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health literacy, pesticide exposure, chemical exposure, farming
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Rachutorn T, Aeksanti T, Pall C et al. Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.12688/f1000research.155630.1)
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Research Article
Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand
[version 1; peer review: 2 approved with reservations]
PUBLISHED 19 Sep 2024
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Public Health and Environmental Health collection.
Abstract
Corresponding author:
Chamroen Pall
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2024 Rachutorn T et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Rachutorn T, Aeksanti T, Pall C et al. Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.12688/f1000research.155630.1)
First published: 19 Sep 2024, 13:1078 (https://doi.org/10.12688/f1000research.155630.1)
Latest published: 19 Sep 2024, 13:1078 (https://doi.org/10.12688/f1000research.155630.1)
Introduction
Currently, the agricultural industry in Thailand uses a variety of chemicals to prevent and control pests, weeds, grasses, and plant diseases, as well as to stimulate production. Thai farmers have reported the use of agricultural chemicals in various cultivation processes.1 Furthermore, 69.9% of farmers use a moderate level of dangerous chemicals, 3.1% of farmers use a high level of dangerous chemicals, while only 19.9% of farmers use a low level of dangerous chemicals.2 The most used pesticides are organophosphates and carbamates.3 Inappropriate and unsafe behaviors around pesticide use are likely to result in negative impacts on human health. Such inappropriate pesticide uses behaviors include mixing chemicals, poor storage, and spraying.4 Other unsafe behaviors include using multiple types of pesticides together in spraying, taking breaks during spraying to smoke, eat, and drink, opening pesticide bottles using one’s teeth, blowing, or sucking the spray nozzle to remove a blockage, and not wearing rubber gloves.3,5 These high-risk behaviors may result in toxic chemical exposure, lead to negative impacts on human health, and result in acute and chronic health concerns. Acute symptoms range from mild to severe, including death, and depends on the chemical concentration and toxicity, as well as the amount ingested or absorbed. Chronic symptoms can result from the accumulation of toxins in the body over time, causing abnormalities in the nervous system.6 Farmers who practice poor pesticide use are at risk for both acute incidents during spraying and chronic effects from long-term contamination. Exposure to pesticides for more than three years increases the risk for cardiovascular and heart diseases.7 Thus, if farmers fail to protect themselves from pesticide exposure and contamination, they are more likely to experience both acute and chronic health conditions.
In 2020, Thailand’s Ministry of Public Health released a report on occupational and environmental diseases which revealed a morbidity rate from pesticide poisoning of 13.75 per 100,000 population, a value which is higher than the rate reported in 2019.
In 2020, Thailand’s Nakhon Ratchasima province reported a morbidity rate as high as 64.26 per 100,000 population, which is over twice the rate of 31.8 per 100,000 population reported in 2019.8 This data reflects an increase in the morbidity rate at both the national and provincial levels. Moreover, a biological risk assessment of pesticide exposure among rice farmers in the Kaeng Sanam Nang sub-district, Kaeng Sanam Nang district, Nakhon Ratchasima province, found that the sample group was at risk and unsafe, with exposures being found in up to 60.0% of sample groups.9 Another study reported that rice farmers were at increased risk of adverse health effects when compared to farmers growing other crops.10 Based on this study, rice farmers can be assumed to have the greatest risk of pesticide exposure.
Sustainable Development Goals (SDGs) rely on the availability of human resources. Therefore, promoting health literacy is crucial as it fosters and enhances individuals’ abilities to sustainably manage their own health, and adopt desirable health behaviors. In the available literature describing past research, health literacy has been associated with improved health outcomes, self-evaluation of health, and informed decision-making. These individuals are also more susceptible to illnesses or health problems, and more at risk to make inappropriate health decisions.11 People with low health literacy are likely to encounter more health issues, while those with high health literacy tend to make better decisions regarding their health.12 Health literacy can be described as consisting of the following six components13,14 across three levels, Level 1: Basic Health Literacy (Functional literacy), including Access to Health Information and Services (Access) and Knowledge and Understanding (Cognitive), Level 2: Interactive Health Literacy, including Communication, Inquiry, Exchange (Communication), and Self-Management, and Level 3: Critical Health Literacy, including Media Literacy and Decision-making. This model of health literacy is used in this study’s design.
