Population-focused community-based health literacy model for high-risk people: preventing type 2 diabetes mellitus through participatory action research in rural Thailand

Type 2 diabetes mellitus (T2DM) represents a significant public health challenge in Thailand, particularly in rural communities. Despite high prevalence rates, evidence-based, culturally appropriate prevention programs for high-risk populations remain limited. This study developed and evaluated a community-based health literacy model for T2DM prevention using participatory action research (PAR). We conducted a four-phase PAR study in a northeast province, Thailand, from April to October 2024. Fifteen high-risk individuals (mean age 54.73 ± 9.22 years, 86.7% female) and 37 healthcare stakeholders participated. The intervention comprised community preparation, model development, 8-week implementation with weekly group activities, and evaluation. We assessed health literacy using a validated questionnaire and measured body composition parameters. Data were analyzed using paired t-tests and Wilcoxon signed-rank tests for quantitative outcomes, and content analysis for qualitative data. Health literacy scores improved significantly across all five domains from insufficient levels (mean 38.33–46.25) to good levels (mean 84.17–87.92) (p < 0.001). Significant improvements were observed in body age, weight, body mass index, waist circumference, visceral fat, total body fat, fat percentage, basal metabolic rate, and fasting blood glucose (all p < 0.05). Four key success factors emerged: community capital, healthcare system reform, self-initiated health management, and supportive monitoring without stigmatization. This PAR effectively improved health literacy and clinical outcomes among high-risk individuals. The model demonstrates the feasibility and effectiveness of leveraging community resources and networks for T2DM prevention in resource-limited settings. Findings support the integration of participatory approaches in primary prevention programs and offer a scalable framework for similar rural communities.