The Influence of Health Literacy on Preventive Behaviors among Village Health Volunteers in Smog-Affected Areas of Sukhothai Province, Thailand

Introduction: Smog, especially fine particulate matter (PM_2.5), poses a major public health challenge in Thailand. Village health volunteers (VHVs) play a crucial role in promoting protective behaviors within affected communities. This study examines how health literacy (HL) influences preventive behaviors among VHVs in smog-affected areas of Sukhothai Province, Thailand. Methods: A cross-sectional survey involving 599 VHVs was conducted using a structured questionnaire to assess environmental health literacy (EHL) and preventive behaviors. HL levels were categorized as low (< 60%), moderate (60–79%), and high (≥ 80%) based on total percentage scores. Descriptive statistics and multiple linear regression were applied to identify predictors of preventive behaviors (p < 0.05). Results: The mean HL score was 84.24 (SD = 10.02) out of 110, indicating a moderate HL level (76.6%). Preventive behaviors were rated high (mean = 44.40, SD = 5.73). Regression analysis revealed that HL self-management (β = 0.239, p < .001), access to information (β = 0.217, p < .001), HL knowledge (β = 0.097, p < .05), and perceived smog severity (β = 0.085, p < .05) significantly predicted preventive behaviors, explaining 22.4% of the variance (adjusted R² = 0.224). Conclusions: HL, particularly in self-management and information access, significantly contributes to preventive behaviors among VHVs. Therefore, community-based education aimed at enhancing HL is recommended to mitigate health risks from air pollution.