The Predictors of Liver Fluke Infection-Preventive Behaviors, Khon Kaen Province: A Structural Equation Model

Liver fluke infection is a public health problem and the main cause of cholangiocarcinoma in northeastern Thailand, especially in Khon Kaen Province. This study aimed to determine the prevalence and predictors of liver fluke infection-preventive behaviors, using the Health Belief Model (HBM) and Structural Equation Modeling (SEM) among adults living in Khon Kaen Province.

This analytical cross-sectional study utilized secondary data. A stratified cluster multi-stage sampling technique, proportional to size, was used to select a provincially representative sample of the Khon Kaen adult population. The participants responded via interview. HBM scale, demographic and environmental factors, knowledge, health behaviors, and information on preventive behaviors (avoidance of consuming various types of uncooked freshwater fish and five personal hygiene practices) were measured. The hypothesized causal path models were examined using SEM analysis.

Among the 980 adult participants, the prevalence of non-consumption of raw freshwater fish and the practice of good hygiene during the past month was 2.9% (95% CI: 2.0, 4.1). The final structural model demonstrated a good fit. The predictors explained 25.7% of the variance in preventive behaviors. The model indicated that the total effect of perceived susceptibility had the strongest correlation with liver fluke infection-preventive behaviors (β = 0.34, p < 0.001), followed by perceived severity (β = 0.31, p < 0.001), having a family member who did not consume raw fish (β = 0.27, p < 0.001), education (β = 0.14, p < 0.001), self-efficacy (β = 0.13, p < 0.001), perceived benefit (β = 0.13, p < 0.001), knowledge (β = 0.10, p < 0.001), non-smoking (β = 0.09, p < 0.05), age (β = -0.08, p < 0.05), cue to action (β = 0.06, p < 0.05), and perceived barriers (β = -0.05, p < 0.05).

Our study showed that significant predictors of preventive behaviors included the HBM constructs, age, education, knowledge, non-smoking, and living with family members who do not consume raw fish. Public health campaigns should focus on strengthening HBM constructs and knowledge with particular attention to older adults, smokers, less-educated individuals, and households in which family members consume raw fish.