Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of the Saudi Society of Agricultural Sciences

journal homepage: www.sciencedirect.com

Predicting farmers’ intention to use PPE for prevent pesticide adverse

effects: An examination of the Health Belief Model (HBM)
Gholamhossein Abdollahzadeh a,⇑, Mohammad Sharif Sharifzadeh b
a
Department of Agricultural Extension and Education, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran
b
Department of Agricultural Extension and Education, Gorgan University of Agricultural Sciences and Natural Resources, Gorgan, Iran

a r t i c l e i n f o a b s t r a c t

Article history: Long-term use of pesticides has been associated with wide range of chronic diseases, and personal pro-
Received 4 June 2020 tective equipment (PPE) can reduce health consequences of pesticide exposure. This study used the
Revised 15 October 2020 Health Belief Model (HBM) as a framework in predicting farmers’ intention to use a series of PPE (face
Accepted 2 November 2020
mask, goggles, gloves, protective clothing and rubber boots) for prevent pesticide adverse effects.
Available online xxxx
Questionnaire including 33 measures of variables which was guided by the HBM were distributed in
May 2019 among a random sample of 387 rice farmers from Sari county in Mazandaran province of
Keywords:
Iran. The relation between HBM measures and the farmers’ confirmation of the intention to use a series
Farmers’ perception
Health motivation
of PPE for prevents pesticide-related health problems was investigated. The majority of the farmers
Pesticide risk (56.33%) agreed that they would use a series of PPE in their future pesticide handling. The results show
Preventive behaviors that the factors positively affecting farmers’ intention to use a series of PPE were three HBM components:
Safety actions higher levels of perceived severity of pesticide adverse effects, cues to action and perceived PPE benefits.
Further perceived PPE barriers has significant, negative effects on farmers’ intention. The overall pattern
of results revealed that the HBM components of perceived benefits, particularly PPE effectiveness in
reducing exposure to pesticide adverse effects and perceived barriers particularly PPE uncomfortableness
and unpleasantness for field work were found to be important predictors of farmers’ intention. These
results imply that extension and training programs which focus on severity of pesticide adverse effect
and the perceived benefits and perceived barriers of PPE will have a better effect on increasing the rate
of preventive behavior among farmers.
Ó 2020 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction Moreover the use of pesticides is frequently accompanied by unde-

Pesticide is important part of the agricultural production sys-
tems all over the world. Using pesticide in farming practice provide
a lot of advantages for farmers including preventing and control-
ling crop losses due to harmful pests such as insects, plant diseases
and weeds, increased harvest yields and protect crops from reduc-
tion of product quality (Damalas and Eleftherohorinos, 2011;
Litchfield, 2005; Abdollahzadeh et al., 2017a; Damalas, 2009).
⇑ Corresponding author.
E-mail addresses: Abdollahzd@gau.ac.ir (G. Abdollahzadeh), sharifzadeh@gau.ac.
ir (M.S. Sharifzadeh).
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
sirable effects such as poisoning and chronic health effects for
farmers and farm workers during the load, mix and spray of pesti-
cide products as well as clean pesticide clothing or spray equip-
ment, posing a threat to the quality of agricultural products and
food and serious contamination for soil and water (Agne et al.,
1995; Damalas, 2009; Abhilash and Singh, 2009; Litchfield, 2005).
The most common health effects associated with pesticide
exposure in agriculture have been well documents in several stud-
ies and include headaches, skin and eye problems, salivation, nau-
sea, diarrhea, respiratory depression, burning sensation, weakness,
cough, seizures, and loss of consciousness (Kachaiyaphum et al.,
2010; Strong et al., 2004; Esechie and Ibitayo, 2011; Walton
et al., 2016; Maumbe and Swinton, 2003; Kori et al., 2018; Akter
et al., 2018). Similarly, various chronic effects such as hormone dis-
ruption, damages to the brain, birth defects and cancer were
reported among different groups of farmers (Mills et al., 2009;
Abhilash and Singh, 2009; Alavanja et al., 2004; Kamel and
Hoppin, 2004).

