How lifestyle counselling supports behaviour change among Thai adults with non-communicable diseases: a rapid realist review.

Abstract

Non-communicable diseases (NCDs) are major contributors to morbidity and mortality in Thailand, yet the effectiveness of lifestyle counselling within routine practice is underexplored. This rapid realist review examined how, for whom and under what circumstances lifestyle counselling supports behaviour change among Thai adults. Rapid realist review following guidance from the Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES). Lifestyle counselling and health-coaching interventions for NCD prevention and management delivered in Thai primary care, community settings or digitally supported programmes. Six international and Thai databases (Scopus, Google Scholar, ProQuest, PubMed, EMBASE (Ovid) and ThaiJo) were searched for studies published between 2005 and 2025. Empirical studies involving adults (≥18 years) in Thailand that described lifestyle counselling or coaching interventions for NCD-related prevention or management and reported outcomes. Data were extracted to identify contexts (C), mechanisms (M), outcomes (O) and equity considerations. These were synthesised into context-mechanism-outcome configurations (CMOCs) and helped to form programme theories. 16 studies were included. 19 explanatory configurations were identified across six mechanisms: self-efficacy, social support, motivation, accountability, emotional resilience and relevance and engagement. These mechanisms and programme theories (PTs) were supported by family-centred education, routine self-monitoring with feedback, culturally or literacy-tailored materials and brief stress-regulation strategies. Barriers included low health and digital literacy, conflicting norms, short programme duration and rural workforce constraints. Facilitators included plain-language materials, low-tech or hybrid follow-up, co-designed dietary strategies and task-sharing with village health volunteers and family members. This rapid realist review identified six PTs, suggesting that the operation of lifestyle counselling interventions for non-communicable diseases in Thailand may be influenced by cultural norms, family and community support, village health volunteers and health service capacity. The findings highlight the potential importance of sustained follow-up, cultural and literacy tailoring and accessible modes of delivery in supporting behaviour change and self-management across different contexts. These PTs provide insight into how lifestyle counselling may operate in Thailand and may inform future research and the refinement of lifestyle counselling interventions.