How Lifestyle Counselling Supports Behaviour Change Among Thai Adults with Non-Communicable Diseases: A Rapid Realist Review

Objective. 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. Design. Rapid realist review following guidance from the Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Setting. Lifestyle counselling and health-coaching interventions for NCD prevention and management delivered in Thai primary care, community settings, or digitally supported programmes. Data sources. Six international and Thai databases (Scopus, Google Scholar, ProQuest, PubMed, EMBASE (Ovid), ThaiJo) were searched for studies published between 2005 and 2025. Eligibility criteria. 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 extraction and synthesis. 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. Two Thai doctoral students with community health experience provided public involvement feedback on cultural relevance and feasibility. Results. Thirteen studies were included. Nineteen explanatory configurations were identified across six mechanisms: self-efficacy, social support, motivation, accountability, emotional resilience, and relevance and engagement. Mechanisms were strengthened 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. Public contributors emphasised cultural alignment, feasibility, and equity. Conclusions. Lifestyle counselling in Thailand operates through six key mechanisms shaped by cultural norms, family dynamics, village health volunteers and service capacity. Effective programmes should prioritise long-term, low-intensity support; cultural and literacy tailoring; and hybrid low-tech maintenance. These findings provide theory-driven guidance for designing and implementing future lifestyle counselling interventions.