Abstract This quasi-experimental study aimed to evaluate the effects of a group-based participatory self-health promotion model on self-care behaviors among community-dwelling older adults in Tai Had Subdistrict, Samut Songkhram Province, Thailand. The model was developed based on participatory learning and empowerment principles to support self-care capacity and promote positive behavioral change. A one-group pretest–posttest design was employed with 30 older adults. The intervention consisted of group-based participatory learning activities, peer discussion, and hands-on demonstrations focusing on hygiene-related self-care, exercise behavior, and accident-prevention behavior, delivered over a four-week period.

Self-care behaviors were assessed using validated self-report questionnaires administered before and after the intervention. The results showed significant increases in post-intervention mean scores for hygiene-related self-care (pretest M = 3.42, SD = 0.64; posttest M = 4.26, SD = 0.51; P < .001), exercise behavior (pretest M = 3.18, SD = 0.57; posttest M = 4.31, SD = 0.49; P < .001), and accident-prevention behavior (pretest M = 3.45, SD = 0.63; posttest M = 4.28, SD = 0.55; P < .001). Overall self-care behavior also increased significantly, with a large effect size (Cohen’s d = 1.31).

These findings suggest that group-based participatory self-health promotion may support improvements in self-care behaviors among community-dwelling older adults. However, the results should be interpreted with caution due to the quasi-experimental design and limited sample size. The study provides preliminary evidence to inform the development of community-based participatory health promotion strategies for older adults.

Keywords: Participatory health promotion, Community-dwelling older adults, Self-care behaviors, Group-based intervention, Quasi-experimental study

Citation:  Chantarasonpoch, V. and Khawinpat, P. 2026. Effects of a group-based participatory self-health promotion model on self-care behaviors among community-dwelling older adults: A quasi-experimental study. Natural and Life Sciences Communications. 25(3): e2026052.

Graphical Abstract:

INTRODUCTION

Thailand has officially entered an aging society, with older adults accounting for more than 20% of the total population, and is projected to become a “super-aged” society by 2030 (The Nation Thailand, 2024). This rapid demographic transition presents substantial health, social, and economic challenges, as aging is commonly associated with progressive declines in physical strength, sensory function, cognitive capacity, and functional independence (Zhang and Chen, 2025). These changes increase vulnerability to chronic illness, disability, and accidents, thereby placing greater demands on individuals, families, and health care systems.

Physiological changes in later life, including sarcopenia, impaired balance, and slower neuromuscular responses, contribute to frailty and elevate the risk of falls and injuries (Edeer and Kankaya, 2025). In addition, many older adults live with multiple chronic conditions that limit daily functioning and negatively affect overall well-being (González-González and Requena, 2023). As a result, strengthening self-care capacity has become a critical strategy for maintaining autonomy, preventing functional decline, and enhancing quality of life among older adults (Pender et al., 2006).

Despite its importance, self-care behavior among older adults remains suboptimal. Internal barriers such as limited health literacy, low self-efficacy, and declining motivation, together with external constraints including social isolation and restricted access to community-based health programs, often hinder engagement in essential behaviors such as personal hygiene, regular physical activity, and home safety practices (Meraz, 2020; Lin et al., 2024). Traditional health education approaches that rely primarily on passive information delivery may be insufficient to address these multifaceted challenges, particularly among aging populations with diverse needs and lived experiences.

Participatory health promotion has increasingly been recognized as a promising approach to overcoming these limitations. Grounded in principles of empowerment and social learning, participatory models actively involve older adults in identifying health problems, planning interventions, and evaluating outcomes. Such engagement has been shown to enhance self-efficacy, shared responsibility, and sustained behavior change (Yang and Park, 2025). Evidence from community-based participatory programs indicates positive effects on physical activity, dietary management, and adherence to self-care practices among older adults (Röger-Offergeld et al., 2023). Moreover, integrating social participation into health promotion efforts supports emotional well-being and social connectedness, which are essential determinants of healthy aging (Lin et al., 2024).

In Thailand, participatory self-care and health promotion models have been applied mainly among vulnerable groups, particularly homebound older adults or those with limited mobility and dependence on caregivers. However, there is limited empirical evidence on the effectiveness of participatory health promotion interventions targeting community-dwelling older adults who are functionally independent and actively engaged in daily life. This population has distinct needs and characteristics compared to more dependent older adults. Furthermore, only a few studies have explored participatory interventions that address multiple domains of self-care behavior such as hygiene, physical activity, and accident prevention within a single integrated model (González-González and Requena, 2023; Thongaram et al., 2025).