Previous research has yet to characterize health literacy among Thai farmers, a group more closely involved with, and more often exposed to plant pest control chemicals than other groups. Previous studies have reported that farmers display incorrect behaviors around the prevention of exposure to pest control substances, such as not reading the labels or instructions before use, not wearing a mask, or covering their nose during pesticide use, not wearing eye protection or protective gloves, inhaling chemicals during spraying, or drinking water while working. Furthermore, improper storage of substances and incorrect disposal of chemical containers in violation of public health principles have also been observed.15 The most reported unsafe behaviors included mixing multiple types of chemicals into a single spray, followed by not wearing protective gloves while working with chemicals, and not having a specific safe storage place for plant pest control chemicals.16 The negative health impact on farmers exposed to plant pest control chemicals is significant. Exposures to plant pest control chemicals over a period of three years or more has been associated with a risk of cardiovascular and heart diseases.7 In summary, poor protective behaviors of rice farmers to pest control chemicals will result in exposure to plant pest control chemicals and endanger human health. Therefore, this study aims to investigate health literacy in Thai farmers and explore the association between health literacy and exposure-preventing behaviors, especially in farmers who are responsible for spraying plant pest control chemicals. This research is conducted at key farming areas in Thailand, so as to provide an understanding of the problem in the community context and aid in the development of a health literacy promotion program to improve the health literacy and behaviors of farmers. This research aims to ultimately prevent exposure to plant pest control chemicals, improve work safety, and reduce the risks to, and impacts on, farmers’ health.
Methods
A cross-sectional analytical study was conducted to study the association between health literacy and behaviors aiming to prevent exposure to plant pest control chemicals among Thai farmers. The variables measured include general information characterizing the sample group, health literacy, and behaviors aimed at preventing exposure to plant pest control chemicals.
Population and sample group
The population consists of men and women farmers aged 18 and over engaged in agriculture with agricultural households registered with the agriculture office totaling 521,593 people.17 The required sample size was calculated using G*Power software,18 which was created from Cohen’s (1988) formula.19 The calculation was performed according to the statistics used in data analysis, with a 95% confidence level, a margin of error of .05, test power of .80, and an effect size of .05.18 This resulted in a required sample size of 464 people. Multi-stage stratified cluster random sampling was used and divided according to the characteristics of agricultural areas in a stratified random sampling method, which resulted in 3 groups: 1) paddy farming only, 2) paddy and upland rice farming, and 3) paddy farming and cash crop growing.
Research ethics
We obtained ethical approval from the Ethical Review Committee of the Public Health Office of Nakhon Ratchasima Province, Thai Ministry of Public Health (Reference No: NRPH 053). The Ethics in Human Research Committee of the Nakhon Ratchasima Public Health Provincial Office. The research was reviewed and approved on August 9, 2021, and the approval expires on August 9, 2022. The research is conducted in compliance with the Declaration of Helsinki, The Belmont Report, and the CIOMS Guideline International Conference on Harmonization in Good Clinical Practice (ICH-GCP). The research team is led by Thiwakorn Rachutorn from Nakhon Ratchasima Rajabhat University.
The research has been approved with an expedited review, which means that it is considered to be a low-risk study. The documents reviewed include the full protocol, participant information sheet, informed consent form, and questionnaire. In addition to research consent form was provided to participants with volunteer consent with type of written consent obtained before collecting data. All the participants was provided read and understood the objectives of research and signs consent form willingly.
Informed consent: The form ensures that participants are fully informed about the research objectives, procedures, and potential risks and benefits.
Confidentiality: It explicitly states that the researcher will treat participant responses as confidential, protecting their personal information.
Voluntary participation: Participants are free to choose whether or not to participate and can withdraw at any time.
Witness signatures: The requirement for two witnesses to sign the form adds a layer of assurance that the participant’s consent is voluntary and informed.
Data aggregation: The research findings will be presented in an aggregated form, protecting individual participant identities.
These elements together contribute to a consent form that aligns with ethical principles for research involving human subjects.
