Understanding farmers' protective behavior towards pesticide use in Northern India: A health belief model approach using PLS-SEM and fsQCA

Unsafe pesticide use in agriculture poses severe risks to human and environmental health. Yet, the behavioral drivers of protective measures remain poorly understood, particularly in North India, where intensive agriculture has degraded the agroecosystem. This study investigated farmers' protective behavior (PB) through the Health Belief Model (HBM) using an integrated framework that combines Partial Least Squares Structural Equation Modeling (PLS-SEM) with Fuzzy-Set Qualitative Comparative Analysis (fsQCA). Field survey data from the Hindon River Basin revealed widespread use of hazardous insecticides (WHO Class Ia, Ib, and II; >7 applications/season), poor adoption of personal protective equipment (PPE), and unsafe handling and disposal practices, leading to acute health symptoms including skin and eye irritation, headaches, and dizziness. Although most farmers recognized the health risks from pesticide exposure, awareness of environmental impacts remained limited. PLS-SEM findings indicated that cues to action (β = 0.228, p < 0.01), self-efficacy (β = 0.188, p < 0.05), and perceived benefits (β = 0.182, p < 0.05) significantly promoted PB, whereas higher perceived barriers and perceived severity had negative effects; perceived susceptibility showed no direct effect. fsQCA demonstrated its indirect role and identified combinations of high perceived susceptibility, perceived benefits, self-efficacy, and education as the most effective pathways for strengthening PB. Self-efficacy emerged as a core condition for safe behavior, while the absence of cues to action was linked to unsafe practices. These findings highlight the need for targeted, group-specific interventions such as training, awareness, and regulatory measures to inform integrated environmental health policies in similar agricultural contexts across developing countries.