Addressing these gaps is important because community-dwelling older adults represent a growing segment of the aging population and play a key role in maintaining their health and independence. A deeper understanding of how participatory, group-based health promotion influences various dimensions of self-care behavior can help inform the design of more effective, scalable, and sustainable health strategies within community settings.

Therefore, the present study aimed to develop and evaluate a group-based participatory self-health promotion model for community-dwelling older adults in Tai Had Subdistrict, Samut Songkhram Province, Thailand. Specifically, the study sought to examine the effects of the model on hygiene-related self-care behavior, exercise behavior, and accident-prevention behavior. It was hypothesized that participation in the participatory self-health promotion model would result in significantly improved self-care behaviors compared with pre-intervention levels.

MATERIALS AND METHODS

Research design

This study employed a quasi-experimental one-group pretest–posttest design to evaluate the effects of a participatory self-health promotion model on self-care behaviors among older adults. This design was selected to examine changes in participants’ behaviors over time within a real-world community context, where random assignment and the inclusion of a control group were not feasible due to practical and ethical considerations (Polit and Beck, 2008). The one-group pretest–posttest approach is commonly used in community-based health promotion research to assess preliminary intervention effectiveness under naturalistic conditions.

The intervention focused on participatory learning and collective health promotion activities, with emphasis on three core domains of self-care behavior: hygiene-related self-care, exercise behavior, and accident-prevention behavior. These domains were selected based on their relevance to functional independence, health maintenance, and injury prevention among community-dwelling older adults.

To strengthen internal validity within the constraints of a one-group design, several procedural controls were implemented. The intervention was delivered over a relatively short and clearly defined period, and no other organized health promotion programs targeting similar behaviors were conducted in the study area during the intervention timeframe. All participants received the same intervention content, facilitation approach, and assessment procedures. Pretest and posttest measurements were conducted using the same validated instruments and standardized data collection procedures to ensure consistency and comparability of outcomes.

Although the absence of a control group limits the ability to fully rule out potential threats to internal validity, such as maturation or history effects, the design was considered appropriate for the exploratory evaluation of a participatory, community-based health promotion model. The findings of this study therefore provide preliminary evidence regarding the potential effectiveness of participatory self-health promotion in improving self-care behaviors among older adults and may inform the design of future studies employing more rigorous experimental or randomized controlled designs.

Study population and sample

The target population comprised community-dwelling older adults aged 60–69 years who were members of the Elderly Club, a community organization for older adults, in Tai Had Subdistrict, Samut Songkhram Province, Thailand. This community setting was selected because it represents an active elderly population regularly engaged in local social activities and community-based programs, making it appropriate for evaluating a participatory health promotion intervention.

Participants were recruited using purposive sampling to ensure that individuals possessed the functional capacity and communication ability required for active participation in group-based learning activities. Eligibility was determined according to the following inclusion criteria:

1)    aged 60 years or older;

2)    able to read, write, and communicate in Thai;

3)    physically capable of performing daily activities independently; and

4)    willing to participate throughout the entire intervention period.

Older adults who were unable to participate in group activities due to severe physical limitations, cognitive impairment, or acute illness were not included in the study. Recruitment was conducted on a voluntary basis through announcements and invitations made by Elderly Club leaders, and all eligible individuals who expressed interest were screened according to the inclusion criteria.

A total of 30 participants met the eligibility requirements and provided written informed consent prior to participation. The sample size was considered adequate for detecting within-group changes in behavioral outcomes at a significance level of α = 0.05 and a statistical power greater than 0.80 (Cohen, 2013). Although the use of purposive sampling and a single community setting may limit the generalizability of the findings, this sampling strategy was deemed appropriate for an exploratory evaluation of a participatory intervention tailored to a specific community context.

Research instruments

Two main instruments were used for data collection in this study.

1)     Personal information form

This form was developed by the researchers to collect baseline demographic and health-related information of the participants. Items included age, gender, marital status, educational level, occupation, average monthly income, height, weight, and the presence of underlying chronic diseases. The information was used to describe participant characteristics and contextualize the study findings.

2)     Participatory self-health promotion questionnaire

The Participatory Self-Health Promotion Questionnaire was constructed based on a review of relevant literature and previous empirical studies on older adult self-care and health promotion (Department of Older Persons, Thailand, 2022). The instrument was designed to assess self-reported self-care behaviors and participants’ perceptions of the participatory intervention. It consisted of four sections, each comprising 10 items, for a total of 40 items.

