Abstract
Background: The global rise in non-communicable diseases (NCDs), particularly type 2 diabetes, is a major concern. Existing literature highlights the effectiveness of non-pharmaceutical interventions, such as weight reduction, in reducing the risk of diabetes among pre-diabetic individuals. Grounded in the integrated people-centered care concept and recent behavior change theories, researchers developed a peer-coaching program led by health professionals. Methods: The program was implemented across primary care settings in four districts, representing four regions of Thailand. A total of 423 pre-diabetic patients were enrolled in the experimental group, while 443 were assigned to the control group. Participants in the experimental group engaged in five behavior change activities. To evaluate the program's effectiveness, BMI, waist circumference, blood pressure, health behaviors, and blood glucose levels were measured pre- and post-activity. Satisfaction and perspectives were collected from healthcare professionals and patients using quantitative and qualitative methods. Program delivery costs were assessed, and a cost-benefit analysis was conducted. Results: A 97.2% attendance rate was recorded for the experimental group, who demonstrated statistically significant reductions in BMI, waist circumference, blood glucose levels, and diabetes risk scores compared to the control group. The 10-year diabetes risk score for the experimental group decreased by 12.65% after attending the program. The benefit-cost ratio was 2.96, indicating the program's value. High satisfaction levels were reported among both healthcare professionals and patients. Discussion and conclusion: The behavior change program designed for pre-diabetic patients, emphasizing people-centered care and modern behavior change concepts, proved effective and worthwhile for primary care settings. After minor revisions, the diabetes prevention program package should be included in benefit package of Thailand health insurance schemes to promote its widespread adoption and utilization.
