Community-tailored One Health educational intervention to enhance knowledge and practices for zoonotic disease prevention in rural Thailand: A protocol for a prospective cluster randomised controlled Trial in Chanthaburi, Thailand (Saan Suk trial)
5 affiliations
- 1Heidelberg Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
- 2Kranuan Crown Prince Hospital, Khon Kaen, Thailand
- 3Center for Research on Plurality in the Mekong Region (CERP), Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
- 4Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- 5Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
Abstract
Background: Zoonotic infectious disease risk arises at human–animal–environment interfaces where pathogen spillover can occur. Rural communities living in biodiverse settings may experience frequent contact with wildlife and shared environments through livelihoods, food practices, and economic activities. Reducing spillover risk and strengthening pandemic prevention requires both structural and individual-level change. Community-based interventions that promote awareness, risk perception, self-efficacy, pro-environmental behaviour, and safe coexistence with wildlife may support prevention by shifting behavioural determinants of zoonotic disease risk. The Saan Suk intervention was co-developed with rural communities in Thailand using a Human-Centred Design approach and is grounded in the Health Belief Model and One Health principles. The intervention is intended to be feasible, acceptable, and deliverable through Thailand’s established Village Health Volunteer (VHV) system. Methods: This protocol describes a parallel-arm, cluster-randomised controlled superiority trial that will be conducted during July – October 2026, in Chanthaburi Province, Thailand. 24 villages will be equally randomised to the Saan Suk intervention or the current practice (control). In intervention villages, trained VHVs will deliver, once a week over four weeks, a multimodal One Health educational intervention designed to improve knowledge of zoonotic spillover, promote protective behaviours, reduce risky wildlife-related contacts, and support respectful coexistence with wildlife. Trained outcome assessment teams will conduct structured interviews with 42 adult participants per village, yielding a total sample size of 1,008 participants. The sample size was calculated for the primary outcome, accounting for clustering, with 90% power to detect a medium effect size (6 points on the 0–100 knowledge scale) at a significance level of 0.05, accounting for a design effect with an ICC of 0.028. The primary outcome is knowledge of zoonotic spillover, transmission pathways, risk factors, protective and risky behaviours, and safe coexistence with wildlife. Secondary outcomes include attitudes, self-efficacy, preventive and risky behaviours, and reported contacts with major local reservoir hosts. A structured questionnaire was developed, expert-reviewed, and piloted for the outcome assessment. Outcomes will be analysed using mixed-effects regression models with random effects for village and adjustment for relevant pre-specified confounders. Primary analyses will follow the intention-to-treat principle. Discussion: This trial will evaluate whether a co-designed, VHV-delivered One Health educational programme can improve knowledge of zoonotic disease prevention and behavioural determinants in rural communities living in close contact with wildlife and shared ecosystems. If effective and feasible, Saan Suk could inform integration into routine VHV training and community-based zoonotic disease and pandemic prevention strategies. Trial Registration: The Saan Suk trial is registered with the German Clinical Trials Register (DRKS). Registration ID: DRKS00038582; date of registration: 11 May 2026.
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BibTeX
@article{treskova2026communitytailored,
title = {{Community-tailored One Health educational intervention to enhance knowledge and practices for zoonotic disease prevention in rural Thailand: A protocol for a prospective cluster randomised controlled Trial in Chanthaburi, Thailand (Saan Suk trial)}},
author = {Marina Treskova and Cassia Rocha Pompeu and Pirrahyah Puntumetakul and Sasithorn Chaiphonngam and Kate Bärnighausen and Uliana Kachnova and Keeratiporn Jutaviriya and Monchai Phongsiri and Joacim Rocklöv and Till Bärnighausen and Patcharin Lapanun and Hans J. Overgaard},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0354989},
url = {https://doi.org/10.1371/journal.pone.0354989},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Community-tailored One Health educational intervention to enhance knowledge and practices for zoonotic disease prevention in rural Thailand: A protocol for a prospective cluster randomised controlled Trial in Chanthaburi, Thailand (Saan Suk trial)
AU - Marina Treskova
AU - Cassia Rocha Pompeu
AU - Pirrahyah Puntumetakul
AU - Sasithorn Chaiphonngam
AU - Kate Bärnighausen
AU - Uliana Kachnova
AU - Keeratiporn Jutaviriya
AU - Monchai Phongsiri
AU - Joacim Rocklöv
AU - Till Bärnighausen
AU - Patcharin Lapanun
AU - Hans J. Overgaard
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0354989
UR - https://doi.org/10.1371/journal.pone.0354989
AB - Background: Zoonotic infectious disease risk arises at human–animal–environment interfaces where pathogen spillover can occur. Rural communities living in biodiverse settings may experience frequent contact with wildlife and shared environments through livelihoods, food practices, and economic activities. Reducing spillover risk and strengthening pandemic prevention requires both structural and individual-level change. Community-based interventions that promote awareness, risk perception, self-efficacy, pro-environmental behaviour, and safe coexistence with wildlife may support prevention by shifting behavioural determinants of zoonotic disease risk. The Saan Suk intervention was co-developed with rural communities in Thailand using a Human-Centred Design approach and is grounded in the Health Belief Model and One Health principles. The intervention is intended to be feasible, acceptable, and deliverable through Thailand’s established Village Health Volunteer (VHV) system. Methods: This protocol describes a parallel-arm, cluster-randomised controlled superiority trial that will be conducted during July – October 2026, in Chanthaburi Province, Thailand. 24 villages will be equally randomised to the Saan Suk intervention or the current practice (control). In intervention villages, trained VHVs will deliver, once a week over four weeks, a multimodal One Health educational intervention designed to improve knowledge of zoonotic spillover, promote protective behaviours, reduce risky wildlife-related contacts, and support respectful coexistence with wildlife. Trained outcome assessment teams will conduct structured interviews with 42 adult participants per village, yielding a total sample size of 1,008 participants. The sample size was calculated for the primary outcome, accounting for clustering, with 90% power to detect a medium effect size (6 points on the 0–100 knowledge scale) at a significance level of 0.05, accounting for a design effect with an ICC of 0.028. The primary outcome is knowledge of zoonotic spillover, transmission pathways, risk factors, protective and risky behaviours, and safe coexistence with wildlife. Secondary outcomes include attitudes, self-efficacy, preventive and risky behaviours, and reported contacts with major local reservoir hosts. A structured questionnaire was developed, expert-reviewed, and piloted for the outcome assessment. Outcomes will be analysed using mixed-effects regression models with random effects for village and adjustment for relevant pre-specified confounders. Primary analyses will follow the intention-to-treat principle. Discussion: This trial will evaluate whether a co-designed, VHV-delivered One Health educational programme can improve knowledge of zoonotic disease prevention and behavioural determinants in rural communities living in close contact with wildlife and shared ecosystems. If effective and feasible, Saan Suk could inform integration into routine VHV training and community-based zoonotic disease and pandemic prevention strategies. Trial Registration: The Saan Suk trial is registered with the German Clinical Trials Register (DRKS). Registration ID: DRKS00038582; date of registration: 11 May 2026.
SN - 1932-6203
ER -