Section 1: Hygiene-related self-care behavior

This section assessed routine personal hygiene practices, such as regular handwashing, oral hygiene, bathing, and general cleanliness maintenance.

Section 2: Exercise behavior

Items in this section measured engagement in physical activity, including frequency, consistency, and participation in age-appropriate exercises such as stretching, walking, and low-impact movements.

Section 3: Accident-prevention behavior at home

This section evaluated safety-related practices within the home environment, including fall-prevention measures, hazard awareness, and the use of safety modifications or assistive devices.

Section 4: Opinions toward the participatory self-health promotion model

This section assessed participants’ satisfaction with and perceptions of the intervention, including clarity of content, applicability to daily life, participatory processes, and overall usefulness.

All items were rated on a 5-point Likert scale, ranging from 1 (lowest agreement) to 5 (highest agreement). Higher scores indicated higher levels of self-care behavior or more positive perceptions of the participatory model.

Content validity of the questionnaire was evaluated by a panel of three experts in community health and gerontology. The overall Content Validity Index (CVI) was 0.92, indicating excellent content relevance. Internal consistency reliability was assessed through pilot testing with 10 older adults from a community similar to the study setting, yielding a Cronbach’s alpha coefficient of 0.89, which reflects high reliability (Jamieson, 2023).

Development of the participatory self-health promotion model

The participatory self-health promotion model was developed based on the principles of Community-Based Participatory Research (CBPR) and health empowerment theory, emphasizing shared decision-making, active engagement, and mutual learning between researchers and participants (Suarez-Balcazar et al., 2020). The model was designed to be culturally appropriate and responsive to the lived experiences of community-dwelling older adults. The intervention process was structured into three sequential phases: planning, implementation, and evaluation.

Planning phase: During the planning phase, researchers and participants collaboratively identified priority health concerns related to daily self-care through small-group discussions. Participants were encouraged to share personal experiences, perceived challenges, and existing self-care practices. These discussions were used to jointly prioritize key areas for improvement, namely hygiene-related self-care, exercise behavior, and accident prevention in the home environment. These participatory needs assessment ensured that the intervention content was relevant to the participants’ context and perceived needs.

Implementation phase: The implementation phase consisted of weekly participatory activities conducted over a four-week period. Each session lasted approximately 90 minutes and was facilitated by the research team using participatory learning techniques. The activities included:

1)    hygiene education combined with practical demonstrations of appropriate handwashing and personal hygiene practices;

2)    group-based exercise and stretching routines tailored to the physical abilities of older adults, focusing on flexibility, balance, and safe movement; and

3)    home-safety modification workshops aimed at increasing awareness of fall risks and promoting practical strategies to prevent household accidents.

All sessions emphasized hands-on practice, peer interaction, and open discussion to reinforce learning and encourage mutual support among participants.

Evaluation phase: In the evaluation phase, participants reflected on their experiences and perceived behavioral changes following the intervention. Group discussions were conducted to allow participants to share feedback, discuss challenges encountered during behavior change, and suggest improvements to the model. This reflective process supported continuous learning and provided qualitative insight into the acceptability and perceived usefulness of the participatory approach.

Throughout all phases of the intervention, participants were actively encouraged to exchange experiences, support one another, and co-create practical solutions relevant to their daily lives. This approach aligns with best practices for involving older adults in participatory health research and promotes empowerment, ownership, and sustained engagement (Goodwin et al., 2023).

Data collection procedure

Data were collected between September and October 2025. Baseline (pre-intervention) assessments were conducted during Week 1 prior to implementation of the participatory self-health promotion activities. The intervention was then delivered over a four-week period, followed by post-intervention assessments conducted in Week 5 using the same instruments and procedures.

Data were collected using structured, interviewer-administered questionnaires. Trained research assistants conducted face-to-face interviews by reading each question aloud and recording participants’ responses directly into the questionnaire forms. This approach ensured consistency, minimized variation due to literacy or vision limitations, and maintained data quality among older adults. All participants completed both pretest and posttest assessments. The same data collection procedures, question wording, and response formats were used at both time points to minimize measurement variability. As the study employed a one-group pretest–posttest design, blinding of participants to intervention exposure was not applicable.

Ethical approval for the study was obtained from the Ethics Committee of Shinawatra University (Approval Code: 015/2025). Prior to participation, all participants received detailed information about the study objectives, procedures, potential benefits, and their right to withdraw at any time without consequences. Written informed consent was obtained from all participants. Confidentiality and anonymity were maintained throughout the study by assigning identification codes and restricting access to data to the research team only.

