A community-based approach of health governance for COVID-19 prevention: evidence from Thai Muslim communities

Purpose This study aimed to develop and validate a community-based protective model for COVID-19 prevention among Thai Muslim communities in southern Thailand by examining the roles of primary healthcare services, community nutrition status, social support, public trust, and public compliance. Design/methodology/approach A cross-sectional survey was conducted among 233 Thai Muslim residents from eight communities in Nakhon Si Thammarat Province, Thailand. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate the measurement and structural models. Findings The model demonstrated acceptable reliability, discriminant validity, predictive relevance, and adequate model fit (SRMR = 0.082). Primary healthcare services significantly influenced social support (ß = 0.541, p < 0.001), community nutrition status (ß = 0.358, p < 0.001), and public trust (ß = 0.329, p < 0.001). Community nutrition status showed the strongest direct effect on public compliance (ß = 0.509, p < 0.001) and significantly influenced social support (ß = 0.227, p = 0.001). Public compliance significantly influenced public trust (ß = 0.297, p < 0.001), while social support significantly influenced public trust (ß = 0.164, p < 0.029). The model explained 41.5% of the variance in public compliance and 49.0% of the variance in public trust, and demonstrated predictive relevance across all endogenous constructs (Q2 > 0). Mediation analysis further revealed significant indirect effects of primary healthcare services through nutrition, social support, and trust-building pathways. Research limitations/implications The findings support a systems-based, prevention-oriented approach to infectious disease control. Policies should prioritize strengthening decentralized, culturally responsive primary healthcare services, given their central role in shaping social support, public trust, and adherence to health protocols. Trust- and nutrition-sensitive strategies should be institutionalized through transparent risk communication, community engagement, and integration of community nutrition into preparedness planning. For nursing practice, the results highlight the expanded preventive role of nurses in community-based primary care, including leadership in culturally sensitive outreach, collaboration with village health volunteers, and routine integration of nutrition assessment and education to sustain preventive behaviors and community resilience. Practical implications The findings have important implications for health governance and public policy. Pandemic preparedness should prioritize decentralized and culturally responsive primary healthcare systems, as healthcare access alone may be insufficient without public trust and community engagement (Edelman et al., 2025; Waewwab et al., 2022). Strengthening community-based healthcare infrastructure, village health volunteers, and culturally sensitive communication may enhance long-term resilience. The findings also highlight the importance of integrating nutrition and food security into pandemic preparedness policies. Furthermore, transparent communication, collaboration with religious leaders and community participation may improve compliance and reduce misinformation, particularly in culturally diverse and underserved populations. Originality/value This study extends health governance literature by integrating healthcare services, nutrition, social support, public trust, and public compliance within a single structural framework in a culturally distinct population. The findings support culturally responsive and community-based governance strategies for strengthening pandemic preparedness and community resilience.