Factors associated with malaria prevention behaviours among residents in endemic areas of Tak Province, Thailand: a mixed-methods study

Malaria remains a significant public health concern in Thailand, particularly in Tak Province along the Thailand–Myanmar border. Despite ongoing elimination efforts, persistent transmission in endemic communities highlights the need to better understand prevention behaviors and associated barriers. This study aimed to identify factors influencing malaria prevention behaviors among residents in endemic border areas using the Health Belief Model framework. A convergent mixed-method study was conducted in four malaria-endemic villages in Khane Chue Subdistrict, Mae Ramat District, Tak Province, Thailand. Quantitative data were collected from 352 participants through face-to-face interviews using structured questionnaires. Qualitative data were obtained from in-depth interviews with 9 villagers. Quantitative data were analyzed using descriptive statistics, chi-square tests, Fisher’s exact test, and multivariable logistic regression. Qualitative data were analyzed using inductive thematic analysis. Overall, 77.3% of participants demonstrated effective malaria prevention behaviors, while 22.7% exhibited poor practices. Factors associated with poor prevention behavior included male gender (aOR = 2.00, 95% CI 1.00–4.02), previous history of malaria infection (aOR = 2.27, 95% CI 1.22–4.24), residence in bamboo housing (aOR = 21.48, 95% CI 2.38–193.99), low malaria knowledge (aOR = 5.45, 95% CI 2.28–13.03), low perceived benefits of malaria prevention (aOR = 11.40, 95% CI 1.96–66.33), and moderate perceived barriers to malaria prevention (aOR = 4.10, 95% CI 1.40–12.04) as well as high perceived barriers (aOR = 2.64, 95% CI 1.23–5.64) were significantly associated with poor malaria prevention behaviour. Qualitative findings provided context for these associations. Occupational exposure among males and structural housing vulnerability contributed to poor preventive practices. Previous malaria infection influenced preventive behaviors in different ways: some participants became more concerned and adopted preventive measures following infection, whereas others perceived malaria as a common and treatable illness, resulting in lower perceived severity and inconsistent preventive practices. A knowledge–behavior gap was also observed, while discomfort with preventive measures and limited access to protective tools remained major barriers. Malaria prevention behaviors in endemic border communities are influenced by socio-demographic, environmental, and cognitive factors. Targeted interventions addressing behavioral barriers, risk perception, and structural vulnerabilities are essential to improve malaria prevention in high-risk border populations.