than 5~7 energy drinks/week) and to avoid co-consumption with alcohol [19]. In Cambodia, the prevention of NCDs is focused on tobacco and alcohol use, unhealthy diet, and physical inactivity [9]. Energy drinks need to be managed because of the potential adverse events triggered by their use. Government and stakeholders can intervene on reducing the consumption of energy drinks through IEC (information, education, and communication) activities such as social media, television and radio, and additional taxation of some types of drinks.

Compared to a previous study conducted in South Africa [5], the levels of perceived susceptibility, perceived cues to action, and perceived self-efficacy were lower among respondents of this study. The perceived severity, perceived benefits, and perceived barriers were even higher or at least comparable to the previous study. Among these constructs, the perceived self-efficacy showed the lowest scores, quite lower than the previous study. The perceived self-efficacy is a significant contributing factor for health behaviors and preventive health practice [20, 21]. For example, an increase in self-efficacy scores was related to an increased chance of having had a Pap smear [20]. Self-efficacy was significantly associated with self-management of chemotherapy [21]. Based on the study finding, the lower levels of perceived self-efficacy need to be focused on when health promotion and improvement programs are implemented in Cambodia. Educational intervention, including providing basic information about epidemiology, risk factors, complications, signs and symptoms of a certain disease, importance of early detection, and recommended screening methods, is effective for enhancing self-efficacy [22]. Considering the low percentages for self-efficacy items (e.g., “I have information on how to prevent NCDs,” “I am confident about how to prevent NCDs,” and “There is a lot I can do to reduce my chances of getting an NCD-related illness”) in this study, programs should focus on self-regulatory efficacy in the healthy lifestyle behavior intervention for successful prevention of NCDs [23].

Our study found that more respondents diagnosed with a disease by a doctor reported higher levels of the perceived susceptibility of NCDs than their counterparts. When respondents had medical examination, they perceived lower barriers to NCD prevention. Regular health check-ups are an effective way to screen and early detect chronic disease [5, 24, 25]. Those respondents who had a diagnosed disease and had experienced medical examination might have more opportunities to receive health information, increasing health literacy. This might improve the perceived susceptibility of NCDs and decrease the perceived barriers. The relationship between medical examination and perceived barriers could be operating in either direction (i.e., medical examination leading to lower perceived barriers vs. lower perceived barriers leading to medical examination). Outreach health services in a community might be an effective strategy for providing medical examination, which might reduce the perceived barriers to NCD prevention. Community outreach was proposed in guidelines addressing comprehensive primary healthcare to manage NCDs in a low-income country [26]. However, in the screening and medication for NCDs, few studies reported outreach approaches in low- and middle-income countries [27]. In Cambodia, medical examination through either facility-based delivery or outreach health services can be useful in reducing the perceived barriers to NCD recommended health actions.

Our study has several limitations. This study used a cross-sectional design, which does not allow us to draw causal inferences between participants’ general characteristics and the risk perceptions of NCDs. We used non-proportional sampling, limiting the generalizability of study findings, and it is difficult to apply our study findings to other settings. A self-reported questionnaire was used to collect the data, which is subject to recall bias. Some participants might report socially desirable risk perceptions and health behaviors. There is a potential limitation related to the relatively low reliability of the HBM construct in interpreting the results. The low reliability may have been due to cultural sensitivity and the residents participating in the survey fir the first time. However, given limited studies about the personal perceptions of NCDs based on the HBM, this study provides the risk perceptions of NCDs according to the HBM in a low-income country, Cambodia, which is a strength of this study.

CONCLUSION

In this study, we examined the risk perception of NCDs based on the HBM with six constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived cues to action, and perceived self-efficacy). We found health behaviors contributing to NCDs (smoking, drinking alcohol, insufficient physical exercise, and unhealthy diet). Additionally, Cambodians drink energy drinks frequently. Among the risk perceptions, the perceived self-efficacy showed the lowest score. Respondents diagnosed with disease by a doctor reported higher perceived susceptibility of NCDs than their counterparts. Medical examination was related to lower perceived barriers to NCD recommended health actions. In Asian regions, few studies have assessed the risk perception of NCDs. Based on the present study finding, it is important to improve perceived self-efficacy in health promotion and improvement programs and to reduce perceived barriers through medical tests either by facility-based delivery or the outreach health services in Cambodia.

Notes

This work was supported by the Korea International Cooperation Agency’s. Incubating Program in the part of Public-private Cooperation Programs.

