Effectiveness of insecticide application models program (IAMP) intervention to increase safety behavior and reduce health risks in Shogun Orange Farmers, Khao-Phanom District, Krabi Province, Thailand

Abstract

Objectives: 1) To develop and implement a multi-component intervention program, drawing upon on social cognitive theory, to improve insecticide-related knowledge, attitude, and practice scores (continuous outcomes), and to reduce unsafe serum cholinesterase (SChE) prevalence and insecticide-related symptom prevalences (dichotomous outcomes), in Shogun orange farmers in Khao-phanom District Krabi Province: 2) to test intervention effects on these outcomes in a quasi-experimental study (42 farmers in the intervention group, 50 in the control group), in which outcomes were measured at baseline, and at 2 and 5 months post-intervention; 3) to further assess the possible benefit of one intervention component, inclusion of a small "role model group" of respected peers, on practice scores; and 4) to assess relationships among knowledge, attitude, and practice in insecticides use scores. Methods: Data were collected with a standardized, pre-tested questionnaire, based largely on the Agricultural Health Study in the US and previous studies in Thailand. Baseline characteristics were compared between the intervention and control groups. Overall intervention effects on continuous outcomes were evaluated with repeated-measures analysis of variance. Intervention effects were also evaluated at each follow-up time, using difference-in-difference analysis, with linear mixed models for continuous outcomes and generalized linear models with generalized estimating equations (GEE) for dichotomous outcomes. All time-specific analyses gave modeled absolute magnitudes of intervention effects, as opposed to relative risks or odds ratios. Results: In the baseline comparison between study groups, 3 characteristics, personal illness history, use of mosquito coils, and spraying pesticides at home, exhibited p-values < 0.1. Intervention effects were reported both unadjusted and adjusted for these 3 characteristics. The intervention was associated with statistically significant increases in knowledge, attitude, and practice scores, and with clear reductions in unsafe SChE prevalence, at each follow-up time, and in both unadjusted and adjusted analytical models. The intervention was also associated with reduction in prevalence of digestive symptoms, but not of neuromuscular, respiratory, eye, or skin symptoms. Inclusion of the small "role model group" appeared to increase the beneficial effect of the intervention on practice. Knowledge, attitude, and practice scores were positively and significantly associated with each other. However, in a multivariable mixed model (K-A-P), attitude score, but not knowledge score, was positively and significantly associated with practice score. Conclusion and discussion: The performance of the role models behaviors was associated with considerable improvement in most of the studied outcome and helpful in enhancing the intervention effect on safety practice. The Insecticides Application Models Program should consider for safety insecticide applicators and orange farmers. In main assumption is this education tools modified for influencing behavior and emphasizes the safety messages about preventing insecticides exposure, seeing a clear pictures of insecticides contamination, and increase the priority of doing during insecticides application to minimize further contamination with quick demonstrations in field applications that given them a proper step for decontaminated while observed the difference between using PPE and did not. And observed media role models determines what behaviors a farmer was able to observe and it imitated most frequently when observers perceive the role models as similar to themselves that influencing safety behavior changed, it’s value of insecticides exposure reduction.