Health Literacy, Service Readiness, and Community Reinforcement of Rabies-Prevention Behaviors in Rural Thailand

Background: Rabies is almost invariably fatal once clinical symptoms develop, yet it is preventable through canine vaccination and timely post-exposure prophylaxis (PEP). In rural Thailand, preventive behaviors likely depend on health literacy and contextual conditions that enable and reinforce protective action, but structural pathways remain unclear. Methods: We conducted a cross-sectional study among 750 adults in rabies-risk areas of Si Sa Ket Province, Thailand. A socio-ecological, One Health-informed structural equation model (SEM) examined associations among rabies-related health literacy skills (HLskill), service/system enabling conditions (ENAB), reinforcing community mechanisms (COMM), and rabies-prevention behaviors (BEHAV). Results: Model fit was acceptable (CFI = 0.948; TLI = 0.918; SRMR = 0.047; scaled RMSEA = 0.090). HLskill and COMM showed direct associations with BEHAV (β = 0.352 and 0.371, respectively), while ENAB was strongly associated with COMM (β = 0.939), indicating an indirect pathway through community reinforcement (β = 0.348; 95% CI [0.273, 0.424]). Conclusions: Rabies-prevention behaviors were associated with health literacy skills and reinforcing community mechanisms; service readiness operated primarily through community reinforcement. Rabies control should combine health literacy strengthening with community communication, coordinated dog vaccination, bite management, and timely PEP uptake.