Data analysis

Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarize participants’ demographic characteristics and self-care behavior scores. Changes in self-care behaviors between pretest and posttest measurements were analyzed using paired-sample t-tests at a significance level of 0.05.

Effect sizes were calculated using Cohen’s d to determine the magnitude of observed behavioral changes (Cohen, 2013). Prior to inferential analysis, the data were examined for normality and homogeneity to ensure that the assumptions underlying the paired-sample t-test were met. All analyses were conducted using the same dataset, and no missing data were observed, as all participants completed both assessment points.

Research rigor and quality control

Several measures were implemented to ensure methodological rigor and quality control throughout the study. Instrument development emphasized content validity and reliability, and pilot testing was conducted to refine questionnaire items and improve clarity. Research assistants received training on standardized data collection procedures to reduce interviewer bias and enhance consistency.

Intervention fidelity was monitored on a weekly basis to ensure that participatory principles, session structure, and activity content were delivered as planned. The research team maintained regular communication with participants to support engagement and minimize attrition. Continuous feedback from participants was collected during and after the intervention to assess acceptability and to ensure that the participatory process aligned with best practices in community-based health research (Suarez-Balcazar et al., 2020; Goodwin et al., 2023).

RESULTS

A total of 30 older adults completed the participatory self-health promotion intervention and both pretest and posttest assessments. All participants met the inclusion criteria and attended all scheduled sessions. Data were obtained from all participants at both measurement points, resulting in a complete dataset with no missing values.

Demographic Characteristics of Participants

The demographic characteristics of the participants are presented in Table 1. All participants were community-dwelling older adults aged 60–69 years residing in Tai Had Subdistrict, Samut Songkhram Province.

Table 1. Demographic characteristics of the older adult participants (N = 30).

As shown in Table 1, most participants were female (63.33%) and aged 60–65 years (56.67%). The majority were married or living with a partner (66.67%) and had completed primary education (66.67%). In terms of occupation, participants were primarily laborers (46.67%) or unemployed (23.33%). Most participants reported an average monthly income of less than 5,000 Thai Baht (63.33%). Regarding health status, 73.33% of participants reported having at least one underlying chronic disease.

Self-care behaviors before and after the intervention

Participants’ self-care behaviors were assessed in three domains: hygiene-related self-care, exercise behavior, and accident-prevention behavior. Differences between pretest and posttest mean scores were analyzed using paired-sample t-tests, and effect sizes were calculated using Cohen’s d.

Hygiene-related self-care

Changes in hygiene-related self-care behavior before and after participation in the participatory self-health promotion program are presented in Table 2.

Table 2. Comparison of hygiene-related self-care behavior scores (N = 30).

 Note: *Significant at the 0.05 level.

As shown in Table 2, the mean hygiene-related self-care score increased from 3.42 (SD = 0.64) at pretest to 4.26 (SD = 0.51) at posttest. The difference between pretest and posttest scores was statistically significant (t(29) = 5.27, P < 0.001), with a large effect size (Cohen’s d = 0.96).

Exercise behavior

Changes in exercise behavior scores before and after participation in the participatory self-health promotion program are presented in Table 3.

Table 3. Comparison of exercise behavior scores (N = 30).

Note: *Significant at the 0.05 level.

As shown in Table 3, the mean exercise behavior score increased from 3.18 (SD = 0.57) at pretest to 4.31 (SD = 0.49) at posttest. The difference between pretest and posttest scores was statistically significant (t(29) = 6.02, P < 0.001), with a large effect size (Cohen’s d = 1.10).

Accident-prevention behavior

Changes in accident-prevention behavior scores before and after participation in the participatory self-health promotion program are presented in Table 4.

Table 4. Comparison of accident-prevention behavior scores (N = 30).

Note: *Significant at the 0.05 level.

As shown in Table 4, the mean accident-prevention behavior score increased from 3.45 (SD = 0.63) at pretest to 4.28 (SD = 0.55) at posttest. The difference between pretest and posttest scores was statistically significant (t(29) = 5.11, P < 0.001), with a large effect size (Cohen’s d = 0.93).

Summary of self-care behavior outcomes

Across all three domains of self-care behavior, including hygiene-related self-care, exercise behavior, and accident-prevention behavior, posttest mean scores were significantly higher than pretest scores (P < 0.05). Among the three domains, the largest effect size was observed for exercise behavior (Cohen’s d = 1.10), followed by hygiene-related self-care (Cohen’s d = 0.96) and accident-prevention behavior (Cohen’s d = 0.93).

