Strengthening Rabies Protection Behaviors Among Thai Children: The Role of Health Literacy and Protection Motivation.

BACKGROUND

Rabies remains a life-threatening yet preventable disease, particularly among school-aged children in Thailand. Understanding how health literacy (HL) and protection motivation theory (PMT) influence rabies protective behaviors (RPB) is vital for school health interventions.

METHODS

Using validated questionnaires, a cross-sectional study was conducted among 1751 Grade 4-6 students in Chonburi Province. HL, PMT constructs, and RPB were measured. Structural equation modeling was used to examine predictive relationships.

RESULTS

HL was a strong predictor of RPB (β = 0.439, p < 0.001), especially in accessing, appraising, and applying health information. PMT constructs, particularly response efficacy and self-efficacy, also significantly predicted RPB (β = 0.200, p < 0.001). HL levels were higher among older students, private school attendees, and those with stronger academic performance.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating HL and PMT frameworks into rabies education curricula may improve behavioral outcomes. Programs should be developmentally appropriate and address disparities across school types and student performance levels.

CONCLUSIONS

Strengthening HL and motivational factors through school-based education and multisectoral collaboration is critical to achieving rabies prevention goals and advancing child health equity in endemic settings.