https://doi.org/10.1016/j.jssas.2020.11.001
1658-077X/Ó 2020 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: G. Abdollahzadeh and M.S. Sharifzadeh, Predicting farmers’ intention to use PPE for prevent pesticide adverse effects: An exam-
ination of the Health Belief Model (HBM), Journal of the Saudi Society of Agricultural Sciences, https://doi.org/10.1016/j.jssas.2020.11.001
G. Abdollahzadeh and M.S. Sharifzadeh
Therefore, appropriate exposure reduction measures are
required to reduce the negative side-effects associated with occu-
pational pesticide exposure. Luckily, the health effects of pesticides
can be minimized among farmers and other pesticide operators by
using personal protective equipment (PPE) when working with
pesticide (Damalas and Abdollahzadeh, 2016; Walton et al.,
2016). A large body of research on the safe use of pesticide has
shown that use of PPE, including face mask, goggles, gloves, hat,
protective clothing, boots and respirator when working with pesti-
cide is effective risk-mitigation strategy to prevent pesticide expo-
sure’ health problems (Gomes et al., 1999; Tsakirakis et al., 2010;
Hines et al., 2007; Damalas and Abdollahzadeh, 2016; Damalas
and Hashemi, 2010).
Despite the hazards inherent in pesticide handling process, PPE
is rarely used by farmers or farm workers while working with pes-
ticide in farm field (Sharifzadeh et al., 2019; Ibitayo, 2006; Clarke
et al., 1997; Arcury et al., 1999; Walton et al., 2016; Esechie and
Ibitayo, 2011; Damalas et al., 2019). In one study in Gaza strip
revealed that despite the awareness of protective equipment
advantages, only low percentage of the farmers reported perma-
nent use of gloves, goggles, or special boots when working with
pesticide (Yassin et al., 2002). Many studies have investigated bar-
riers and benefits of wearing PPE among different groups of farm-
ers, farm workers and pesticide operators. Common reasons cited
for non-use of PPE during pesticide handling were lack of adequate
knowledge about the importance of PPE in pervert pesticide risk
(Phung et al., 2013; Norkaew et al., 2010), discomfort, the unavail-
ability of PPE when needed, the extra time required for using it,
and the non-necessity of PPE for every situation (Weng and
Black, 2015; Damalas and Hashemi, 2010). While PPE potential to
diminish direct exposure to pesticide and consequently reduce
its related injuries were most cited as benefits of PPE use
(Tsakirakis et al., 2010). The results of some studies revealed that
the majority of farmers are unaware of the type of PPE that should
be used when working with pesticide (Damalas and
Abdollahzadeh, 2016). Sharifzadeh et al. (2019) found that per-
ceived barriers of using safety measures such as time, cost, acces-
sibility, uncomfortableness related to PPE use were the strongest
determinant of farmers’ safety behavior in pesticide application.
Bakhsh et al. (2017) reported that health cost and perception of
adverse health effects are main predictors of adopting PPE among
the cotton pickers in Pakistan.
Despite the importance of wearing PPE when work with pesti-
cide, relatively less attention has been attracted on explaining
determinants of farmers’ intention to use a series of PPE in farm
field. Moreover, academic research explaining hazardous behavior
related to pesticide use which guided by theoretical basis has been
somewhat limited, as the majority of existing literature have
extensively discussed the role of demographical and farm manage-
ment’s characteristics.
Many psychological theories and models have been suggested
to explore human behavioral change toward a variety of health
care practice. Those theories that have focused on human behavior
change include the Health Belief Model (HBM), Theory of Reasoned
Action (TRA), Theory of Planned Behavior (TPB), the Transtheoret-
ical Model (TM), Social Cognitive Theory and, the Precaution Adop-
tion Process Model (PAM). Although these theories have been
designed and developed to examine behavior change at the indi-
vidual level, some scholars claimed that among these theories
the HBM is the most suitable and commonly used technique to
study the health-related behaviors (Glanz et al., 2008). The main
reason is that health motivation is at the central focus point of it,
and HBM addresses problem behaviors that have raised health
concerns (Rimer and Glanz, 2005). Several prior researches have
been successfully applied HBM to address the reasons people
engage in a wide range of health maintenance behaviors and
2
Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx
provided a well-developed conceptual basis for different educa-
tional interventions (e.g., Bunn et al., 2002; Cyr et al., 2010;
Thornton and Calam, 2011; Salari and Filus, 2017). Given that the
HBM is well established and widely used for health interventions
this study used this model to predict farmers’ intention to use
PPE for prevent pesticide health problems.
The HBM suggests that the tendency to participate in health
maintenance behaviors is based on a two-stage assessment
approach: (1) the threat perception of the situation, and (2) the
evaluation of benefit and cost of the health maintenance behaviors
(Rosenstock, 1974; Maiman and Becker, 1974; Janz and Becker,
1984). Based on this model, the threat perception of the situation
contains three subcomponents including (a) the perceived suscep-
tibility to a particular disease or illness, (b) the perceived serious-
ness of contacting a particular disease or illness, and (c) cues to
action that stimulate appropriate health maintenance behavior.
(e.g., sickness of a neighbor farmer and information about the pes-
ticide exposure’ health problems transferred by the local extension
agent). The evaluation of benefit and cost of the behavior pertains
to perception of the positive outcomes of various actions available
to reduce the threat assessment and perception of the possible
undesirable aspects of the health maintenance behavior (Janz
and Becker, 1984).
A number of studies have used the HBM variables to explain
farmer’s intention and safety behavior when working with pesti-
cide (Bhandari et al., 2018; Khan et al., 2013; Yazdanpanah et al.,
2016). Support for the HBM constructs in predicting farmers’ pre-
ventive behaviors of exposure to pesticide adverse effects was
not consistent across studies. One contributing factor to this prob-
lem is lack of consistent operationalization and measurement of
the HBM constructs in the domain of preventive behaviors of pes-
ticide risk. This study operationalized constructs arising from the
HBM as predictors to use a series PPE (face mask, goggles, gloves,
hat, protective clothing and boots) during pesticide handling in a
sample of rice farmers in Sari County, Mazandaran Province, Iran.
The region is well known by intensive rice production with mass
use of chemical products for the control of rice stem borer
(Abdollahzadeh et al., 2015). Moreover, a sizeable fraction of farm-
ers in these areas do no wear PPE during pesticide handling due to
barriers such as limited accessibility and low affordability.
Government-sponsored campaigns to promote safe use of pesti-
cide and particularly PPE use have had little effect on changing
farmers’ behavior. Therefore, understanding determinants of farm-
ers’ intention to use PPE would enable educational interventions or
agricultural extension programs to target more effective strategies
for promoting, and implementing pesticide risk-preventive prac-
tices within farmer groups.
The rest of the paper is organized as follows. After this introduc-
tion, basic information related to study area, research design, sam-
pling technique, measures and method of data analysis are
reported in the second section. The results are presented in the
next section, followed by discussion and conclusion sections.
2. Method
2.1. Study area
This study was conducted in the Sari County, Mazandaran Pro-
vince (the largest rice-producing area of Iran with 53% of the total
cultivated area) located in south coast of Caspian Sea, Iran (Fig. 1.).
Sari County is spread over an area of 3685 km2 and contains some
of the most fertile agricultural lands in Iran. The basic economic
sector of Sari County is agriculture with main agricultural produc-
tion of rice, wheat, barley, fruits, and cotton. The surveyed area was
selected for the study because the majority of farmers in the area
G. Abdollahzadeh and M.S. Sharifzadeh Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx

Fig. 1. Map of the study area.

heavily depend on the use of insecticides, such as diazinon, an
organophosphate insecticide that is applied up to five to six times
in a cropping season (Noorhosseini-Niyaki, 2010) to control pests
especially the Asiatic stem borer. Moreover, this area has been rec-
ognized as being at risk of occupational injuries and health prob-
lems associated with pesticide exposure such as exhaustion,
sweating, cough and headache, dizziness, skin inflammation and
irritation, nausea and vomiting (Abdollahzadeh et al., 2017b).
2.2. Design
in Fig. 2. Based on this model, the following hypotheses are
proposed:
H1. perceived susceptibility of pesticide adverse effects has a
positive effect on farmers’ intention.
H2. perceived severity of pesticide adverse effects has a positive
effect on farmers’ intention.
H3. cues to action has a positive effect on farmers’ intention.
H4. health motivation has a positive effect on farmers’
intention.

In this research we apply HBM to explore why farmers will take

action to prevent, or to control pesticide-related health effects. Perceived
susceptibility H1
According to this model the factors which influence farmers’ inten-
tion to use a series of PPE during pesticide handling i.e., perceived
susceptibility (likelihood of experiencing health injuries and poi-
soning by pesticides), perceived severity (feelings about the seri- Perceived H2
severity
ousness of experiencing a health effect associated with pesticide
exposure), perceived benefits (perceived effectiveness of PPE use
in reducing health effects associated with pesticide exposure) Cues to H3 Farmers' intention
and perceived barriers (The negative effects and the barriers asso- action to use a series of
ciated with PPE use in farm field i.e., time, cost, accessibility, side PPE during
effects during use). The HBM also proposes that (e) a cue or a trig- pesticide handling
H4
ger to appropriate action is necessary- such as having a contact Health
with extension agents in farm field, or media attention to the motivation
health threats of pesticide, may alert farmers to adverse effects H4
of pesticide and thus increase their willingness to use PPE when
PPE barriers
work with pesticide. In addition to these variables, measure of
health motivation which suggested by several previous studies H4
can include in predicting health behavior (Becker et al., 1977;
PPE benefits
Becker & Maiman, 1975). We considered individual measures of
these six HBM components as independent variables. The hypoth-
esized model of relations between the HBM variables is presented Fig. 2. Hypothesized model of relations between the variables.

