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

BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.