Research tools
The study included a questionnaire and risk screening, which was conducted using a finger-prick blood test. The details are as follows:
The questionnaire consisted of three parts:
Part 1: General information. Questions included gender, age, education, average annual household income, history of using chemical pest control substances, sources of information about using chemical pest control substances, use of chemical pest control substances in rice cultivation, history of exposure to chemical pest control substances, and history of training on the use of chemical pest control substances.
Part 2: A questionnaire to measure health knowledge for using chemical pest control substances across six aspects, which was divided into two sub-sections:
Part 2.1 covered one aspect: knowledge and understanding. This portion consists of 13 questions with closed-ended response options yes, no, and unsure. The correct answer scored 1 point, while wrong or unsure answers scored 0 points. A participant’s total score in the area of health knowledge could be classified as high (a score above 80%), moderate (a score between 60% and 80%), or low (a score below 60%) using Bloom’s cut-off point.20,21
Part 2.2 covered five aspects: access to information and services (7 items), communication (8 items), self-management (6 items), media and information literacy (6 items), and decision-making (10 items). Responses were closed-ended with five answer choices describing the frequency with which the participant performed that behavior: regularly (all seven days in a week), frequently (5-6 days in a week), sometimes (3-4 days in a week), infrequently (1-2 days in a week), or never (not at all). For the 30 positive questions, responses were scored from 5-1 respectively, and for the seven negative questions, responses were scored from 1-5 respectively.
Part 3: covered preventive behavior aiming to reduce exposure to chemical pesticides, consisting of 30 items divided as follows: behaviors performed in the preparation for (10 questions), during (9 questions), and after (11 questions) the spraying of chemical pesticides. Responses were closed-ended with five answer choices, with 13 questions scored positively and 17 questions scored negatively. Response options and scoring were as described in part 2.2. Scores from parts 2.2 and 3 were used to interpret the level of health knowledge or behavior. Total scores could be classified as either high (75-100 %), medium (26-74 %), or low (0-25 %) using quartile calculation.
The risk of exposure to chemical pesticides was determined by finger-prick blood tests using cholinesterase reactive paper on farmers following the procedure set in place by the Bureau of Occupational and Environmental Diseases, within Thailand’s Ministry of Public Health.22 The blood test results of farmers were divided into four groups by the level of AChE: safe (≥ 100.0 U/ml), normal (87.5 – 99.9 U/ml), at-risk (75.0 – 87.4 U/ml), and unsafe (< 75.0 U/ml).23
Quality assessment of the research tool
The research tool used in this study underwent examination for accuracy and content coverage by three qualified experts, namely a health knowledge expert, an occupational health and safety professional, and a researcher specializing in the health of farmers. Only questions with an index of item objective congruence (IOC) of greater than 0.60 were selected. Suggestions were then implemented, and the tool was piloted in a group of 30 farmers similar to the research sample group. The reliability of each questionnaire item and part was evaluated separately. The knowledge and understanding part were analyzed using the Kuder-Richardson 20 (KR20) method and yielded a reliability of r = 0.79. The parts covering access to information and services, communication, self-management, and media literacy, yielded a Cronbach’s alpha coefficient (α) of α = 0.86. For decision-making, the reliability was α = 0.85, and for the questionnaire on behaviors aimed at avoiding exposure to chemical pesticides, the reliability was α = 0.88.
Data collection process
1. Field research assistants were trained to collect data in the communities where the sample group resided. The lead investigator distributed a data collection manual for the study, which included the details of the research project, the purpose of the research, the guidelines for introducing the data collectors, an explanatory letter and research consent form, the characteristics of the sample group for data collection, the content of each part of the tool, and steps on how to use the tool to collect data. To ensure that the data collectors understood and could correctly use the tool according to the research procedures, the lead investigator organized a practical training session and demonstrated how to collect data in the field. This training included information on how to introduce themselves, how to explain the purpose of seeking cooperation when providing information, how to correctly record data and how to check for complete responses. The data collectors also practiced actual data collection with farmers who were like the research sample group, and their performance was evaluated until they could fully follow the study procedures.
2. A letter was sent to the Subdistrict Administrative Organization leader to request permission for data collection within the chosen area. Once approval was received, the researchers met with the village leader and village health volunteers (VHV) to explain the details of the research, emphasizing the ethical principles of research to protect the rights of the sample group throughout the study period.