3
G. Abdollahzadeh and M.S. Sharifzadeh
H5. perceived PPE benefits has a positive effect on farmers’
intention.
H6. perceived PPE barriers has a negative effect on farmers’
intention.
2.3. Sampling and data collection at the farm level
Our field survey was conducted over a five months’ period from
May to September 2019. Sample villages and farmers were selected
through a multi-stage sampling technique. In the first stage, among
the total ten sub-districts in Sari County, we selected five sub-
districts purposely after visiting the area and with the consultation
of local agriculture authorities. In the second stage, 20 villages
(four villages from each sub-districts) were randomly selected
within each sub-districts, and finally, the farmers were selected
randomly according to the list of rice farmers published by the Sari
County Agricultural Management Office in 2019. In the end, a sam-
ple of 387 participants was obtained and interviewed personally.
The respondents in the final sample were all male small-scale
farmers with a mean age of 44.25 years. Most farmers had low edu-
cation level; 17.57% were illiterate, while 29.72%, 40.83% and
11.89% had elementary school, high school and college degree
respectively. Regarding intention items 46.3% reported intending
to use a series of PPE during pesticide handling and 51% reported
do not intend to use.
2.4. Measures
We measured the dependent variable according to responses to
the question, ‘‘If a series of PPE were available to you now, would
you be likely to use it in the next pesticide handling?” Use a series
of PPE meant using at least three types of protection during pesti-
cides handling (face mask, goggles, gloves, hat, protective clothing
and boots), for any farmer who used pesticides at all. Multiple
items were also developed for measuring each construct of HBM
(Table 1). These include: perceived susceptibility of pesticide
adverse effects (six items, Cronbach’s alpha 0.73, adopted from
Arcury et al., 2002; Abdollahzadeh et al., 2015; Levesque, 2011);
perceived severity of pesticide adverse effects (four items, Cron-
bach’s alpha 0.70, adopted from Mayer et al., 2010;
Abdollahzadeh et al., 2017b); cues to action (six items, Cronbach’s
alpha 0.78, adopted from MacFarlane et al., 2008; Abdollahzadeh
et al., 2017a); health motivation (six items, Cronbach’s alpha
0.82, adopted from Petro-Nustas, 2001), perceived PPE benefits
(four items, Cronbach’s alpha 0.77, adopted from Tsakirakis et al.,
2010; Damalas and Abdollahzadeh, 2016) and perceived PPE barri-
ers (seven items, Cronbach’s alpha 0.70, adopted from Phung et al.,
2013; Weng and Black, 2015; Yuantari et al., 2015). We examined
the relationship between these 33 HBM component items as pre-
dictors and the farmers’ confirmation of the intention to use a ser-
ies of PPE for prevents pesticide-related health problems
(dependent variable).
Respondents were asked to rate each item based on a five-point
Likert scale ranging from 5 = strongly agree, 4 = agree, 3 = uncertain,
2 = disagree to 1 = strongly disagree. A panel of three experts in the
area of health behavior, agricultural extension and education and
crop protection were invited to validate the questionnaire. The pre-
pared questionnaire was pre-tested on 15 farmers those were not
be included in the final study to identify the clarity and simplicity
of questions for respondents and time required to complete. Based
on the results of the pilot test a few modifications were made to
the wording and order of the questionnaire to achieve a more log-
ical layout.
4
Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx
2.5. Method of data analysis
Data were analyzed using SPSS software, version 16.0 for win-
dows. Descriptive statistics (mean, standard deviation (SD), fre-
quency, and percentage) were used to describe and interpret
data. Given that the dependent variable was binary (intention to
use or not to use), multivariate logistic regression was utilized
for assessing the predictors of farmers’ intention to use a series
of PPE when working with pesticide. The regression model is
adjusted for socio-economic variables such age, education, farm
size, and annual income from rice production activities. Moreover,
we transformed the initial 5-point Likert scale of 33 individual
items associated with each HBM component into a binary scale
(yes/no response) so all of these items were coded as dichotomous
variable (Cyr et al., 2010). Specifically, on the Likert-scale questions
(where the answers were 5 = yes, I strongly agree; 4 = yes, I agree;
3 = uncertain; 2 = no, I disagree; 1 = no, I strongly disagree), 5 and 4
were coded as yes (1) and all other answers were coded as no (0).
Predictor variables were included to the model using the enter
method i.e., all the predictor variables (33 HBM items) are entered
at once. The Pseudo R square measures (Cox and Snell R square,
and Negelkerke R square) were used to assess the predictive power
in all models. We also used independent t-tests to compare com-
posite score of HBM components between farmer who intend use
a series of PPE and who did not intend to use it.
3. Results
Two different series of logistic regression models were per-
formed to examine potential predictors of farmers’ intention. First,
a regression model was performed to explore the influence of 33
component items of HBM as independents variables on farmers’
intention to use a series of PPE during pesticide handling (Table 1).
In this analysis we followed the strategy recommended by Janz
et al. (2002) and we included the individual items associated with
each component of HBM in the regression model. The above
researchers made this recommendation because they believed this
kind of analysis would provide detailed information for health
improvement planning. According to this strategy, we entered all
individual items of HBM components in the first regression model
rather than developing an overall score for each component. The
results of the regression analysis indicated that the model reason-
ably fitted to the observed values and the independent variables
captured between 61.6% and 82.6% of the variance in farmers’
intention. The model is highly persuasive, with an overall predic-
tive accuracy of 92.0%.
None of the component items of perceived susceptibility or
health motivation contributed significantly to farmers’ intention
to use PPE. The two items of severity component that were posi-
tively affecting farmers’ intention included: ‘exposure to pesticides
can have chronic health effects in addition to respiratory problems
and dermatologic conditions’ (OR = 2.081, P value = 0.022) and
‘farmers who are consistently exposed to pesticides are at higher
risk of developing cancer (OR = 3.481, P value = 0.010).
The two items within the cues to action component that had a
statistically significant positive relationship with the dependent
variable farmers’ intention included: ‘local extension agents and
agricultural technicians recommended using PPE for avoiding
health problems from pesticide exposure’ (OR = 3.216, P
value = 0.013) and ‘family members advised using PPE during pes-
ticide handling’ (OR = 3.819, P value = 0.007).
The three items within the benefits component that were posi-
tively affecting farmers’ intention included: ‘using a series of PPE
during working with pesticides is effective in reducing occupa-
tional injuries and health problems’ (OR = 4.018, P value = 0.004),
G. Abdollahzadeh and M.S. Sharifzadeh Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx

Table 1
Multivariate logistic regression of individual HBM components associated with farmers’ intention to use a series of PPE during pesticide handling.

