Strengthening Rabies Protection Behaviors Among Thai Children: The Role of Health Literacy and Protection Motivation.

Background: Rabies remains a life-threatening yet preventable disease, particularly among school-aged children in Thailand. Understanding how health literacy (HL) and protection motivation theory (PMT) influence rabies protective behaviors (RPB) is vital for school health interventions.

Methods: Using validated questionnaires, a cross-sectional study was conducted among 1751 Grade 4-6 students in Chonburi Province. HL, PMT constructs, and RPB were measured. Structural equation modeling was used to examine predictive relationships.

Results: HL was a strong predictor of RPB (β = 0.439, p < 0.001), especially in accessing, appraising, and applying health information. PMT constructs, particularly response efficacy and self-efficacy, also significantly predicted RPB (β = 0.200, p < 0.001). HL levels were higher among older students, private school attendees, and those with stronger academic performance.

Implications for school health policy, practice, and equity: Integrating HL and PMT frameworks into rabies education curricula may improve behavioral outcomes. Programs should be developmentally appropriate and address disparities across school types and student performance levels.

Conclusions: Strengthening HL and motivational factors through school-based education and multisectoral collaboration is critical to achieving rabies prevention goals and advancing child health equity in endemic settings.