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This research is part of the mixed methods research to evaluate an integrated operations to prevent and solve teenage pregnancy problems in provincial level. This article is part of qualitative research to explain the operation process to prevent and solve the problems of pregnancy in teenagers in Nakhon Phanom Province, Thailand. The research was conducted in 2 phases during December 2015-May 2017 in 3 districts. In Phase 1, the key informant is the operator at the provincial, district and sub-district levels using a purposive sampling method. The data were saturated at 22 persons. Phase 2, the key person are project manager, teenagers, parents, community leaders, teachers and health care personnel. The data were saturated at 80 persons. Both phases were collected by group discussion, in-depth interviews, field notes and documentary analysis. The data was analyzed using the thematic analysis method. The research findings were: 1) after first year of operation, it focuses on the management of sexuality education in schools and coordinated in a horizontal manner with other related sectors in the "joint meeting - separated responsibility" 2) In the third year of operation, there are 4 steps of operation, which have expanded the results of teaching sexuality education in schools and integrated support for pregnant students in the school. It can be concluded that the province operation process, that took the school as a centered, can be achieved by the education personnel adjusting their ideas about sex in teenagers, focus on sexual health in adolescents and working closely with relevant agencies. However, there are suggestions for those involved to transfer this lesson to educational agencies throughout the country.