Characteristics Parameter Standard p- Odds

estimate error value ratio
Perceived susceptibility
I am at risk of pesticide-induced illness. 0.869 0.456 0.057 2.385
My family members are at risk of pesticide exposure 0.458 0.457 0.317 1.581
I believe health of farmworkers hurt by pesticides 0.204 0.451 0.652 1.226
I believe health of farmworkers’ family members hurt by pesticides 0.059 0.505 0.908 0.943
I believe health of unborn children hurt by pesticides 0.246 0.524 0.639 1.279
I believe ability to have children hurt by pesticides 0.372 0.502 0.458 1.451
Perceived severity
Pesticide exposure can result in a wide range of acute health effects including nausea, dizziness, vomiting, 0.733 0.481 0.127 2.081
headaches, stomach pain, and eye problems.
Exposure to pesticides can have chronic health effects in addition to respiratory problems and dermatologic 1.032 0.450 0.022* 2.806
conditions.
Farmers who are consistently exposed to pesticides are at higher risk of developing cancer. 1.247 0.484 0.010** 3.481
Illnesses related to pesticide exposure can cause fatality. 0.907 0.481 0.059 2.478
Cues to action:
Local extension agents and agricultural technicians recommended using PPE for avoiding health problems from 1.168 0.472 0.013* 3.216
pesticide exposure.
**
Family members advised using PPE during pesticide handling. 1.340 0.501 0.007 3.819
I have read about using PPE in the extension materials published by local agricultural services office. 0.631 0.484 0.193 1.879
I have attended a training course about safe use of pesticide. 0.227 0.570 0.690 1.255
I have heard about PPE from neighbor farmers. 0.553 0.497 0.266 1.738
I have read about safety measures during pesticide handling from the product label. 0.134 0.556 0.809 0.874
Health motivation
I am likely to change my behavior because of health risk of pesticide use. 0.761 0.520 0.143 2.141
I want to discover pesticide-induced illness early. 0.265 0.485 0.585 1.303
I search for new information to protect my health from pesticide toxicity effects. 0.418 0.514 0.416 1.519
I feel it is important to carry out activities which will improve my health. 0.716 0.560 0.201 2.045
I have regular health check-ups even when I am not sick. 0.210 0.660 0.750 1.234
Maintaining good health is extremely important to me. 0.495 0.527 0.347 1.641
PPE benefits
Using a series of PPE during working with pesticides is effective in reducing occupational injuries and health 1.391 0.481 0.004** 4.018
problems.
Using a series of PPE during working with pesticides is effective in avoiding pesticide contact with eyes, mouth, and 1.859 0.509 0.000** 6.419
skin.
Using a series of PPE during working with pesticides can prevent pathways of pesticide exposure for the operator. 1.502 0.471 0.001** 4.489
Using a series of PPE during working with pesticides is a good way to avoid potential hazards of different pesticide 0.457 0.464 0.324 1.580
formulations.
PPE barriers
I find PPE awkward to use when working with pesticides. 1.058 0.455 0.020* 0.347
PPE would reduce the physical flexibility during pesticide application. 2.952 0.496 0.000** 0.052
Working with a series of PPE in the hot and humid paddy field is very tortious. 2.538 0.628 0.000** 0.079
Washing, storing, and reusing PPE is an unpleasant task. 1.987 0.477 0.000** 0.137
PPE items are not available locally. 1.030 0.450 0.022* 0.357
Preparing PPE for use is a time-consuming process. 1.501 0.459 0.001** 0.223
Paying for PPE is an extra cost. 0.696 0.460 0.130 0.498
Intercept 1.863 1.224 0.128 0.155

Cox & Snell r2 = 0.616; Nagelkerke r2 = 0.826; overall percentage of right prediction = 92.0%.
*
Significant at P < .05.
**
Significant at P < .01.

‘using a series of PPE during working with pesticides is effective in
avoiding pesticide contact with eyes, mouth, and skin’ (OR = 6.419,
P value = 0.000), and ‘using a series of PPE during working with
pesticides can prevent pathways of pesticide exposure for the
operator’ (OR = 4.489, P value = 0.001).
Finally, six out of seven barrier items that significantly
decreased the likelihood of using a series of PPE during working
with pesticides included: ‘I find PPE awkward to use when working
with pesticides’ (OR = 0.347, P value = 0.020), ‘PPE would reduce
the physical flexibility during pesticide application’ (OR = 0.052,
P value = 0.000), ‘working with a series of PPE in the hot and humid
paddy field is very tortious’ (OR = 0.079, P value = 0.000), ‘washing,
storing, and reusing PPE is an unpleasant task’ (OR = 0.137, P
value = 0.000), ‘PPE items are not available locally’ (OR = 0.357, P
value = 0.022), and ‘preparing PPE for use is a time-consuming pro-
cess’ (OR = 0.223, P value = 0.001).
In second regression analyses six composite HBM components
(susceptibility, seriousness, cues to action, health motivation, PPE
benefits and PPE barriers) were entered into model as independent
5
variables to be tested as predictor factors for intention to use a ser-
ies of PPE (Table 2). In this model between 50.5% and 67.7% of the
variance of farmers’ intention is accounted for by the composite
HBM component. The model is highly persuasive, with an overall
predictive accuracy of 85.0%.
The results in Table 2 show that the significant factors posi-
tively affecting the farmers’ intention to use a series of PPE during
pesticide handling include higher levels of perceived severity of
pesticide health effects (OR = 3.343, P value = 0.000), higher levels
of perceived cues to action (OR = 2.876, P value = 0.000), higher
levels of PPE benefit (OR = 4.491, P value = 0.000) and lower levels
of PPE barriers (OR = 0.036, P value = 0.000). These results indicate
that farmers’ intention is highly correlated with all the HBM vari-
ables except perceived susceptibility and health motivation (all the
hypothesis are supported except from the hypotheses H1 and H4).
We also conducted the independent sample t-test to determine
if there is a significant difference between HBM components of the
two groups. Table 3 displays a summary of the scaled means and
standard deviations of each of the HBM components in the survey
G. Abdollahzadeh and M.S. Sharifzadeh Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx

Table 2
Multivariate logistic regression of composite HBM components associated with farmers’ intention to use a series of PPE during pesticide handling.

Characteristics Parameter estimate Standard error p-value Odds ratio

Perceived susceptibility 0.575 0.310 0.063 1.777
Perceived severity 1.207 0.280 0.000** 3.343
Cues to action 1.056 0.303 0.000** 2.876
Health motivation 0.361 0.373 0.333 1.435
PPE benefits 1.703 0.281 0.000** 5.491
PPE barriers 3.317 0.371 0.000** 0.036
Intercept 3.679 2.190 0.093 0.025

Cox & Snell r2 = 0.505; Nagelkerke r2 = 0.677; overall percentage of right prediction = 85.0%.
**
Significant at P < .01

Table 3
Comparison of HBM components among intender and non-intender of PPE use.

