The mediation effect of attitude on the association between knowledge and practices toward air pollution among commercial drivers and traders in South-Western Ghana: A cross-sectional study

There are extant studies on the knowledge, attitudes and practices of air pollution in sub-Saharan Africa and Ghana, however, studies among commercial drivers and traders in transport stations in Ghana are sparse. This study examined the mediation effect of attitude on the association between knowledge and practice toward air pollution among two high-risk workers in the Greater Accra Metropolitan Area, Ghana. A population-based cross-sectional study was conducted among commercial drivers and traders between November 2023 and June 2024. A consecutive sampling technique was used to select 1011 participants (drivers [n = 619, 61.2%] and traders [n = 392, 38.8%]). A structured questionnaire was used, including questions on knowledge (9 items), attitude (7 items) and practices (5 items) toward air pollution. Statistical analysis (descriptive, hierarchical linear regression and partial least squares structural equation modelling) was performed using Stata 17/MP. The primary sources of air pollution information for drivers and traders were social media and radio. The PLS-SEM revealed a significant direct effect of knowledge for both drivers/traders (β = 0.23/0.26, p < 0.001). Moreover, attitude partially mediated the relationship between knowledge and practices, with a direct significant effect observed for drivers/traders (β = 0.10/0.02, p < 0.001). HLR further confirmed that knowledge strongly predicted protective practices for both drivers (β = 0.23, p < 0.001) and traders (β = 0.26, p < .001. Higher educational level consistently predicted better knowledge and protective practices but old age had an inverse relationship with protective behaviour toward air pollution. Although a cross-sectional design precludes causality, attitude partially mediated the association between knowledge and practices, but the effect was more substantial among drivers than traders. The findings have implications for social and traditional media education and attitudinal change campaigns to effectively reduce air pollution exposure risk among these high-risk occupational groups.