“Development” is a process from unsatisfying conditions to a more satisfying state, involving a dynamic process [ 1]. Development is directly related to change. It means a process of changes which have been planned. These planned changes hypothesize that the new conditions will be better than the old ones. However, changes sometimes have problems naturally that more or less will depend on each context. Development can be defined based on two aspects, modern perception and religion. Firstly, the modern perception views development as materialized growth in terms of both format and quantity, such as roads and transportation, housing construction and economic indexes. Secondly, according to the Buddhist point of view [2], development means the growth of body and mind. It emphasizes quality of life, correctness and sufficiency and maximizes utility, cohesiveness and beneficence, without destroying nature and the environment.

“Local community” is a human habitat connected to geographic conditions and social relationship systems, supporting human life [3]. Attachment and interaction, among others, create a process for maintaining peaceful lives. It constitutes a primary unit for both self-reliance and dependence, related to social mobilizing processes. The community is a valuable psycho-cultural unit representing its identity concerning ideology, rights and management power [4].

The dynamics of economics and technology have changed policy and country development trends, resulting in health development guidelines in Thailand. Disease control and prevention policy focus on non-communicable diseases, while communicable diseases, an indicator for underdeveloped countries, have been neglected. However, rapid development creates big gaps in health accessibility between urban and rural areas and rich and poor populations. The health of vulnerable groups, such as the poor and minorities, remain specific issues needing attention. To address these problems, tailor-made solutions are crucial. The management process has to integrate, synchronize and remain consistent with local lifestyle, as well as consider community participation processes [5, 6]. Disease control capacity development in a community involves health learning processeswhose tools include communication and community health education to create community participation in disease control. Its goals are harmonized, peaceful and focused on creating a healthy community. Then management mechanisms for community development require a whole community social system consisting of public partners, local governors, private partners and civil society. The dominant working body comprises local governors, whereas the beneficiary will be the civil society. In conclusion, community development involves everyone’s responsibility to participate in every step of the process, including design, plan, implementation and evaluation, to share common benefits.

Community well-being development is a process to improve community well-being conditions in all aspects, including economic, societal, political, and environmental, to address the dynamics of globalization, and advance self-reliance [7]. By this, communities will be able to solve their problems and fulfil their needs by themselves. The target of community development is “people” varied and distributed around the country, in many forms such as villages, urban cities, occupational groups or even some specific activity groups, etc. These groups form the foundation of the country; as a consequence developing these groups leads to developing the country.

The Pgazkoenyau ethnic group (Karen) comprises border seam line inhabitants between western Thailand and Burma, in Tak Province. Their communities are located in remote rural areas and face many difficulties in terms of transportation and amenities. They cannot access equitable educational, economic and health opportunities [8]. This impacts their quality of life and well-being conditions. Her Royal Highness Princess Maha Chakri Sirindhorn has expressed an understanding concerning the quality of life of children, youth and populations in remote rural areas [9]. Therefore, most of her works emphasized developing remote rural areas. These programs and activities focus on developing community potential, at the same time avoiding changes in culture and local way of life [10]. She has included these ethnic communities in her royally initiated projects. These projects emphasize developing human capital according to the National Economic and Social Development Plan, starting from the 8^th plan until now. Especially the 9^th to11^th National Economic and Social Development Plans promoted social immunity in Thai society by promoting literacy. The importance of developing human capital and sustainable society is prominent in the 12^th National Economic and Social Development Plan, incorporating the sufficiency economy philosophy and Sustainable Development Goals using a people-centered approach [11]. Because the focus remains on the community, every related stakeholder should seriously cooperate in the development process. To achieve country and society targets, each individual and community has to be developed. This means the targets of every royally initiated project are not only to improve people’s quality of life in remote rural areas but also to maximize human resource capacity. Thus, community harmony constitutes the key to fulfilling people’s and community members’ happiness. This study aimed to (1) explore the well-being development processes in the community and (2) investigate the results of well-being development processes in the community under the royally initiated projects of Her Royal Highness Princess Maha Chakri Sirindhorn. This constituted a case study from Tak Province.

Research and development built a multi-stage community health development project. Its foundation was based on Deming’s Cycle concept [12]. The data were collected using mixed methods technique, as shown in Table 1.

The target of ethnic community development in the areas under royally initiated projects was to improve people’s quality of life under their original community lifestyle and specific contexts. Therefore, all community health development activities covered three significant dimensions, including physical illness, environmental management and population learning processes to improve health behaviors. The details are provided below.

1. Regarding physical examination in the ethnic community, people prioritized economic issues rather than health. Then communicable diseases remained a major health problem, particularly, helminths infection among students [40]. Although they were infected, no symptoms or any severity were observed. Then screening tests to identify infection became important [40-41]. Moreover, communicating treatment guidelines and infection data were crucial for secondary prevention (re-infection) because the majority of the population comprised mono-crop farmers. Chemical substances and pesticides were always used on their farms to increase product yield. Some farmer practices were appropriate, while the others were harmful when considering chemical using guidelines. Blood chemical residue testing among farmers and consumers created awareness and activated strategic plans toward preventing chemical contact and reducing agricultural chemical use [42].

