Implementing a seven-color NCD risk screening system across 39 academic health institutions in Thailand using the consolidated framework for implementation research

Globally, non-communicable diseases (NCDs) cause approximately 75% of deaths (around 43 million in 2021), and over 70% of these deaths are in low- and middle-income countries (LMICs). NCDs account for around 75% of all mortality in Thailand, but early detection and long-term control of these conditions are limited. The Ministry of Public Health has implemented a seven-color “Life Traffic” NCD risk stratification system in 39 nursing and public health colleges in Thailand since 2014. It has been used for over ten years in an attempt to solve the issue across the country, but has yet to be assessed through an explicit implementation-science lens. A process evaluation using the five domains of the Consolidated Framework for Implementation Research (CFIR) was conducted as a convergent mixed-methods study. An all-inclusive survey of all 39 institutions in 13 health regions was conducted involving 228 key informants (39 deputy directors, 74 faculty members/program coordinators, and 115 community health leaders). Screening coverage, resource adequacy, and implementation activity were measured using quantitative questionnaires, while concurrent semi-structured interviews assessed perceived outcomes, facilitators, and barriers. Data analysis was conducted separately for the two datasets and then merged during interpretation; qualitative data analysis was performed using a framework analysis with an a priori CFIR-based codebook. There was 74.3% student screening coverage, 78.4% student-staff screening coverage, and 97.3% of institutions had the model incorporated into the curriculum. The mean rating for implementation-activity ranged from 4.38 to 4.72 out of 5. Adequacy of the knowledge resources was rated as adequate by 91.9%. The adequacy of the budget and workforce were both below the 75% mark, at 56.8% and 54.1%, respectively. Family-based approaches (North), health cards (Central), virtual case management (Northeast), and mobile outreach (South) are some of the regional adaptations. Improved screening access and increased health knowledge were more commonly reported community outcomes, followed by demonstrated behavior change (23.1%) and sustained program continuity (15.4%). The seven-color NCD screening model was adopted and included in the national academic network curricula. Policy focus areas included budget gaps, staffing needs, and targeted behavior change. Academic health institution networks in Asia-Pacific could provide transferable infrastructure for NCD screening scale-up.