References
Kulikov A, Mehta A, Tarlton D, Grafton D, Aarsand R. Prevention and control of noncommunicable diseases in Cambodia. UNDP Cambodia; 2019 [cited 2021 September 10].
Ministry of Health in Cambodia. National strategic plan for the prevention and control of noncommunicable diseases. 2012 [cited 2021 August 31].
Ministry of Health in Cambodia. National multisectoral action plan for the prevention and control of noncommunicable diseases 20212018-2027. 2018 [cited 2021 August 1].
Kaba Z, Khamisa N, Tshuma N. Age-group differences in risk perceptions of non-communicable diseases among adults in Diepsloot township, Johannesburg, South Africa: A cross-sectional study based on the Health Belief Model. South African Medical Journal 2017;107(9):797–804. [doi: 10.7196/samj.2017.v107i9.12168]
LaMorte WW. The health belief model. 2019 [cited 2021 September 1].
Wang T, Wang H, Zeng Y, Cai X, Xie L. Health beliefs associated with preventive behaviors against noncommunicable diseases. Patient Education and Counseling 2022;105(1):173–181. [doi: 10.1016/j.pec.2021.05.024]
Olutende OM, Wanzala MN, Wamukoya EK. Do health beliefs predict exercise behavior? Exploring the constructs of the health belief model. European Journal of Physical Education and Sport Science 2019;5(12):59–72. [doi: 10.5281/zenodo.3451272]
Al-Hassan YT, Fabella E, Estrella E, Al-Ramada HA, Bujbara AH. Utilizing the health belief model in determining the association between perceptions on obesity and exercise behavior of Saudi university students. The Open Public Health Journal 2020;13(1):87–93. [doi: 10.2174/1874944502013010087]
Luna F, Luyckx VA. Why have non-communicable diseases been left behind? Asian Bioethics Review 2020;12(1):5–25. [doi: 10.1007/s41649-020-00112-8]
Slovic P, editor. The perception of risk. 1st ed. Routledge: Earthscan Publications; 2000. pp. 511.
Paek HJ, Hove T. In: Risk perceptions and risk characteristics. Oxford Research Encyclopedia of Communication; 2017.
Haregu TN, Wekesah F, Oti SO, Egondi T, Kyobutungi C. The connection between non-communicable disease risk factors and risk perception among urban slum dwellers in Nairobi, Kenya. African Population Studies 2016;30(3):3094–3102. [doi: 10.11564/30-3-924]
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods 2009;41:1149–1160.
Birbili M. Translating from one language to another. Social Research Update 200;31(1):1–7.
Department of Preventive Medicine of Cambodia. National standard operating procedure for diabetes and hypertension management in primary care. 2019 [cited 2022 February 28].
Ramsay LC. In: A cross-sectional evaluation of sodium consumption by people in Cambodia [Master thesis]. [Ontario]: University of Guelph; 2014. pp. 114.
Laohasiriwong W, Samphors S, Chamroen P, Pisey V, Dewey RS. Association between socioeconomic factors and soft drink consumption among adults in Cambodia: A cross-sectional study. F1000Research 2020;9:708 [doi: 10.12688/f1000research.24890.3]
Nadeem IM, Shanmugaraj A, Sakha S, Horner NS, Ayeni OR, Khan M. Energy drinks and their adverse health effects: A systematic review and meta-analysis. Sports Health 2021;13(3):265–277. [doi: 10.1177/1941738120949181]
Ghalavandi S, Heidarnia A, Zarei F, Beiranvand R. Knowledge, attitude, practice, and self-efficacy of women regarding cervical cancer screening. Obstetrics & Gynecology Science 2021;64(2):216–225. [doi: 10.5468/ogs.20236]
Papadakos J, Barnsley J, Berta W, Rowlands G, Samoil D, Howell D. The association of self-efficacy and health literacy to chemotherapy self-management behaviors and health service utilization. Support Care Cancer 2021;30(1):603–613. [doi: 10.1007/s00520-021-06466-5]
Srithongklang W, Panithanang B, Kompor P, Pengsaa P, Kaewpitoon N, Wakkhuwatapong P, et al. Effect of educational intervention based on the health belief model and self-efficacy in promoting preventive behaviors in a cholangiocarcinoma screening group. Journal of Cancer Education 2019;34(6):1173–1180. [doi: 10.1007/s13187-018-1424-7]
Rejeski WJ, Mihalko SL, Ambrosius WT, Bearon LB, McClelland JW. Weight loss and self-regulatory eating efficacy in older adults: The cooperative lifestyle intervention program. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2011;66(3):279–286. [doi: 10.1093/geronb/gbq104]
Kaur G, Chauhan AS, Prinja S, Teerawattananon Y, Muniyandi M, Rastogi A, et al. Cost-effectiveness of population-based screening for diabetes and hypertension in India: An economic modelling study. The Lancet Public Health 2022;7(1):e65–e73. [doi: 10.1016/S2468-2667(21)00199-7]
Christe DM, Vijaya S, Tharangini K. Screening for non-communicable diseases. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2020;9(3):1092–1097. [doi: 10.18203/2320-1770.ijrcog20200881]
Mondal S, Van Belle S. India's NCD strategy in the SDG era: Are there early signs of a paradigm shift? Global Health 2018;14(1):39 [doi: 10.1186/s12992-018-0357-6]
Shah S, Munyuzangabo M, Gaffey MF, Kamali M, Jain RP, Als D, et al. Delivering non-communicable disease interventions to women and children in conflict settings: A systematic review. BMJ Global Health 2020;5 Suppl:e002047 [doi: 10.1136/bmjgh-2019-002047]

RCPHN : Research in Community and Public Health Nursing