2. Concerning environmental management described in the Ottawa’s Charter, environmental health promotion comprised one significant issue accounting for a population’s well-being [43, 44]. Health hazards were encountered when people resided in polluted or contaminated environments. Environmental management could protect humans from both direct and indirect biological, chemical and physical health impacts [45, 46]. Then ethnic community development had to assess environmental health risks using community participation processes. These activities concerned reflecting on health professionals’ opinions based on community contexts. Then these environmental health risks illnesses links should be depicted to understand the community and related networks, an important learning processes. The environmental health risks in the ethnic community are detailed below:

• Toilet use was an important and urgent issue in community development. Toilet use reduced helminths epidemics because less helminths contamination occurred in the local environment [47]. Then public toilets were built in the ethnic community. To promote toilet use, some toilet standards should be adapted to fit the ethnic community contexts. Government officers’ participation was a key success factor for public toilet construction, especially in the ethnic communities located in forest reservation areas and national parks, due to economic difficulties of the ethnic people. The evidence showed that providing only material support for them to build public toilets by themselves was unsuccessful.
• Regarding household wastewater management, ethnic people, preferred to build their houses on sloping land, so wastewater from houses built on higher land would flow toward houses built on lower land. This initiated the hookworm epidemic cycle in wet areas [48]. Household wastewater management for use in farming was the solution to this situation. Moreover, it could reduce water consumption and household wastewater discharged in natural water sources.
• For garbage, the majority produced in the ethnic community comprised plastics and waste materials. Originally garbage disposal practices in the ethnic community involved burning and littering. Littering in nature caused risks in chemical contact, especially agricultural chemical substances. These could also contaminate community water reservoirs constituting a problematic issue [49]. Two recommendations were offered to manage garbage from the Department of Health. Firstly, garbage sorting was employed for reusing, recycling or transforming to agricultural products and economic resources. Secondly, waste (the garbage which could not be reused or recycled) should be burnt [50]. Community garbage management could reduce disease vectors as well as vector sources [51].
• Regarding livestock management, an ethnic community’s traditional livestock was raised in nature, such as space under their houses because it constituted an economic and convenient practice. Moreover, these animals were easy to guard from their predators [52]. However, confining animals under houses caused annoying results and health deteriorating factors for residences. Raising livestock on a ranch separated from the house was suggested as a livestock management guideline. It became necessary to educate people about the risks of under the house livestock, and usefulness of a ranch separated from the house. Moreover, raising pigs on a ranch could reduce Ascariasis by preventing Ascaris lumbricoides eggs contamination on the ground [53].

3. Health behavior improvement was a causal factor of both non-communicable and communicable disease management [54]. However, implementing only health behavioral change programs or health education programs could not effectively change human behaviors. The aforementioned programs could only trigger people’s learning processes [55]. Continuous health literacy development processes with regular stimulation were believed to activate people’s pre-contemplation to contemplation, leading to decision making for behavioral change processes [56-58]. These involved time consuming processes need consistency and continuity based on behavioral sciences. Achieving behavioral change in ethnic populations was more difficult than usual because of community-specific concepts, ideology, culture and tradition. The most important factor was differences in language for communication. This was the reason health behavioral change among ethnic people needed “ethnic health communicators”. They served as key individuals acting as interpreters, communicators, process designers and actors on the health team. They provided the main mechanism of the ethnic health behavioral change system [59]. This showed the significance of additional capacity building processes for ethnic health communicators concerning content understanding and persuasive skills. To achieve this, ethnic health communicator recruitment was also one of the key success factors, because we needed to implement it correctly at the beginning. The role of academic and health staff as process facilitators supported the ethnic health communicators along the planned community development process.

The target of health behavioral improvement could change health behaviors, or reduce health risks. Specific health behavior changes need time. Evaluating any health behavioral change also requires closely observing backstage behaviors. The first step of behavioral change was to adjust people’s mindsets. This could be assessed through willingness to change or contemplate where people became open to suggestion and adaptation or ready to change. Then it led to preparation for change, change or action, and maintenance. The impact of health behavioral improvement was reflected by the illness situation caused by those specific risks targeted in behavioral change programs. In short, reduced illnesses could serve as a success indicator of health behavioral programs.

The foundation of this community development involved confidence and faith among community members. The processes were valuable, meaningful and competent to community members who maintained their own dignity. Consequently, any practice undermining human dignity should be seriously avoided [60]. Hence, the concepts of this community development are described below.

(1) The principle of human dignity and belief in people’s potential: The action plan focused on community members’ empowerment to maximize their own potential and social capital. The local people possessed the ability to learn and improve themselves when they were provided the opportunity. Thus, they could design, plan, implement and evaluate their own community development projects.

(2) Self-reliance principle: The action plan promoted self-reliance using community empowerment processes. The government organization only supported and facilitated these development processes, particularly issues beyond the community’s authority.

(3) Community participation: Local people were the owners of their community development processes. They would participate in every step of the process from the beginning to the end including problem recognition, situation analysis, design, plan, implementation and evaluation. Government staff created a sense of belonging in the community development project among the local people.

(4) Democracy concept: The community development process was started using dialogue, discussion, creative meetings and consultation to promote community participation. These involved coordinating decision making, implementation and responsibility for the consequences, according to a democratic pattern.

The successes of this three-year development project included better prevention of illness and reduced health risks. Local people attained their expected health behaviors. In addition, the sustainability of this project was illustrated through action plans of every related organization and was consistent and synergized toward the targets of this community development project. Another benefit of this project was coordination, according to democratic concepts, between community leaders and their networks. Most importantly, the ultimate achievement of this project was the community’s learning process to design and plan their next development project based on their specific conditions, contexts and social capital in their community, which we could claim as sustainable development.