Abstract
INTRODUCTION: Conventional one-to-one health education models face scalability and sustainability limitations. Group education and communities of practice may simultaneously improve reach, effectiveness, and economic sustainability. We sought to demonstrate, using a microeconomic model contextualized by integrative evidence, that group-based education and communities of practice represent economically sustainable and scalable strategies for health promotion that can enhance professional value while maintaining or improving clinical outcomes documented in existing literature. METHODS: We developed a theoretical-propositional model grounded in an integrative review (2010-2025) and a session-level microeconomic simulation comparing individual versus group formats under realistic market assumptions in Brazil (currency: Brazilian Real, R$; year 2025). Outcomes included gross revenue, net margin, average cost per participant, and break-even price. Scenarios incorporated group sizes (10-30), online versus in-person delivery, attendance (70%-100%), and variable costs (R$0-R$20 per participant). We interpreted results alongside published health economic evaluations of structured group education and shared/telemedicine group visits. RESULTS: In the base case (N=20; online; price R$120; fixed cost R$300; variable cost R$0; 100% attendance), net margin was R$2,100 per one-hour session; a 12-week program reached R$25,200 cumulative margin. In-person with R$10 per participant variable cost and 85% attendance (17 attendees) yielded approximately R$790 per session in conservative operational designs and about R$9,480 over 12 weeks. Group formats exhibited strong economies of scale with robustness in sensitivity analyses. CONCLUSION: Group education and communities of practice present a sustainable, scalable approach to health promotion that can improve access, leverage peer support, and enhance professional value. Complementary evidence from diabetes education, telemedicine group visits, school- and community-based programs, and public health return-on-investment analyses supports the potential for favorable economic performance without sacrificing effectiveness.