Revisiting the Role of Health Literacy in Predicting Knowlesi Malaria Prevention Behaviour: Evidence from At-Risk Communities in Peninsular Malaysia

Arina Anis Azlan, Sivasangari Genapathy, Hazwani Damanhuri, Emma Mohamad, Mohammad Rezal Hamzah

Abstract


Health literacy has been widely recognised as a key determinant of health behaviour; however, there’s insufficient evidence for its role in shaping prevention behaviours in zoonotic disease contexts. The current study attempts to revisit the role of health literacy in predicting behavioural intention towards Knowlesi malaria prevention behaviours among at-risk communities in Peninsular Malaysia. The Integrated Behaviour Model (IBM) is used to examine how attitudes, perceived norms, personal agency, and health literacy influence the intention to perform four Knowlesi malaria prevention behaviours: wearing long-sleeved clothing during outdoor activities, using mosquito repellents, using bed nets, and using mosquito coils. Data were collected through a cross-sectional survey among 440 respondents from four malaria-endemic districts and were analysed using IBM SPSS version 27 software. The hierarchical regression analysis indicates that IBM constructs, attitudes, perceived norms, and personal agency showed strong and significant associations with behavioural intention across all prevention behaviours. But, health literacy showed limited and inconsistent predictive power, with no significant effect observed for certain behaviours and a negative association in others. These findings challenge the common assumptions regarding the role of health literacy in promoting health behaviours. The results suggest that while health literacy enhances an individual’s capacity to process information, it does not necessarily translate into behavioural intention without the support of motivational or social determinants. This study contributes to health communication scholarship and helps policy-makers by highlighting the need to integrate cognitive, social, and contextual factors when designing effective malaria intervention strategies, especially for at-risk populations.

 

Keywords: Knowlesi malaria prevention behaviours, integrated behaviour model, health literacy, at-risk communities, Peninsular Malaysia.

 

https://doi.org/10.17576/JKMJC-2026-4202-23


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