Abstract
This study aimed to assess the readiness of Subdistrict Health Promoting Hospitals (SHPHs) transferred to Provincial Administrative Organizations (PAOs) to implement a prediabetes prevention program under the Value-Based Healthcare (VBHC) concept, examine the key drivers and system-level conditions influencing program implementation, and develop policy recommendations to support primary healthcare services under the SHPH transfer policy. A mixed-methods research design was employed in Chiang Mai Province. The quantitative component assessed participants' knowledge of VBHC and the prediabetes prevention program, as well as healthcare providers' perceived readiness for program implementation. The qualitative component comprised focus group discussions, feedback on the Pre-DM program, and stakeholder meetings. Findings from both components were integrated and synthesized using a Causal Loop Diagram (CLD) to explain the underlying system dynamics.
Following the workshop, participants (n = 89) demonstrated a significant improvement in knowledge scores, increasing from 5.35 ± 2.58 to 6.72 ± 2.37, with a mean increase of 1.37 points (t = 5.18, p < 0.001). Among healthcare providers (n = 85), all readiness domains showed positive mean scores, indicating favorable readiness for program implementation. However, qualitative findings revealed that healthcare personnel readiness alone was insufficient for successful implementation. Effective implementation depended on interconnected system-level factors, including post-transfer organizational management, workforce capacity development, information systems, policy support, and collaboration among local stakeholders. Integration of quantitative and qualitative findings together with the CLD demonstrated that implementation readiness resulted from interactions among multiple reinforcing and balancing system factors. Workforce shortages, workload, limited resources, and time constraints were identified as major barriers to the continuity and sustainability of program implementation.
The study concludes that successful implementation of Value-Based Healthcare following the transfer of SHPHs requires not only competent healthcare personnel but also system support in governance, organizational management, workforce development, information systems, and collaboration among Provincial Administrative Organizations, the Ministry of Public Health, and local partners. These findings provide empirical evidence on the system-level mechanisms influencing implementation of the prediabetes prevention program within Thailand's decentralization context and support policy development and the scale-up of Value-Based Healthcare at local and national levels.