Comparison of self-care behavior scores

Overall self-care behavior scores, combining hygiene-related self-care, exercise behavior, and accident-prevention behavior, were compared between pretest and posttest measurements to evaluate the overall effect of the participatory self-health promotion model. The results are presented in Table 5.

Table 5. Comparison of overall self-care behavior scores (N = 30).

Note: *Significant at the 0.05 level.

As shown in Table 5, the mean overall self-care behavior score increased from 3.35 (SD = 0.55) at pretest to 4.28 (SD = 0.48) at posttest. The difference between pretest and posttest scores was statistically significant (t(29) = 7.16, P < 0.001), with a large effect size (Cohen’s d = 1.31).

Figure 1. Changes in self-care behavior scores before and after the intervention.

Figure 1 presents the mean self-care behavior scores before and after the intervention across the three self-care domains.

Participants’ opinions toward the participatory model

Participants’ opinions toward the participatory self-health promotion model were assessed after completion of the intervention. The evaluation covered aspects related to content clarity, practicality, participatory processes, and overall satisfaction. The results are presented in Table 6.

Table 6. Mean and standard deviation of participants’ opinions toward the participatory self-health promotion model (N = 30).

Note: Interpretation scale: 4.51–5.00 = Very High, 3.51–4.50 = High, 2.51–3.50 = Moderate, 1.51–2.50 = Low, 1.00–1.50 = Very Low

As shown in Table 6, the overall mean score of participants’ opinions toward the participatory self-health promotion model was 4.63 (SD = 0.48), which was classified as very high. All individual items received mean scores above 4.50, indicating very high ratings across all assessed aspects of the model.

Hypothesis testing

The research hypothesis was tested to examine whether overall self-care behavior scores differed between pretest and posttest measurements following participation in the participatory self-health promotion model. The hypothesis was formulated as follows:

H₁: The mean self-care behavior score after participation in the program is higher than before participation.

Table 7. Results of hypothesis testing on self-care behavior (N = 30).

Note: *Significant at the 0.05 level.

As shown in Table 7, the mean overall self-care behavior score increased from 3.35 (SD = 0.55) at pretest to 4.28 (SD = 0.48) at posttest. The difference between pretest and posttest scores was statistically significant (t (29) = 7.16, P < 0.001).

DISCUSSION

The findings of this study indicate that participation in a group-based participatory self-health promotion model was associated with significant improvements in self-reported self-care behaviors among community-dwelling older adults. Statistically significant increases were observed across all three domains of self-care behavior, including hygiene-related self-care, exercise behavior, and accident-prevention behavior, with large effect sizes. In addition, participants reported very high levels of satisfaction with the participatory model, suggesting strong acceptability of the intervention approach.

Beyond quantitative improvements, the results suggest that the participatory format may have supported learning processes related to self-care knowledge, skill development, and motivation. The high ratings for interaction, mutual learning, and applicability to daily life indicate that active involvement and peer-supported learning were central features of the intervention experience. These findings are consistent with participatory health promotion principles, which emphasize empowerment, shared learning, and engagement as mechanisms for behavior change among older adults.

Discussion on hygiene behavior

The findings of this study demonstrated a significant improvement in hygiene-related self-care behavior following participation in the participatory self-health promotion model, as reflected by higher posttest scores and a large effect size. This finding is consistent with previous evidence indicating that multimodal and behavior-focused interventions are effective in improving hygiene practices among older adults (Teesing et al., 2020; Sandbekken et al., 2024). Collectively, these studies suggest that hygiene behavior is most responsive to interventions that combine knowledge provision with practical demonstration and behavioral reinforcement.

The improvement observed in the present study may be explained by the participatory learning processes embedded within the intervention. Small-group discussions, hands-on demonstrations, and peer exchange encouraged active engagement and experiential learning, which are known to strengthen self-efficacy and motivation for behavior change. Similar effects have been reported in community-based participatory approaches that emphasize interaction and shared learning to enhance health awareness and service utilization (Odima et al., 2023). In related contexts, hands-on education and staff-supported learning have also been shown to improve oral hygiene practices among older adults in long-term care settings  (Wu et al., 2020). Behavioral frameworks such as the Health Action Process Approach further support the role of structured, participatory instruction in improving hygiene-related habits among adults aged 65 years and older (Baumann et al., 2025).

Evidence from systematic reviews reinforces these findings, demonstrating that hygiene and oral health interventions for older adults are most effective when they incorporate repetition, tailored content, and active participation (Bashirian et al., 2023). Thai studies similarly report that participatory self-care programs can improve hygiene maintenance and health-promoting behaviors among community-dwelling older adults (Thongaram et al., 2025). In addition, environmental factors remain important determinants of hygiene behavior, as home sanitation conditions have been shown to influence self-care capacity among older adult populations in Thailand (Kongpran et al., 2021).

