Behavior change through educational interventions and text messaging to improve personal protective equipment use during pesticide handling among smallholder farmers in Uganda: A cluster randomized controlled trial.

The use of personal protective equipment (PPE) reduces occupational pesticide exposure. However, PPE use remains low among farmers. Effective behavior change requires tailoring education programs to relevant psychosocial determinants. This study evaluated the effects and mechanism of a two-day educational intervention on pesticide safety, delivered with or without follow-up text messages grounded in the risks, attitudes, norms, abilities, and self-regulation (RANAS) behavior change approach on PPE and glove use. A cluster-randomized controlled trial was conducted between October 2020 and October 2021 in Uganda. Twelve subcounties (clusters) with 45 smallholder farmers each were randomized to: (i) an educational intervention (n = 180), (ii) an educational intervention + RANAS text messages (n = 179), (iii) or a control group (n = 180). Intervention effects on self-reported overall PPE and glove use at the 12-month follow-up were assessed with mixed regression models while mediation analyses were performed to test the mechanisms of the interventions. Both the educational and education + RANAS text messages interventions increased overall PPE use (beta 13 %; 95 % confidence interval 5-20; 17 %; 6-28, respectively) and glove use (17 %; 5-29; 30 %; 18-41, respectively). Others' behavior explained the mechanism of the educational intervention on PPE use. RANAS text messages improved the effectiveness of the educational intervention. The locally developed educational intervention improved PPE and glove use among Ugandan smallholder farmers. Additional gains from RANAS text messages highlight the value of targeting and addressing psychosocial determinants in designing and implementing educational interventions. These findings support scalable, cost-effective behavior change strategies to reduce pesticide exposure.