3. The date, time, and location of each visit to the area for data collection were coordinated and agreed upon with the sample group of farmers.
4. Each data collector proceeded to the field and collected data from the sample. If a member of the sample group was unable to read the questionnaire by themselves, the data collector would read the questionnaire and let the participants respond by themselves.
5. The lead investigator checked the accuracy of the collected data again and digitally inputted the obtained information into the database for analysis.
Data analysis
The analysis was performed using SPSS version 16 https://www.ibm.com/products/spss-statistics to present the results. Descriptive statistics were used to present values, frequency distributions, percentages, averages, standard deviations, and minimum and maximum values. Inferential statistics were used to assess the association between health knowledge and exposure prevention behaviors using the Spearman rank correlation coefficient (or Spearman’s rho [rs]). As the data obtained from the questionnaire was found not to be normally distributed, binary logistic regression was performed using the stepwise method, which consisted of selecting the independent variable with the highest correlation value for the first analysis, followed by variables with successively lower correlation values.
Results
The results describe the participant cohort of 464 individuals, and include their general information, health awareness, exposure prevention behaviors, the association between health awareness and exposure prevention behaviors, and binary logistic regression associations between variables of interest.
General information
Most of the sample group of farmers were women, accounting for 62.3%, with an average age of 55.3 years. 65.1% had completed secondary education, and 59.3% had an annual average household income of less than 60,000 THB in USD is 1,700 USD. Regarding the use of chemical pesticides by the sample group, 73.6% reported a history of using chemical pesticides for 1-5 years. Information about chemical pesticides was obtained mainly from sellers (42.8%), followed by public health officials and fellow farmers (14.6% each). In past growing seasons, 73.5% had used pesticides, 68.3% had used herbicides, and most had used up to five types of chemical pesticides. Only 10.3% had received training in the use of chemical pesticides in the past year.
Health awareness
The assessment of health awareness covered the following six components: 1) Understanding and knowledge were low in 40% of the sample. When considered on a per-item basis, the highest level of knowledge was in reading and understanding the label each time before using the chemical pesticides (91%). The least amount of knowledge was in using chemicals in quantities different from those specified on the label (52.7%). 2) Access to information and services was moderate in 44.4% of the sample. The highest level of knowledge was in farmers accessing services when they experienced health problems resulting from the use of chemical pesticides (45.6%), while the lowest was in searching for and choosing information sources detailing the use of chemical pesticides (39.1%). 3) Communication was moderate in 46.6% of the sample. The highest level of knowledge was in farmers asking public health personnel how to better take care of their health (40%), while the lowest was in reading and listening to information about chemical pesticides from others and understanding the content (44%). 4) Self-management was moderate in 42.9% of the sample. The ability to self-monitor for health conditions that may result from the use of pesticides was highest 45%, while the use of personal protective equipment such as helmets, glasses, masks, gloves, shoes, and tight clothes at all times, even when not expecting to experience an allergic reaction to the pesticides, was lowest (28.7%). 5) Information literacy was moderate in 44.2% of the sample. Knowledge of comparing products from multiple sources to confirm and verify their accuracy and reliability before buying pesticide products was the highest (37.1%), while knowledge around trusting the promotional marketing materials of pesticide sales without reconsideration was the lowest (29.4%). 6)Decision-making was moderate in 43.8% of the sample. Wearing masks and rubber gloves to protect oneself from contact with pesticides when spraying pesticides was highest (39.0%), while knowledge around trusting information about pesticides received from friends or acquaintances without doubt was lowest (52.9%). Overall, it was found that the majority of the sample had a moderate level of health knowledge (48.8%), followed by a high level (26.0%), and a low level (25.2%).
Behaviors aimed at preventing exposure to pesticides
Assessing the frequencies of farmers reported self-protective behaviors in the past month, it was found that the majority performed behaviors overall at a moderate level (44.6%). When looking individually at behaviors performed before, during, and after pesticide use, it was found that: 1) In preparation for using pesticides, most reported performing behaviors at a moderate level (47.1%), with wearing rubber gloves to prevent contact with pesticides (29.2%) as the most frequently reported behavior, and checking the condition of the spray head, spray line, container, and equipment used for spraying chemicals before use (34.4%)as the least frequently reported behavior. 2) During the spraying of pesticides, most participants reported performing self-protective behaviors at a low level (53.7%), with wearing rubber gloves to prevent contact with pesticides (36.7%) as the most frequently reported behavior and wearing a mask as the least frequently reported behavior (31.9%). 3) After spraying pesticides, most reported performing self-protective behaviors at a moderate level (42.5%), with storing pesticides and equipment in a safe place out of the reach of children (39.2%) as the most frequently reported behavior and placing warning signs to alert others of pesticide use in the area as the least frequently reported behavior (48.3%).
