Environmental health literacy and preventive behaviors related to PM2.5 Exposure among village health volunteers in Thai rural communities: a cross-sectional study

This study assessed environmental health literacy and its association with PM2.5-related preventive behaviors among 414 village health volunteers (VHVs) in Samut Songkhram Province, Thailand. A cross-sectional study was conducted from June to December 2025. Participants were selected using multistage sampling, and data were collected using a structured questionnaire. Descriptive statistics and multiple linear regression analysis were performed. Overall environmental health literacy was moderate (M = 3.57, SD = 0.59), whereas preventive behaviors were high (M = 3.77, SD = 0.66). In the adjusted model, environmental health literacy was positively associated with preventive behavior scores and had the largest standardized regression coefficient (B = 0.518, 95% CI: 0.449–0.587, β = 0.619, p < 0.001). Age was also positively associated with preventive behavior scores (B = 0.190, 95% CI: 0.073–0.308, β = 0.159, p = 0.002). The model explained 36.8% of the variance in preventive behavior scores (R² = 0.368, adjusted R² = 0.354), whereas the other sociodemographic factors were not significantly associated with the outcome. Overall environmental health literacy may be considered a candidate target for evaluation in future training and risk communication interventions. However, the cross-sectional design precludes causal inference. Longitudinal and intervention-based studies are needed to determine whether improvements in environmental health literacy lead to changes in preventive behaviors.