Effects of Interventions to Reduce Pesticide Exposure Among Farmers: Application of an Intervention Mapping Approach to Development

Considering the intricate complexity of pesticide management, we applied the intervention mapping approach to develop, implement, and evaluate two interventions aimed at improving protective behaviors and the use of personal protective equipment (PPE), thereby reducing pesticide exposure among farmers. We used the steps of the Intervention Mapping (IM) process. First, a needs assessment was conducted, including a case study and a cross-sectional survey. Subsequently, the program outcomes and change objectives were specified. This was followed by program design and program production focusing on creating a culturally appropriate program. Finally, we conducted a three-armed randomized trial: 201 farmers were equally assigned to 1) education-only (n = 67); 2) education plus PPE provision (n = 67); or 3) control (n = 67) groups. Repeated-measures ANOVA revealed group × time interaction for acetylcholinesterase (AChE) activity was significant (p = .001). There was significantly increased AChE activity in the two intervention groups compared with controls (education-only p = .037; combined p = .001), with no between-intervention difference (p = 1.00). For protective behavior, both interventions did better than the controls (p = .001 for both), and self-reported use of PPE revealed the combined intervention did better than education-only (p = .030). Our results showed both interventions improved outcomes. Given its lower cost and high feasibility, educational intervention seems particularly suitable to more widespread use in farmer health programs.