Knowledge, Health Literacy, and Health Behaviors for Non-Communicable Disease Prevention Based on the 3E-2S Principle among Village Health Volunteers in Wang Sala Subdistrict, Tha Muang District, Kanchanaburi Province

Abstract

Non-communicable diseases (NCDs) are major public health problems associated with modifiable behavioral risk factors. Village Health Volunteers (VHVs) are central to Thailand’s community health system and should possess adequate knowledge, health literacy, and appropriate health behaviors to serve as community role models. This cross-sectional survey aimed to (1) assess knowledge, health literacy, and health behaviors for NCD prevention based on the 3E-2S principle and (2) identify predictors of those health behaviors among VHVs in Wang Sala Subdistrict, Tha Muang District, Kanchanaburi Province. The target population consisted of 241 registered VHVs. All were invited, and 234 voluntarily participated (response rate, 97.1%). Data were collected using a four-part questionnaire covering personal characteristics, 25 NCD-knowledge items, 30 health-literacy items across six domains, and 15 items assessing 3E-2S health behaviors. Content validity was reviewed by three experts; all items had an item-objective congruence index above .50. The questionnaire had a Cronbach’s alpha of .87. Data were analyzed using descriptive statistics and multiple linear regression at a significance level of .05. Most participants were women (77.78%), were aged 45-59 years (48.29%), and had worked as VHVs for more than five years (76.92%). The overall knowledge score was 80.63% of the maximum score, indicating a high level. Overall health literacy was good (M = 3.43, SD = 0.83); decision-making had the highest domain mean (M = 3.63, SD = 0.76), whereas self-management had the lowest (M = 3.27, SD = 0.98). Overall 3E-2S health behavior was fair (M = 2.91, SD = 0.84), with diet and exercise also classified as fair. In the final regression model, health literacy was the strongest predictor of health behavior (β = .373, p < .001), followed by sex (β = .152, p = .011) and age (β = .117, p = .049). The model explained 19.6% of the variance (R² = .196; adjusted R² = .186). The findings indicate that high knowledge and generally good health literacy do not necessarily translate into consistently appropriate preventive behaviors. VHV development programs should emphasize practical self-management, goal setting, and sustained behavior change, particularly for healthy eating and physical activity.