Variables Intend to use Do not intend to use t test (P value)

Mean SD Mean SD
HBM components
Perceived susceptibility 2.827 0.534 2.736 0.545 1.66 (0.099)
Perceived severity 3.512 0.601 3.170 0.663 5.31 (0.00)**
Cues to action: 2.751 0.614 2.466 0.526 4.91 (0.00)**
Health motivation 2.906 0.452 2.888 0.427 0.39 (0.69)
PPE benefits 3.854 0.611 3.318 0.618 8.51 (0.00)**
PPE barriers 3.216 0.585 4.048 0.453 15.29 (0.00)**

SD: standard deviation.

*Significant at P < .05.
**
Significant at P < .01.

for two groups of farmers (intend to use a series of PPE and do not
intend to use). As expected, the results in this table confirm per-
ceived severity of pesticide health effects, perceived cues to action
and PPE benefit among respondents who intend to use a series of
PPE were significantly higher than those who do not intend to
use a series of PPE (p < 0.01). However, perceived PPE barriers
among those who intend to use a series of PPE were significantly
lower than those who did not intend to use a series of PPE
(p < 0.01).
4. Discussion
This study tested several predictors of intention to use a series
of PPE (face mask, goggles, gloves, protective clothing and rubber
boots) during pesticide handling using an adapted form of the
HBM in 378 rice farmers. The results revealed that the majority
of the farmers (56.33%) agreed that they would use a series of
PPE in their future pesticide handling while a noticeable propor-
tion of the farmers (43.67%) reported intention to not use of a ser-
ies of PPE during pesticide handling. These proportions were
unexpected given that the literature indicates famers show low
intention to engage in safety behavior (Sharifzadeh et al., 2019;
Bakhsh et al., 2017), low willingness to use PPE when working pes-
ticide (Sharifzadeh et al., 2017) and perceived low importance of
personal safety in pesticide spraying (Damalas et al., 2019). The
unwillingness of farmers to not pursue preventive behavior may
be due in part to the highly inconvenient of PPE or high cost of
PPE for small scale farmers in the study area as confirmed by pre-
vious research (Sharifzadeh et al., 2019).
The findings of this study revealed that, most HBM constructs
were related to intention to use a series of PPE: perceived severity
of pesticide adverse effects, cues to action, high PPE benefit and
low PPE barriers (most hypotheses were strongly supported,
except from the hypotheses H1 and H4). These findings revealed
that the HBM are somewhat successful in explaining predictors
of PPE use intention. Moreover, perceived susceptibility to
pesticide adverse effects and health motivation showed to not be
6
a significant predictor of the intention to use a series of PPE during
pesticide handling. Overall the model explained about 61.6% of the
variance in intention to use a series of PPE. With regard to the HBM
model but not specific to PPE use, the findings of this research are
consistent with prior researches (Bunn et al., 2002; Cyr et al., 2010;
Thornton and Calam, 2011; Salari and Filus, 2017) indicating that
perceived benefits were the most important predictor of intention,
followed by perceived barriers, while perceived susceptibility and
severity had no or only a slight connection to intention.
The results of current study are congruent with some prior
studies for the components of barriers and benefits. Majority of
measures of perceived PPE benefits and barriers were included in
the regression model. The results from this study revealed that
PPE effectiveness in reducing occupational injuries and health
problems, PPE efficiency in avoid pesticide contact with eyes,
mouth, and skin and PPE capability in prevent pathways of pesti-
cide exposure for the operator were significant factors in regres-
sion model. The optimal effectiveness of PPE in reducing the risk
of pesticides and maintaining the health of pesticide operators
has been an important factor in increasing its use (Tsakirakis
et al., 2010). The PPE barriers were a significant predictor of inten-
tion include PPE awkward to use, reduction of physical flexibility,
the torment of work with PPE in the hot and humid paddy field,
washing, storing and reusing PPE is unpleasant task, problems with
time constraints and accessibility in local shops. Other studies
reported that due to limited availability of comfortable PPE, farm-
ers do not give priority to their personal safety (Phung et al., 2013;
Weng and Black, 2015). In other studies, researchers have found
that wearing PPE was highly inconvenient for farmers, as it
reduced their physical flexibility and interfered with their ability
to work with pesticides (Sharifzadeh et al., 2019). The findings of
this study provide additional support that barriers are strong pre-
dictors for PPE use. However, there is a need to more research to
accurately identify how we can much encourage farmers to use
PPE despite the inconvenience of working with this equipment in
the farm field.
G. Abdollahzadeh and M.S. Sharifzadeh
According to information of this study, the HBM component of
perceived benefits and barriers are a significant and important pre-
dictor of farmers’ intention to use PPE. Therefore, in order to
increase PPE use among rice farmer in the study area, developing
and implementing support subsidies for PPE and facilitating its
access in local agricultural service centers is essential. These
results also suggest that extension and educational programs or
training campaigns which provide sufficient information to
increase farmers’ perceived severity of pesticide health effects,
and also provide them with enough information on PPE benefits,
its effectiveness in reducing the risks of pesticides, its low potential
side effects and its availability, could increase the rate of farmers
