Frontline knowledge, attitudes, and practices on climate change and its link to zoonotic diseases: a mixed-methods study of healthcare workers in Ada East, Ghana

Climate change alters patterns of infectious diseases and increases the risk of zoonotic spillover in vulnerable areas. This study examines how frontline healthcare workers (FHWs) in Ghana’s Ada East District understand and perceive the relationship between climate change and zoonotic disease transmission. We conducted a concurrent mixed-methods study in the Ada East District, Ghana. A cross-sectional survey of FHWs evaluated knowledge, attitudes, and practices (KAP) regarding climate change and its link to zoonotic diseases. KAP scores were classified using Bloom’s cut-off points; adjusted logistic regression models identified predictors of good KAP. A purposively selected focus group (n = 9) explored perceived links between climate change and zoonotic disease, lived experiences, and institutional barriers. Most participants demonstrated good knowledge (≥ 60% correct; 83.2%) and attitudes (≥ 60% positive attitudes; 86.8%), but fewer reported good climate-mitigation practices (≥ 60% of good practices; 62.4%). Clinical staff other than nurses and midwives were associated with higher odds of good knowledge (adjOR = 4.52, 95% CI 1.12–22.76), while those trained on the human monkeypox virus were associated with lower odds of good knowledge (adjOR = 0.24, 95% CI 0.08–0.64). For practices, working in a district/regional hospital was associated with lower odds (adjOR = 0.18, 95% CI 0.05–0.61), as was training delivered by the Ministry/Government authorities (adjOR = 0.44, 95% CI 0.21–0.91) and training on human monkeypox virus (adjOR = 0.39, 95% CI 0.17–0.90). Providers associated land-use change and bushmeat hunting with zoonotic spillover risk. They noted that spiritual beliefs, self-medication, and fear of income loss delayed care-seeking for suspected cases. Institutional preparedness was perceived as reactive. Participants called for climate-resilient infrastructure, integrated early-warning systems, and One Health training. FHWs in Ghana’s Ada East District are knowledgeable and motivated to address climate-sensitive zoonotic risks. Yet, structural and sociocultural barriers limit the translation of frontline commitment into system-wide resilience. Strengthening climate-health education, investing in facility-level preparedness, and integrating FHW’s insights into surveillance could enable a shift from reactive outbreak response to proactive, community-based preparedness.