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.

Learning health systems (LHS) are an approach to translate patient data into actionable clinical insights, empower healthcare teams to drive quality improvement and reduce health inequalities. Here we present a protocol for a realist evaluation to explore what works to implement a learning health system approach in primary care settings in Thailand, for whom does it work, how, why and in what circumstances.

A mixed-methods realist evaluation will run in parallel with an interventional trial [Reg No: NCT06873243] in Northern Thailand which aims to improve the management of hypertension (HTN), type 2 diabetes mellitus (T2DM) and chronic kidney diseases (CKDs) using a data-supported learning health systems approach. As part of the trial, 16 primary care units (PCUs) in Chiang Mai and Lamphun provinces will be randomly selected to receive a learning health system intervention to support quality improvement for care of HTN, T2DM and CKD. Performance will be compared between intervention PCUs and all other PCUs in the region. Participants of the realist evaluation will include clinical and other professional staff involved in the development and implementation of the LHS. This realist evaluation will use both quantitative and qualitative data, including semi-structured interviews, surveys and documents from participating sites. Quantitative and qualitative findings will be systematically integrated to test, refine and validate context-mechanism-outcomes to identify consistencies, contradictions and explanatory mechanisms as part of a final programme theory for the successful implementation of the LHS.

Ethical approval has been granted by all collaborating university Research Ethics Committees (ref: 1090, 0321, 32540). Results will be disseminated to stakeholders, including patients and the public, health providers, the Thai government and WHO office. Our methods and dissemination will be guided by National Institute for Health Research and Guidelines International Network reporting standards for Patient and Public Involvement and Engagement.

Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system, driven by limited nephrology capacity and high rates of unplanned dialysis. The kidney failure risk equation (KFRE) estimates the risk of progression to kidney failure (KF) on age, sex, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the four-variable KFRE for the Thai population and to assess the potential impact of KFRE-guided referral strategies on clinical care and health system performance.

We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3–5 will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1000 iterations) indicated that approximately 920 KF events by 5 years would be required to achieve the target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.

Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences and policy briefs to supplement evidence-based referral strategies and health system planning.