Culturally-Tailored Health Literacy: A Pilot Study of VHV-Led Cannabis Harm Reduction Under Nursing Supervision in Rural Northern Thailand.

Chomsri P.; Matrakul M.; Chairinkam W.; Likhitsathian S. · Public health nursing (Boston, Mass.) · 2026

**Background & Methods** This exploratory sequential mixed-methods study evaluated a culturally-tailored cannabis health literacy program delivered by Village Health Volunteers (VHVs) under nursing supervision in rural Northern Thailand. The three-phase design included a baseline survey (n=462), focus group co-design sessions, and a quasi-experimental pilot comparing an intervention group (n=25) with controls (n=25) at 3-month follow-up. **Key Findings** - Baseline assessment revealed 72.8% of the community demonstrated inadequate cannabis health literacy, establishing significant need for intervention in the context of Thailand's recent cannabis policy transition. - Post-intervention, the experimental group achieved significantly higher overall health literacy scores compared to controls (p=0.016), with the greatest improvements in information access (p=0.021), communication skills (p=0.024), and self-management capabilities (p=0.025). - The VHV-delivered, nursing-supervised intervention model demonstrated effectiveness as a community-based harm reduction strategy, providing a replicable framework for addressing knowledge gaps regarding cannabis medicinal use boundaries and preventing non-medical misuse. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This pilot study has several limitations that warrant consideration. The quasi-experimental design lacks randomization, increasing bias risk. Small sample sizes (n=25 per group) limit generalizability and statistical power. The 3-month follow-up period is relatively brief for assessing sustained behavior change. The study is geographically limited to Northern Thailand, potentially restricting applicability to other regions with different cultural contexts or cannabis policy frameworks. As a proof-of-concept pilot, findings require validation through larger, more rigorous randomized controlled trials before broad implementation. The reliance on self-reported health literacy outcomes may introduce response bias. However, the study's mixed-methods approach and community-engaged design represent methodological strengths, and the integration of cultural tailoring with established nursing supervision provides pragmatic relevance for policy implementation.

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