Thailand’s health officials are planning to offer digital weight-loss tools to 250,000 overweight citizens each year, but first they need to know whether the technology actually works for everyone—including elderly, rural, and low-income groups. The problem is that Thailand’s existing behavioural weight management programme failed to engage users because the support was too weak and impersonal. Digital tools could fix that cheaply, but they risk excluding the very people who need them most. This research will co-create two versions of a technology-enabled weight management programme at different price points, then test them in a cluster-randomised trial involving 4,500 overweight adults across 60 primary care clinics. Participants will be tracked for 12 months to measure weight loss and cardiovascular risk. If the interventions prove effective, Thailand’s policymakers can roll out a national programme that reaches 250,000 people annually, reducing heart disease burden without widening health inequalities. The work also includes researchers from Laos and Cambodia, so the findings could help other under-resourced health systems in Southeast Asia adopt similar approaches. The project is applied and policy-driven—its success is measured in kilograms lost and heart attacks prevented, not in fundamental discoveries.
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Research question: Can technology-enabled behavioural support deliver clinically important weight loss economically and reduce cardiovascular risk for diverse populations in Thailand? Background: In an effort to tackle the growing burden of cardiovascular disease, Thailand s policy makers are planning to offer behavioural support to overweight individuals. Our evaluation of their planned intervention suggested low levels of engagement among end-users due to inadequate intensity and quality of support. Digital technology could be used to address these limitations economically but requires careful consideration of the context to ensure equitable participation of digitally underserved groups such as the elderly, rural/remote, and low-income populations. Aims and objectives: We will work with Thailand s policy makers and healthcare providers to develop their proposed weight management intervention into state-of-the-art technology-enabled interventions that can deliver clinically important weight loss economically and reduce cardiovascular risk for diverse populations in Thailand. The specific objectives are to: Undertake context (behavioural, technological, and organisational) analysis to inform intervention development Co-create technology-enabled interventions for two price points being considered by the Thai policy makers, and assess their acceptability to diverse socio-demographic groups Evaluate the effectiveness of intervention using a cluster randomised trial Conduct economic evaluation and develop service standards for the interventions Methods: Research will be carried out at primary healthcare centres in two provinces of Thailand. First, we will use mixed methods to undertake context (behavioural, technological, and organisational) analysis. Next, we will use the findings to co-create technology-enabled interventions for two price points being considered by Thailand s policy makers, and assess their acceptability, particularly among the digitally underserved groups. Then, we will conduct a cluster-randomised trial to evaluate the effectiveness of interventions against the standard of care, which is brief educational advice. Approximately 4,500 overweight individuals across 60 primary healthcare will be randomised to one of three trial arms (two interventions, one control) and monitor their body weight (primary outcome) and cardiovascular risk over 12 months. An in-depth process evaluation will be carried out to understand barriers to implementation, while data from the trial and external sources will be used to conduct economic evaluation and develop service standards for the interventions. Impact and dissemination: Our research will enable Thailand s policy makers to meet their goal of equitably reducing the cardiovascular risk of 250,000 persons annually. Our multidisciplinary team of experts (in behaviour science, technology, and research methods) and policy makers will ensure scientific validity and implementation of research findings. Involvement of researchers from the neighbouring countries of Laos and Cambodia, including a structured capacity building program, and dissemination of findings through a range of offline (academic, policy) and digital channels, will facilitate the diffusion of learnings to other under-resourced settings in the region and beyond.
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