considering PPE use during pesticide handling.
There was some support for the notion that extension materials,
training course or product label could influence the farmers’ inten-
tion to take safety measures when working with pesticide
(MacFarlane et al., 2008; Phung et al., 2013; Damalas and
Abdollahzadeh, 2016; Sharifzadeh et al., 2019). However, when
the individual items of each HBM component in regression model
were entered, recommendation from extension agents/ agricul-
tural technicians and family members were significant cue to
action. Howbeit, these results cannot be generalized to other areas
and other groups of farmers and further study is needed to explain
the association between intention to use PPE and the recommen-
dation from extension agents and family members as important
cues to action.
Numerous studies (Maumbe and Swinton, 2003; Kori et al.,
2018; Akter et al., 2018) revealed that pesticide-related health
symptoms (e.g., nausea, dizziness, vomiting, headaches, stomach
pain and eye problems) and even the probability of death due to
pesticide exposure could influence the farmers’ intention to con-
sider precautions measures when working with pesticide. How-
ever, when all individual items of HBM components were
entered into a single regression model, the chronic health effects
including respiratory problems and dermatologic conditions and
risk of developing cancer were significant predictors of farmers’
intention. Prior to this study, much of the studies revealed experi-
ence health problems related to pesticide handling has relationship
with farmers’ intention to take safe use of pesticide (Sharifzadeh
et al., 2019; Schenker et al., 2002) and highlighted the impact of
health education to raise farmers’ safety behaviour. However,
based on the results of this study, it appears that details of training
content to draw rice farmers’ willingness to safety measures when
working with pesticides should focus more on respiratory prob-
lems and dermatologic conditions and risk of developing cancer.
The strength of this study was the use of a sample that was at
high risk of pesticides health effects and also boosts methodologi-
cal issues. Although a fairly substantial literature on the use of PPE
among farmers, and also its determinants has been recognized, we
have applied various measures in operationalizing HBM compo-
nents such as perceived susceptibility of pesticide adverse effects,
perceived severity of pesticide consequence, cue to action, per-
ceived PPE benefit and perceived PPE barriers. The applicability
of these measures in farmers’ safety behavior studies may warrant
further investigation. However, some limitations of the study war-
rant caution in interpreting the results. The convenience sample of
rice farmers, small scale, who were poor educated and of lower
income, limits generalization of the study findings to other farmer
groups. Moreover, the regression analysis didn’t include personal
demographic variables of the farmers and characteristics of farm
production system that may be important factors in willingness
to use PPE in farming practice (Sharifzadeh et al., 2019). Therefore,
it would be interesting to establish similar studies focusing on
these variables. Finally, we studied predictors of farmers’ intention
to use PPE, not actual use. While there is a discrepancy between
expressing willingness to use an innovation and actual use.
7
Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx
Although intention to engage a behavior predicts actual behavior
(Ajzen, 1991), when farmers reveal they intend to use a series of
PPE during pesticide handling, it does not necessarily imply they
will actually do so. Hence, subsequent researches should investi-
gate whether the similar patterns of association are observed for
farmers’ actual behavior when working with pesticide. Hence, sub-
sequent researches should investigate whether similar patterns are
beheld for the actual behavior of farmers when working with
pesticides.
5. Conclusion
The study has made a few theoretical contributions. The most
significant is the development of appropriate measures based on
HBM to predict farmers’ intention to use PPE for prevent pesticide
adverse effects. Furthermore, utilizing constructs of the HBM to
instruct future researches is merited in that the individual mea-
sures arose from the model contributed to detect specific items
that were important determinants PPE use intention during pesti-
cide handling. Specifically, this study revealed that perceived ben-
efits and barriers of PPE appear to play a main role in shaping the
intention to use a series of PPE among farmers during pesticide
handling particularly PPE effectiveness in reducing exposure to
pesticide adverse effects and PPE uncomfortableness and unpleas-
antness for field work. These findings have practical implications
for efforts to encourage farmers to use PPE, particularly for provid-
ing technical supports regarding safe measures during and after
use of pesticide and also incorporating actions related to safe use
of pesticide in the context of extension programs that deal with
favorite performance of PPE for preventing pesticide health prob-
lems. However, some of the main constructs of HBM especially
perceive susceptibility to pesticide adverse effects failed to predict
farmers’ intentions. Moreover, constructs outside the HBM (in this
case health motivation) were also found not to predict farmers’
intentions. Hence, while the individual items detailed in this study
comprised suitable determinants, the findings reveal that HBM is
somewhat successful to direct the psychological prerequisites of
pesticide risk-preventive intentions. Unexplained variance sug-
gests that other important variables could be recognized and addi-