At a broader public health level, international reviews emphasize that sustainable hygiene promotion requires not only education but also supportive environments and community engagement (MacLeod et al., 2023). Emerging evidence also highlights the potential of technology-assisted education, such as mobile augmented reality–based programs, to enhance engagement and hygiene-related knowledge among community-dwelling older adults (Romalee et al., 2024). While the present study did not incorporate digital components, its participatory and community-based structure aligns with these principles by fostering interaction, shared responsibility, and contextual relevance.

Overall, the findings suggest that participatory learning approaches can translate hygiene-related knowledge into consistent self-care practices by enhancing confidence, motivation, and peer support. When combined with contextual relevance and community engagement, participatory health promotion models represent a practical and evidence-supported strategy for improving hygiene-related self-care behaviors among community-dwelling older adults.

Discussion on exercise behavior

The present study demonstrated a significant improvement in exercise behavior among community-dwelling older adults following participation in the participatory self-health promotion model, with a large effect size observed. This finding is consistent with growing evidence that participatory and community-based exercise interventions are effective in enhancing physical activity adherence among older adults. A systematic review by Tcymbal et al. (2022) reported that multicomponent interventions integrating social participation, education, and structured exercise yield greater improvements in physical activity and overall health outcomes than single-component programs. Similarly, Alley et al. (2024) found that combining group-based exercise with digital or hybrid monitoring enhanced motivation and continuity of physical activity, highlighting the importance of social reinforcement and supportive structures.

The observed improvement may be explained by the participatory design of the intervention, which emphasized peer engagement, shared learning, and group cohesion. Behavioral determinants such as motivation, perceived ability, and environmental opportunity are central to sustaining long-term physical activity, and participatory exercise programs that incorporate peer interaction and co-designed routines have been shown to strengthen both physical outcomes and psychological resilience (Tcymbal et al., 2022; Peters et al., 2024). Supportive communication and mutual attentiveness, which have been associated with increased participation and well-being in caregiving contexts, further illustrate the broader psychosocial benefits of interaction-based health programs (Backhouse et al., 2024).

From a physiological perspective, regular structured exercise contributes to improvements in muscle strength, balance, and neuromuscular coordination, which are essential for reducing frailty and fall risk in later life. Meta-analytic evidence confirms that targeted exercise interventions significantly improve muscle performance and mitigate sarcopenia-related decline among older adults (Cabrolier-Molina et al., 2025). Consistent with this, multimodal exercise programs combining strength, balance, and aerobic components have demonstrated greater improvements in physical and cognitive function compared with single-mode routines (Kim et al., 2022).

Sustaining engagement in physical activity remains a challenge among older populations. Peters et al. (2024) emphasized that feedback mechanisms, environmental accessibility, and individualized goal setting are key social–ecological factors influencing adherence. These factors closely align with the participatory structure of the present study, in which peer-led interaction, contextual adaptation, and group support were integral components of the intervention.

Evidence from Thailand further supports these findings. Terathongkum and Kittipimpanon (2023) demonstrated that a community-based arm swing exercise program significantly improved glycemic control and nutritional status among adults and older adults with type 2 diabetes. Their quasi-experimental findings suggest that even simple, low-impact, and accessible exercises can produce meaningful health benefits when implemented within a supportive community context. Taken together, the findings of the present study and existing literature indicate that participatory
self-health promotion models emphasizing accessibility, peer support, and collective motivation provide a practical and evidence-based approach for enhancing exercise behavior and promoting active aging among older adults.

Discussion on accident prevention behavior

The present study found a significant improvement in accident-prevention behavior among older adults following participation in the participatory self-health promotion model. This finding suggests that active engagement in group learning and participatory environmental risk assessment can enhance older adults’ ability to recognize and prevent household hazards. Similar outcomes have been reported in previous studies, where multifactorial fall-prevention interventions combining environmental modification, education, and behavioral reinforcement effectively reduced fall incidence and injury severity among community-dwelling older adults (Li et al., 2023; Colón-Emeric et al., 2024).