Association between health knowledge and exposure prevention behaviors
There was a positive and significant association between health knowledge and exposure prevention behaviors in all aspects (rs between.64 and.75, p < .001). However, it was found that the health knowledge and understanding aspect had the lowest correlation with exposure prevention behaviors (rs (478) = .14, p < .05). Details are shown in Table 1.
Table 1. The relationship between health knowledge and exposure prevention behaviors (n = 464).
| Health knowledge | rs | p-value |
|---|---|---|
| Knowledge and understanding | .16 | 0.014* |
| Access to information and services | .65 | <0.001** |
| Communication | .67 | <0.001** |
| Self-management | .74 | <0.001** |
| Media and information literacy | .78 | <0.001** |
| Decision-making | .72 | <0.001** |
| Overall health knowledge | .70 | <0.001** |
Assessment of associations using binary logistic regression
The Binary logistic regression analysis provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs), indicating that the level of knowledge has a statistically significant relationship with exposure prevention behaviors at a level of.001 (Adjusted OR = 6.57, 95% CI = 3.95-10.94), as shown in Table 2.
Table 2. The associations between health knowledge and exposure prevention behavior (n = 464).
| Variable | Count | % of strong protective behaviors | Crude OR | Adjusted OR | 95% CI | p-value |
|---|---|---|---|---|---|---|
| Health knowledge | <0.001** | |||||
| Moderate and low level | 355 | 15.8 | 1 | 1 | ||
| High level | 125 | 54.4 | 6.37 | 6.57 | 3.95-10.94 |
Multiple Logistic Regression analysis provided the adjusted OR and 95%CI. It was found that the level of health knowledge was significantly associated with the frequency at which farmers performed behaviors to prevent exposure to pesticides (p < 0.001, Adjusted OR = 6.57, 95% CI = 3.95-10.94), as shown in Table 3.
Table 3. Crude and adjusted odds ratios (ORs), and 95% confidence interval (CI) values of the association between health knowledge, exposure prevention behaviors, and the results of testing for acetylcholinesterase enzyme activity levels (n = 464).
| Variable | Count | % Normal level of AChE | Crude OR | Adjusted ORa | 95% CI | P-value |
|---|---|---|---|---|---|---|
| Health knowledge | <0.001 | |||||
| Moderate and low level | 350 | 6.6 | 1 | 1 | ||
| High level | 114 | 34.2 | 7.39 | 5.76 | 2.95-11.24 | |
| Behavior to prevent exposure to pesticides | <0.001 | |||||
| Moderate and low practice | 350 | 6.6 | 1 | 1 | ||
| High practice | 114 | 34.2 | 7.39 | 5.43 | 2.78-10.62 |
Discussion
Farmers in this study reported that they had been using pesticides for between 1 and 5 years, with an average of 3.65 years, which is consistent with findings in a study by Suwanrattanat and Panyasophon,24 that reported 83.3% of farmers hade been using chemicals for between 1 and 5 years. The present study found that farmers reported obtaining the majority of their information from pesticide sellers, again consistent with a study by PewKluang, and Hunniran25 that too reported most farmers as having received information from chemical sellers (81.6%) and pesticide distributors (62.1%). The most commonly used pesticides in the recent growing season were, in order of frequency, those for eliminating snails, rats, aphids, insects, and controlling weeds or grass. Most farmers reported using all types of pesticides, indicating that farmers are feeling the need to control a wide and increasing number of pests, especially cherry snails, which continue to increase rapidly in population.26
This study found that overall levels of health knowledge across all components were at a moderate level. When considering each component individually, these findings are consistent with those of a study by Suwanrattanat and Panyasophon,24 which found that most farmers in the Nong Bunmak District in the Nakhon Ratchasima Province, had moderate levels of health knowledge across all aspects. Additionally, this is in agreement with the findings of a study by Suwanphan and Sridaket27 that found farmers to have moderate levels of knowledge about accessing information and services, decision-making, and self-management, but not in the aspect of understanding knowledge and communications, which was found to be at a low level. Considering the results of this study in the context of previous studies, it is clear that the overall level of health knowledge of most farmers still needs improvement. Consequently, all relevant sectors should be compelled to promote the importance of health knowledge to farmers, in addition to taking measures to improve the levels of health knowledge among sellers and distributors of pesticides, due to the reliance of farmers on pesticide sellers for this information, as revealed in the present study.
