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 commonly 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 use 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. Individuals with low or insufficient health literacy tend to have difficulty understanding diseases and health conditions and a more difficult time following doctors' advice and treatment regimen. 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 components [13],[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 commonly 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.
Research Objectives
This study aims to describe health literacy and to determine the relationship between health literacy and behaviors aimed at preventing exposure to plant pest control chemicals among Thai farmers.