The effect of education interventions based on health belief model on safe pesticide use and biomarkers in greenhouse agriculture workers in antalya: Randomized controlled study

Objective: This study aimed to determine the effects of educational interventions based on the Health Belief Model (HBM) on safe pesticide use behaviors and biomarkers among greenhouse agricultural workers in Antalya Province. Method: The research employed a randomized, single-blind, interventional design. The study was conducted in the Kumluca district of Antalya Province between November 2023 and February 2024. The study sample consisted of 65 greenhouse agricultural workers, 33 in the intervention group and 32 in the control group. The intervention group received 11 weeks of educational interventions based on the Safe Pesticide Use Behaviors (HeBSaPU). Data were obtained using the Safe Pesticide Use Behaviors Questionnaire (SPUB), the Health Beliefs Scale for Safe Pesticide Use Behaviors (HeBSaPUB), and urine samples. Dialkyl phosphates (DAPs), biomarkers of organophosphate pesticides, were used in the study. Dimethyl phosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP), diethyl phosphate (DEP), and diethyldithiophosphate (DEDTP) metabolites were analyzed by liquid chromatography/tandem mass spectrometry. Findings: At the end of the HeBSaPU, a statistically significant difference was found between the SPUB pretest-posttest score differences of the intervention and control groups (p<0.001), demonstrating a high level of effect (Cohen d: 2.884). Similarly, the pretest-posttest score differences of the HeBSaPUB subscales of the intervention group were statistically significant compared to the control group (p<0.001). Effect sizes for changes in the HeBSaPUB subscales ranged from 2.139 to 2.994. In urine analyses, DMP and DMTP concentrations in the intervention group decreased statistically significantly (p<0.001) compared to the control group, demonstrating a moderate (Cohen d: 0.639) and low (Cohen d: 0.307) effect. Conclusion: The HeBSaPU program implemented by a public health nurse had positive effects on safe pesticide use behaviors, health beliefs, and some DAP metabolites. Keywords: Health Belief Model, Pesticide Exposure, Agricultural Workers, DAP Metabolites, Public Health Nursing