The observed improvement may be explained by the empowerment-oriented and participatory nature of the intervention. Participatory programs focusing on home safety education have been shown to strengthen self-efficacy and awareness of environmental risks, thereby supporting safer behaviors in daily life. Holte and Bleijenberg (2024) reported that integrating a positive health framework into home care services enhanced older adults’ self-management capacity and reduced reliance on external support, underscoring the importance of empowerment-based approaches. Similarly, Ukpene and Apaokueze (2024) emphasized that practical home adaptations, such as adequate lighting, grab bars, and non-slip flooring, are essential for enabling older adults to age safely in place. These findings are consistent with the present study, in which participants actively discussed and assessed household hazards as part of the learning process.

Broader evidence further supports the role of integrated approaches in accident prevention among older adults. Technology-assisted and community-based interventions have been shown to increase awareness and proactive monitoring of fall risks among home-dwelling older adults (Araújo et al., 2021). In addition, the World Guidelines for Falls Prevention and Management for Older Adults highlight the importance of combining environmental, behavioral, and educational components while ensuring applicability within real-world community settings (Montero-Odasso et al., 2022). The participatory model used in the present study aligns with these recommendations by integrating education, environmental assessment, and active participation.

Recent evidence from Thailand also supports the preventive benefits of participatory approaches. Kaewta et al. (2026) demonstrated that an emergency illness prevention program for older adult caregivers significantly improved knowledge, preparedness, and response to health emergencies in Northern Thailand. Their findings indicate that community-driven participatory interventions can extend beyond routine self-care behaviors to encompass broader safety preparedness and crisis prevention. Taken together, the findings of the present study and existing literature suggest that participatory, empowerment-based health promotion models represent a practical and evidence-supported strategy for improving accident-prevention behaviors and promoting safer aging among community-dwelling older adults.

Theoretical implications

The findings of this study provide theoretical support for multiple behavioral frameworks that explain how participatory engagement facilitates sustainable self-care behaviors among older adults. Rather than operating through a single mechanism, the participatory self-health promotion model appears to function through an integration of cognitive, motivational, and contextual processes described across several established theories.

First, the results align with Bandura’s Social Cognitive Theory (SCT), which conceptualizes behavior change as the result of reciprocal interactions among personal, behavioral, and environmental factors (Bandura, 1986). The participatory activities in this study promoted observational learning, peer modeling, and positive reinforcement within group settings, thereby enhancing self-efficacy. Increased confidence and self-regulation in hygiene, exercise, and accident-prevention behaviors observed among participants are consistent with evidence that self-efficacy is a key determinant of health behavior change in older adults (Yang et al., 2024).

Second, the findings are consistent with the Theory of Planned Behavior (TPB) (Ajzen, 1991), particularly in relation to behavioral intention and perceived behavioral control. Group discussions and peer interaction may have strengthened positive attitudes toward self-care and reinforced supportive subjective norms, while hands-on practice enhanced participants’ perceptions of control over health-related behaviors. Previous research has demonstrated that intention and perceived behavioral control are important mediators of physical activity and self-care behaviors among older populations (Stolte et al., 2017; Lum et al., 2023; Kim and Jeong, 2024).

Third, the results support empowerment-based approaches that emphasize shared decision-making and participatory learning as central drivers of health autonomy. By engaging older adults as active contributors rather than passive recipients, the intervention fostered intrinsic motivation and psychological ownership of health behaviors. These elements are core constructs within empowerment frameworks and have been associated with improved adherence, self-management, and well-being in aging populations (Stommel et al., 2022).

Finally, the participatory model reflects the principles of the Social Ecological Model (SEM), which views health behavior as the outcome of interactions across individual, interpersonal, community, and environmental levels (Bronfenbrenner, 1994). The intervention addressed multiple ecological layers by engaging older adults, facilitators, and the community context, thereby creating supportive social and environmental conditions for behavior change. This multi-level alignment is consistent with recent evidence indicating that sustainable health promotion requires coordinated strategies across ecological levels (Baidya et al., 2023).

Taken together, the theoretical implications of this study suggest that participatory health promotion operates through the integration of self-efficacy enhancement (SCT), intention formation and perceived control (TPB), empowerment and psychological ownership, and multi-level social and environmental support (SEM). This integrated theoretical perspective helps explain the consistent and meaningful improvements in self-care behaviors observed among community-dwelling older adults and reinforces the relevance of participatory models as a theoretically grounded approach in health behavior research.

CONCLUSION

This study demonstrated that participation in a group-based participatory self-health promotion model was associated with significant improvements in self-reported self-care behaviors among community-dwelling older adults. Improvements were observed across all three domains of self-care behavior, including hygiene-related self-care, exercise behavior, and accident-prevention behavior, with large effect sizes indicating meaningful behavioral change following the intervention.

