Health education interventions across Thailand, the Philippines, and Japan: a multisite comparison in varying socio-environmental and policy contexts

This quasi-experimental pre-post study evaluated the health effects of multisite health education interventions implemented in Thailand, the Philippines, and Japan. Standardized programs, based on a shared health education framework, were delivered for 6 to 12 months in Sampran (Thailand), Cebu (Philippines), Matsumoto City, and Minowa Town (Japan), targeting older adults and working-age populations. A total of 481 participants were assessed using anthropometric measurements, blood pressure, physical fitness tests (e.g., grip strength, sit-ups, balance), and cognitive function tests (reaction time and error rate via a go/no-go task device developed at Shinshu University). Physical activity was measured using pedometers to track daily steps. Significant improvements were observed in weight, BMI, muscular strength, balance, and executive function across several sites. In Minowa Town, where participants averaged 73 years in age, the average daily step count was 8,701. This finding suggests that sustained behavioral change may be linked not merely to step targets, but to internalized understanding of the health benefits of physical activity. While more than 7,000 steps per day is generally considered beneficial, our results indicate that age, motivation, and social context may moderate these outcomes. These findings underscore the importance of age- and context-appropriate interventions that integrate both physical and cognitive health components. This study also highlights the value of culturally adaptable health education strategies when addressing diverse populations across national boundaries.