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Article History

Received: 18 November 2025

Accepted: 8 February 2026

First Online: 16 February 2026

Declarations

:

: This study used anonymized, aggregated secondary data obtained from the National Disease Surveillance System (R506), Division of Epidemiology, Ministry of Public Health, Thailand. The data contained no personal identifiers and were analyzed at the provincial level. Therefore, informed consent from individual participants was not required. The study protocol was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Boromrajonani College of Nursing, Nakorn Lampang, Thailand (No. E2568-014 with a date of approval of 18 March 2025).

: Not applicable.

: The authors declare no competing interests.