This study found that farmers’ practices of preventive behaviors aiming to reduce and prevent exposure to chemical pesticides were at a moderate level. A previous study reported that 64.80% of workers had a good level of using Respiratory Protective Equipment (RPE).27 When divided into the different intervals at which these behaviors were practiced (i.e., before, during, and after pesticide use), we found that 1) behaviors around the preparation for the use of chemical pesticides were practiced at a moderate level, 2) behaviors during the spraying of chemical pesticides were practiced at a low level, and 3) behaviors after spraying chemical pesticides were practiced at a moderate level. This is consistent with the findings of Chantaphao, Pandee, and Nuwatthana,28 who reported moderate levels of self-protective behaviors around the use of chemical pesticides among most rice farmers (95%). Moreover, studies by Suanmuang, Kongtaveelert, Sombhopjaroen, and Sujirarat29 and by Thaioou, Thiphom, Yasak, and Chanthorn30 both reported farmers as having moderate levels of self-protective behaviors against exposure to chemical pesticides (63.3% and 58.9%, respectively). This indicates that most rice farmers have some preventive behaviors against exposure to chemical pesticides, but that the frequency with which they practice these behaviors leaves room for improvement. It is of paramount importance that self-protection against chemical pesticide exposure is promoted to reduce the risks to and impact on the health of rice farmers.
Health literacy levels were found to be closely associated with the reported frequency of preventive behaviors in regard to chemical pesticide exposure. While each of the six components of health literacy individually correlated with behaviors at a level that was found to be statistically significant, the knowledge understanding component had the weakest correlation with behaviors aiming to prevent exposure to chemical pesticides in comparison to the other components. This indicates that understanding of information about preventive measures alone is not sufficient to promote good self-protection practices, and that consequently, more training is needed to provide and maintain sufficient levels of knowledge and understanding about chemical pesticides for farmers. Other activities should also be aimed at improving skills in accessing information and services, communication, self-management, media literacy, and decision-making skills, which are components of health literacy that farmers need for effective self-preservation. These suggested interventions are likely to improve farmers’ efficiency at preventing exposure to pesticides, and consequently improve health and quality of life.
Cholinesterase reactive paper screening of finger-prick blood samples taken from farmers demonstrated that the majority of farmers (72.2%) had normal and safe levels of cholinesterase enzyme levels, which is an improvement from the findings of previous studies, where percentages of farmers as low as 24.7% had cholinesterase enzyme levels in the safe range.31 However, the study still found 27.8% of farmers had levels that indicated that they were at risk or unsafe, consistent with inadequate exposure prevention behaviors. While the majority of farmers report behaviors consistent with providing a moderate level of protection, there is research suggesting that the risks to farmers’ health decrease with increased self-protective behaviors. The majority of participants in the present sample reported using personal protective equipment regularly (36.9%) or sometimes (50.8%), which may indicate that the risk to their health has decreased over the course of the past year.31
Conclusion
These findings suggest that, overall, the level of farmers’ health knowledge needs to be improved. As the majority of farmers reported receiving their information primarily from the sellers and distributors of chemical pesticides, individuals working in those industries must also improve their level of health knowledge, so as to promote good practices. We found that most farmers do practice behaviors to prevent exposure to chemical pesticides at a moderate level, but this also requires improvement to decrease the severity and frequency of exposures. Health knowledge was found to be strongly associated with the frequency of self-protective behaviors. As such, the importance of maintaining high levels of health knowledge must be emphasized to rice farmers, in order to modify behavior and increase levels of self-protection against chemical pesticide exposure.
