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Saan Suk intervention to evaluate knowledge of zoonotic spillover in rural Thailand communitiesNew program aims to stop diseases jumping from animals to humans

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Key Takeaway
Note that this is a trial protocol; no results are currently available to inform clinical practice.

The study is designed as a cluster-randomized controlled trial to evaluate the impact of a specific educational intervention on zoonotic disease knowledge. The study will be conducted in rural communities within the Chanthaburi Province of Thailand. The target population consists of 1008 adults residing in these rural areas. The primary objective is to determine if a community-based approach can improve public understanding of zoonotic spillover, transmission pathways, risk factors, and the behaviors associated with safe coexistence with wildlife.

The intervention being tested is the Saan Suk intervention. This is described as a multimodal One Health educational intervention. A critical component of the delivery model is that the intervention will be delivered by trained Village Health Volunteers (VHVs). The comparator group will receive the current practice, which serves as the control for the study. The specific dosing, duration, and frequency of the Saan Suk sessions are not detailed in the provided protocol documentation.

Because this is a protocol for a prospective trial, no primary outcome results are currently available. The primary outcome measure is the participants' knowledge regarding zoonotic spillover, transmission pathways, risk factors, protective and risky behaviors, and safe coexistence with wildlife. These metrics will be compared between the Saan Suk intervention group and the control group to determine the effectiveness of the educational program.

Secondary outcomes identified for the study include attitudes, self-efficacy, and preventive and risky behaviors. Additionally, the study will track reported contacts with major local reservoir hosts. These outcomes are intended to provide a more comprehensive view of how the intervention affects the community's interaction with zoonotic risks beyond just baseline knowledge.

Safety and tolerability data are not reported, as the study has not yet been conducted. There is no information regarding adverse events, serious adverse events, or participant discontinuations. Since the intervention is an educational program delivered by volunteers, the risk profile is expected to be low, but these factors will be monitored during the trial execution.

The study aims to address a gap in how zoonotic disease prevention is communicated in rural settings. By using a co-designed, VHV-delivered One Health educational program, the researchers hope to see if a localized, community-led approach is more effective than standard practices. This approach aligns with One Health principles that integrate human, animal, and environmental health. Several limitations are inherent in the study design. As a protocol, the most significant limitation is the lack of existing data to draw clinical conclusions. The study's results will depend on the consistency of the training provided to the Village Health Volunteers and the representative nature of the 1008 participants in the Chanthaburi Province. Potential biases related to the cluster-randomized design, such as community effects, will need to be accounted for during analysis.

For clinical practice, this study currently offers no direct evidence for treatment or prevention. It serves as a framework to evaluate whether a specific educational model can improve community knowledge regarding zoonotic diseases. Once results are available, they may inform public health strategies for zoonotic disease prevention in rural areas. Currently, the question of whether a VHV-delivered One Health program is superior to current practices remains unanswered until the trial is completed.

Many people live in close contact with wildlife, which can lead to serious health risks. When diseases jump from animals to humans, they are called zoonotic diseases. These types of illnesses can spread quickly and affect entire communities. For people living in rural areas near forests or farms, understanding how to coexist safely with local animals is a vital part of staying healthy and keeping their neighbors safe.

To address this, researchers are preparing a study in the Chanthaburi Province of Thailand. They are testing a program called Saan Suk. This is a multimodal education plan, which means it uses different ways to teach people, such as visual aids or group discussions. The program is designed to be delivered by trained Village Health Volunteers. These are trusted members of the local community who can provide information in a way that feels familiar and helpful to their neighbors.

The study will involve 1,008 adults in these rural communities. The goal is to see if the Saan Suk program can improve what people know about zoonotic spillover. This term refers to how a disease moves from an animal host into a human host. The program also aims to teach people about transmission pathways, which are the ways a disease travels, and the specific behaviors that might put them at risk. By teaching these facts, the goal is to help people adopt safer habits and feel more confident in how they interact with the environment.

Beyond just facts, the study also looks at attitudes and self-efficacy. Self-efficacy is a term for a person's belief in their own ability to succeed in a specific task. In this case, it means whether a person feels confident they can take the right actions to prevent a disease from spreading. The researchers also want to track how many people have contact with local animals that could carry diseases. It is important to note that this study is currently in the protocol stage. This means the researchers have designed the plan and the methods, but they have not started the trial or collected any results yet. Because no data has been gathered, we cannot yet say if the program is effective or how much it improves knowledge. It is a step toward finding better ways to protect people from animal-borne illnesses.

For now, this research represents a proactive step in public health. While it does not offer an immediate change in medical treatment, it seeks to create a better educational framework for rural communities. If successful, it could provide a model for how to educate people on the risks of zoonotic diseases in a way that is culturally and locally appropriate.

What this means for you:
A new educational program is being tested to help rural communities better understand and prevent animal-borne diseases.

Study Details

Study typeRct
Sample sizen = 1,008
EvidenceLevel 2
PublishedJan 2026
View Original 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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