Environmental health literacy of local villagers in Northern Thailand with high seasonal PM 2.5 air pollution; a mixed method study

Seasonal PM2.5 air pollution remains a major public health challenge in northern Thailand. Environmental health literacy (EHL) may influence how communities understand pollution-related health risks and adopt protective behaviors; however, little is known about EHL among rural populations living in highly affected areas. We conducted a mixed-methods study from December 2023 to August 2024 among villagers residing in a rural district of Chiang Mai Province, Thailand, where seasonal air pollution occurs annually. Eligible participants lived in the area for at least two years. Data were collected using a paper-based questionnaire and focus group discussions to assess knowledge, perceptions, and responses to air pollution. Forty villagers participated; 25 (63%) were female, with a median age of 39 years (interquartile range [IQR] 34–56). Most participants completed primary or secondary education (83%), and 80% were maize farmers. Hypertension, allergy, and asthma were reported by 15%, 12.5%, and 7.5% of participants, respectively. Villagers demonstrated good awareness of seasonal air pollution, recognized both short- and long-term health consequences, and reported modifying daily activities to reduce exposure. Participants described complying with government recommendations and measures aimed at reducing burning practices. However, they perceived that air quality had not improved despite these efforts. While recognizing agricultural burning and forest fires as major contributors to PM2.5 pollution, participants emphasized that eliminating burning was difficult because of livelihood and economic constraints. They expressed willingness to participate in community-based solutions but highlighted the need for sustainable support systems, including alternative agricultural practices, reliable water supplies, occupational training, and market access. Villagers living in a high-exposure area of northern Thailand demonstrated meaningful EHL and willingness to adopt protective behaviors. However, individual and community actions alone may be insufficient to address a complex environmental problem driven by structural and socioeconomic factors. Sustainable, multi-sectoral approaches that combine public engagement, livelihood support, and effective policy implementation are needed to reduce air pollution and protect community health.