Educational Intervention Effects on Pesticide-Related Knowledge, Attitudes, Practices, Exposure, and Health Among Ugandan Smallholder Farmers: A Cluster Randomized Controlled Trial

Objectives: This cluster randomized controlled trial assessed the effect of a two-day in-person pesticide safety training with or without text messages grounded in behavioral change theory on knowledge, attitude, and practice scores, exposure intensity scores (EIS) during application, and self-reported signs and symptoms of pesticide poisoning among 539 Ugandan smallholder farmers. Methods: Twelve subcounties were randomized into three groups: educational (n = 180), educational + text messages (n = 179), or control (n = 180). Intervention effects were estimated with mixed-effects regression models using baseline (2021) and follow-up (2022) data. Results: Knowledge scores increased by 4.4% (95% CI: 0.9, 7.8) and 6.1% (95% CI: 2.7, 9.6) in the educational and in the education + text messages groups, respectively. Attitudes increased by 6.6% (95% CI: 1.8, 11.4) with text messages. Practice scores showed no significant change. Both interventions reduced pesticide exposure, and text messages reduced signs and symptoms of pesticide poisoning by 1.1% (95% CI: -1.7, -0.3). Conclusion: The limited changes in general practices suggest that generic and content-heavy training programs may hinder implementation. Tailored behavior change approaches, identifying and addressing locally relevant practices and psychosocial drivers, may enhance farmer safety.