The findings underscore the potential value of participatory and experiential learning approaches that actively engage older adults through group discussion, hands-on practice, and peer interaction. Such approaches may support self-efficacy, motivation, and engagement in daily self-care activities, which are essential for maintaining health and functional independence in later life. The results also align with established behavioral theories, suggesting that participatory health promotion can simultaneously address cognitive, motivational, and social dimensions of behavior change.

Despite these promising findings, the results should be interpreted with caution. The use of a one-group pretest–posttest design, a small purposive sample, and reliance on self-reported measures limit causal inference and generalizability. In addition, outcomes were assessed immediately after the intervention, and the sustainability of behavior change over time remains unknown.

In practical terms, the participatory self-health promotion model appears feasible for implementation in community settings such as elderly clubs and local health promotion programs. However, further research employing randomized controlled designs, larger and more diverse samples, and longer follow-up periods is recommended to confirm effectiveness and examine long-term outcomes. Future studies may also explore the integration of digital or hybrid delivery methods to enhance reach and sustainability.

Overall, this study provides preliminary evidence that participatory health promotion represents a promising approach for supporting self-care behaviors among community-dwelling older adults and contributes to the growing body of research on community-based strategies for healthy aging.

RECOMMENDATIONS

Practical recommendations

1.  Integration into community health programs

The participatory self-health promotion model may be integrated into existing community-based health programs for older adults, such as activities conducted through primary care units, elderly clubs (community organizations for older adults), and local health promotion hospitals. Small-group formats may facilitate active participation and experiential learning.

2.  Training of health volunteers and care providers

Community health volunteers, caregivers, and primary health care personnel may benefit from training in participatory facilitation techniques. Such training could enhance their capacity to guide group discussions, demonstrate safe practices, and support sustained engagement in self-care behaviors among older adults.

3.  Development of participatory learning materials

Practical and user-friendly educational materials, including illustrated manuals, video demonstrations, and self-assessment checklists, may be developed based on participatory principles. These materials should be culturally appropriate and adaptable to varying literacy levels among older adults.

4.  Promotion of peer support networks

Establishing peer learning and support groups within communities may help maintain motivation and accountability for self-care practices. Peer interaction can encourage shared learning and reinforce positive health behaviors over time.

5.  Monitoring and follow-up

Regular follow-up and monitoring may be conducted to assess the retention of self-care behaviors and to identify barriers to sustained practice. Ongoing feedback can support continuous refinement of participatory interventions in different community contexts.

Policy and research recommendations

1.  Policy considerations for older adult health promotion

Participatory health promotion approaches may be considered as complementary strategies within broader older adult health promotion policies to enhance community engagement and support preventive care for older adults.

2.  Support from local administrative organizations

Local administrative organizations and community health funds may play a role in supporting the dissemination and adaptation of participatory health promotion models across different regions, with attention to local needs and resources.

3.  Integration within primary health care systems

Participatory self-health promotion activities may be incorporated into primary health care services as part of preventive and promotive care for older adults, particularly within community-based service delivery models.

4.  Future research on long-term outcomes

Future studies should examine the long-term effects of participatory self-health promotion programs on outcomes such as functional independence, morbidity, and quality of life. Longitudinal designs and follow-up assessments would help clarify the sustainability of behavior change.

5.  Comparative and contextual studies

Comparative research across rural and urban settings is recommended to explore contextual factors that may influence the effectiveness and implementation of participatory health promotion interventions.

6.  Evaluation of digital and hybrid approaches

Further research may investigate the integration of digital or hybrid delivery methods, such as mobile applications or telehealth platforms, to enhance accessibility and participation among older adults with mobility or geographic constraints.

In summary, the findings of this study suggest that participatory self-health promotion has potential as a community-based approach to support self-care behaviors among older adults. With cautious implementation, ongoing evaluation, and further research using more rigorous designs, participatory health promotion may contribute to broader efforts to promote healthy and active aging in Thailand.

AUTHOR CONTRIBUTIONS

Veena Chantarasonpoch: Conceptualization (Equal), Methodology (Equal), Formal Analysis (Equal), Investigation (Equal), Data Curation (Equal), Writing – Original Draft (Equal), Writing – Review & Editing (Equal); Phongdej Khawinpat: Conceptualization (Equal), Methodology (Equal), Formal Analysis (Equal), Investigation (Equal), Data Curation (Equal), Writing – Original Draft (Equal), Writing – Review & Editing (Equal). Both authors contributed equally to this work.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest related to the conduct or publication of this study. The research was conducted independently without any financial or commercial influence from external organizations.

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