Background: Rabies is almost invariably fatal once clinical symptoms develop, yet it is preventable through canine vaccination and timely post-exposure prophylaxis (PEP). In rural Thailand, preventive behaviors likely depend on health literacy and contextual conditions that enable and reinforce protective action, but structural pathways remain unclear. Methods: We conducted a cross-sectional study among 750 adults in rabies-risk areas of Si Sa Ket Province, Thailand. A socio-ecological, One Health-informed structural equation model (SEM) examined associations among rabies-related health literacy skills (HLskill), service/system enabling conditions (ENAB), reinforcing community mechanisms (COMM), and rabies-prevention behaviors (BEHAV). Results: Model fit was acceptable (CFI = 0.948; TLI = 0.918; SRMR = 0.047; scaled RMSEA = 0.090). HLskill and COMM showed direct associations with BEHAV (β = 0.352 and 0.371, respectively), while ENAB was strongly associated with COMM (β = 0.939), indicating an indirect pathway through community reinforcement (β = 0.348; 95% CI 0.273, 0.424). Conclusions: Rabies-prevention behaviors were associated with health literacy skills and reinforcing community mechanisms; service readiness operated primarily through community reinforcement. Rabies control should combine health literacy strengthening with community communication, coordinated dog vaccination, bite management, and timely PEP uptake.
Khumkaew et al. (Fri,) studied this question.