Recommendations
Recommendations for capitalizing on these research findings
This article represents a call to the relevant agencies to capitalize on these research findings when planning and making agricultural policy. Action must be taken to reduce the risks to and impacts on farmers’ health resulting from the improper use of chemical pesticides. This requires the promotion of health knowledge, especially health knowledge relating to the understanding of the use of chemical pesticides. The insufficient levels of health knowledge and understanding demonstrated within this sample indicate an urgent need for improvement in this area.
Recommendations for future research
1. Future research should investigate farmers growing economic crops other than rice, while using chemical pesticides that are severely harmful to health, including, but not limited to, cassava, sugarcane, and feed corn.
2. It is necessary to investigate individuals who work as hired pesticide sprayers. This group is exposed to chemical pesticides continuously and it would be valuable to measure the risks to and impact on health, both acute and chronic.
3. Qualitative research is needed to understand the real causal mechanisms that relate health literacy, preventive behaviors, and cholinesterase enzyme levels. This research should be conducted in targeted and contextually appropriate sectors of the industry such that the findings will have the maximum utility for problem-solving and planning for farmers and policymakers in the most needed areas.
Ethics and consent
We obtained ethical approval from the Ethical Review Committee of the Public Health Office of Nakhon Ratchasima Province, Thai Ministry of Public Health (Reference No: NRPH 053). The Ethics in Human Research Committee of the Nakhon Ratchasima Public Health Provincial Office. The research was reviewed and approved on August 9, 2021, and the approval expires on August 9, 2022. The research is conducted in compliance with the Declaration of Helsinki, The Belmont Report, and the CIOMS Guideline International Conference on Harmonization in Good Clinical Practice (ICH-GCP). The research team is led by Thiwakorn Rachutorn from Nakhon Ratchasima Rajabhat University.
The research has been approved with an expedited review, which means that it is considered to be a low-risk study. The documents reviewed include the full protocol, participant information sheet, informed consent form, and questionnaire
In addition to research consent form was provided to participants with volunteer consent with type of written consent obtained before collecting data. All the participants was provided read and understood the objectives of research and signs consent form willingly.
Informed consent
The form ensures that participants are fully informed about the research objectives, procedures, and potential risks and benefits.
Confidentiality
It explicitly states that the researcher will treat participant responses as confidential, protecting their personal information.
Voluntary participation
Participants are free to choose whether or not to participate and can withdraw at any time.
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how to cite this article
Rachutorn T, Aeksanti T, Pall C et al. Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.12688/f1000research.155630.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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PUBLISHED 19 Sep 2024
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How to cite this report:
Samad NIA. Reviewer Report For: Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.5256/f1000research.170822.r332728)
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https://f1000research.com/articles/13-1078/v1#referee-response-332728
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 25 Nov 2024
Approved with Reservations
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This interesting study discusses the relationship between health literacy and pesticide protective behaviors among farmers. As we all know, health literacy is an important indicator of someone's view and practice toward exposure and risks. Furthermore, this relationship can impact the
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Samad NIA. Reviewer Report For: Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.5256/f1000research.170822.r332728)
The direct URL for this report is:
https://f1000research.com/articles/13-1078/v1#referee-response-332728
https://f1000research.com/articles/13-1078/v1#referee-response-332728
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Povey A. Reviewer Report For: Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.5256/f1000research.170822.r329000)
The direct URL for this report is:
https://f1000research.com/articles/13-1078/v1#referee-response-329000
https://f1000research.com/articles/13-1078/v1#referee-response-329000
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 08 Nov 2024
Andrew Povey,
Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
Approved with Reservations
VIEWS 15
In this manuscript, the authors describe a cross-sectional study of health literacy and pesticide protective behaviours in Thai farmers. They report significant associations between health literacy and those behaviours aimed at preventing pesticide exposure. This is an interesting paper but
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Povey A. Reviewer Report For: Examining the relationship between health literacy and pesticide protective behaviors among farmers in Thailand [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:1078 (https://doi.org/10.5256/f1000research.170822.r329000)
The direct URL for this report is:
https://f1000research.com/articles/13-1078/v1#referee-response-329000
https://f1000research.com/articles/13-1078/v1#referee-response-329000
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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