Community-driven type 2 diabetes prevention in primary healthcare: a mixed-methods pre-post intervention study in Thailand

BACKGROUND: The prevalence of type 2 diabetes (T2D) in low- and middle-income countries demands innovative primary healthcare approaches to disease prevention. This study examined a community-driven type 2 diabetes prevention model (CDDP-model) through primary healthcare settings in a northeast province in Thailand, and analyzed using the World Health Organization Framework: Six building blocks (SBBs). METHODS: A mixed-methods single-arm pre-post intervention study with convergent design was conducted in two sub-districts representing rural and peri-urban contexts. There were 80 people at risk of T2D participated in the CDDP-model for eight weeks and followed-up in the 12th and 24th Weeks. Quantitative data included anthropometric measurements, clinical outcomes, and knowledge assessments, where qualitative data comprised focus group discussions and interviews. Data were analyzed using analysis of variance (ANOVA) with 95% significant level. Thematic analysis was applied. RESULTS: The model demonstrated improvements in health outcomes and perceived enhancements. Governance shifted from top-down management to participatory community co-design. SBBs identified: (1) Health information systems evolved; (2) Local resource mobilization expanded; (3) Service delivery networks is integrated; (4) Health workforce transformation included; and (5) Technology adoption encompassed. Diabetes prevention knowledge scores increased with clinical outcomes. Qualitative findings revealed (1) Enhanced community ownership, (2) Peer support networks, (3) Sustained behavioral change mechanisms, and (4) Strengthened community-primary care relationships. CONCLUSIONS: This community-driven diabetes prevention model is feasible and acceptable in primary healthcare settings, with promising short-term improvements in selected health outcomes. However, further controlled and long-term studies are needed to confirm effectiveness and system-level impact.