02/20/2025
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by Sumatchara Manachevakul on "Factors Related to The Successful Return to School Among Children Who Have Experienced Cancer Treatment in Thailand."

Date: Friday, March 7, 2025
Time: 8 to 11am
Location: This will be a virtual defense via Zoom. Those interested in attending should contact Sumatchara Manachevakul and committee chair Ainat Koren at least 24 hours prior to the defense to request access to the meeting.

Committee:
  • Ainat Koren, Ph.D., DNP, PMHNP, Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, UMass Lowell
  • Ramraj Gautam, Ph.D., FAGHE, Teaching Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, UMass Lowell
  • Jason Rydberg, Ph.D., Associate Professor, School of Criminology and Justice Studies, UMass Lowell
Abstract

Background: Returning to school represents one of the best strategies for regaining normalcy for children with cancer. The success of school reintegration varies among children due to their diverse needs and circumstances. These children come from different backgrounds shaped by personal and social contextual factors, particularly within Thailand's unique cultural and educational environment. Therefore, examining both individual and social contextual factors comprehensively can facilitate effective preparation and ensure a smoother school reentry process for children with cancer.

Aims: The aims of this dissertation were: 1. To synthesize the current literature on factors related to returning to school among children with cancer who have experienced cancer treatment; and 2. To examine factors related to the successful return to school among children who have experienced cancer treatment in Thailand through a quantitative, cross-sectional predictive design with a qualitative component, utilizing the Social Ecological Model (SEM) as a theoretical framework.

Methods: This dissertation first synthesized the literature on factors affecting school return among children with cancer, guided by the integrative review methodology of Whittemore and Knafl (2005). Using these findings as a foundation, the second phase employed a quantitative, cross-sectional predictive design with a qualitative component, employing the SEM as a theoretical framework. Data were collected across seven community sites in Thailand from June to October 2024, recruiting 143 children with cancer aged 8-18 years. The quantitative component utilized six validated Thai instruments to assess factors at intrapersonal and interpersonal levels. The qualitative component involved semi-structured interviews with eight children and eight parents to explore broader systemic influences: institutional, community, and policy factors. Quantitative data were analyzed with IBM SPSS using descriptive statistics, bivariate analysis, and multiple linear regression, with model fit assessed via the Bayesian Information Criterion. NVivo was used for qualitative analysis to identify themes across ecological levels, integrating both methods to comprehensively explore factors influencing successful return to school.

Results: The integrative review of 12 studies identified critical factors at intrapersonal and interpersonal levels affecting the reintegration of children with cancer at schools. Multiple linear regression analysis revealed four significant predictors at both levels: frequency of school absences of more than 28 days per semester (B =-4.370, p< .05), nervous system cancer diagnosis (B =-8.176, p<.05), physical and mental fatigue (B =.426, p< .001), and social support (B =.757, p< .001). These factors explained 65.0% of the variance in successful school return (adjusted R² =.650). The qualitative component revealed crucial institutional support through school and healthcare systems, highlighted the need for enhanced stakeholder communication at the community level, and identified significant gaps in Thailand's healthcare coverage, social welfare assistance, healthcare accessibility, and educational support infrastructure.

Conclusion: Successful school return among Thai children with cancer is influenced by multiple socioecological factors. The findings emphasize the need for comprehensive support addressing both individual and social contextual factors within Thailand's cultural context.

Impacts: The findings can inform the development of targeted interventions and policy modifications to enhance support for children with cancer returning to school in Thailand. Healthcare providers and school personnel should implement systematic assessment protocols, while policymakers need to address gaps in Thailand's Universal Health Coverage, social welfare support, healthcare accessibility, and formal educational support frameworks.

Keywords: children, cancer, successful return to school, Social Ecological Model, Thailand, predictive factors