tional study is required to more definitively explain the predictors
of farmers’ intention to use a series of PPE when working with pes-
ticide and better guide extension agents and agricultural officials
in their intervention efforts.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
References
Abdollahzadeh, G., Damalas, C.A., Sharifzadeh, M.S., 2017a. Understanding adoption,
non-adoption, and discontinuance of biological control in rice fields of northern
Iran. Crop Prot. 93, 60–68.
Abdollahzadeh, G., Sharif Sharifzadeh, M., Qadami Amraei, Z., 2017b. Assessing
awareness of rice farmers of Sari County about impacts of usage of pesticides
and its health risk in cropping year 2015. Iran. J. Health Environ. 9 (4), 545–558
(in Persian).
Abdollahzadeh, G., Sharifzadeh, M.S., Damalas, C.A., 2015. Perceptions of the
beneficial and harmful effects of pesticides among Iranian rice farmers
influence the adoption of biological control. Crop Prot. 75, 124–131.
Abhilash, P.C., Singh, N., 2009. Pesticide use and application: an Indian scenario. J.
Hazard. Mater. 165 (1–3), 1–12.
Agne, S., Waibel, H., Jungbluth, F., Fleischer, G., 1995. Guidelines for pesticide policy
studies. A Framework for Analyzing Economic and Political Factors of Pesticide
Use in Developing Countries. Institute of Horticultural Economics, Hannover.
Ajzen, I., 1991. The theory of planned behavior. Organ. Behav. Hum. Decis. Process.
50 (2), 179–211.
G. Abdollahzadeh and M.S. Sharifzadeh
Akter, M., Fan, L., Rahman, M.M., Geissen, V., Ritsema, C.J., 2018. Vegetable farmers’
behaviour and knowledge related to pesticide use and related health problems:
A case study from Bangladesh. J. Cleaner Prod. 200, 122–133.
Alavanja, M.C., Hoppin, J.A., Kamel, F., 2004. Health effects of chronic pesticide
exposure: cancer and neurotoxicity. Annu. Rev. Public Health 25, 155–197.
Arcury, T.A., Quandt, S.A., Russell, G.B., 2002. Pesticide safety among farmworkers:
perceived risk and perceived control as factors reflecting environmental justice.
Environ. Health Perspect. 110 (suppl 2), 233–240.
Arcury, T.A., Quandt, S.A., Austin, C.K., Preisser, J., Cabrera, L.F., 1999.
Implementation of EPA’s Worker Protection Standard training for agricultural
laborers: an evaluation using North Carolina data. Public Health Rep. 114 (5),
459.
Bakhsh, K., Ahmad, N., Tabasum, S., Hassan, S., Hassan, I., 2017. Health hazards and
adoption of personal protective equipment during cotton harvesting in
Pakistan. Sci. Total Environ. 598, 1058–1064.
Becker, M.H., Haefner, D.P., Kasl, S.V., Kirscht, J.P., Maiman, L.A., Rosenstock, I.M.,
1977. Selected psychosocial models and correlates of individual health-related
behaviors. Med. Care 15 (5), 27–46.
Becker, M.H., Maiman, L.A., 1975. Sociobehavioral determinants of compliance with
health and medical care recommendations. Med. Care 13 (1), 10–24.
Bhandari, G., Atreya, K., Yang, X., Fan, L., Geissen, V., 2018. Factors affecting pesticide
safety behaviour: The perceptions of Nepalese farmers and retailers. Sci. Total
Environ. 631, 1560–1571.
Bunn, J.Y., Bosompra, K., Ashikaga, T., Flynn, B.S., Worden, J.K., 2002. Factors
influencing intention to obtain a genetic test for colon cancer risk: a population-
based study. Prev. Med. 34 (6), 567–577.
Clarke, E.E.K., Levy, L.S., Spurgeon, A., Calvert, I.A., 1997. The problems associated
with pesticide use by irrigation workers in Ghana. Occup. Med. 47 (5), 301–308.
Cyr, A., Dunnagan, T.A., Haynes, G., 2010. Efficacy of the health belief model for
predicting intention to pursue genetic testing for colorectal cancer. J. Genet.
Counsel. 19 (2), 174–186.
Damalas, C.A., 2009. Understanding benefits and risks of pesticide use. Sci. Res.
Essays 4 (10), 945–949.
Damalas, C.A., Koutroubas, S.D., Abdollahzadeh, G., 2019. Drivers of personal safety
in agriculture: a case study with pesticide operators. Agriculture 9 (2), 34.
Damalas, C.A., Abdollahzadeh, G., 2016. Farmers’ use of personal protective
equipment during handling of plant protection products: determinants of
implementation. Sci. Total Environ. 571, 730–736.
Damalas, C.A., Eleftherohorinos, I.G., 2011. Pesticide exposure, safety issues, and risk
assessment indicators. Int. J. Environ. Res. Public Health 8, 1402–1419.
Damalas, C.A., Hashemi, S.M., 2010. Pesticide risk perception and use of personal
protective equipment among young and old cotton growers in northern Greece.
Agrociencia 44, 363–371.
Esechie, J.O., Ibitayo, O.O., 2011. Pesticide use and related health problems among
greenhouse workers in Batinah Coastal Region of Oman. J. Forensic Leg. Med. 18
(5), 198–203.
Glanz, K., Rimer, B.K., Viswanath, K. (Eds.), 2008. Health behavior and health
education: theory, research, and practice. Jossey-Bass, John Wiley and Sons, San
Francisco, CA.
Gomes, J., Lloyd, O.L., Revitt, D.M., 1999. The influence of personal protection,
environmental hygiene, and exposure to pesticides on the health of immigrant
farm workers in a desert country. Int. Arch. Occup. Environ. Health 72 (1), 40–
45.
Hines, C.J., Deddens, J.A., Coble, J., Alavanja, M.C.R., 2007. Fungicide application
practices and personal protective equipment use among orchard farmers in the
agricultural health study. J. Agric. Saf. Health 13 (2), 205–223.
Ibitayo, O.O., 2006. Egyptian farmers’ attitudes and behaviors regarding agricultural
pesticides: implications for pesticide risk communication. Risk Anal. 26 (4),
989–995.
Janz, N.K., Becker, M.H., 1984. The health belief model: A decade later. Health Educ.
Q. 11 (1), 1–47.
Janz, N., Champion, V., Strecher, V., 2002. The health belief model. In: Glanz, K.,
Rimer, B., Lewis, F. (Eds.), Health behavior and health education: Theory,
research and practice. Jossey-Bass, San Francisco.
Kachaiyaphum, P., Howteerakul, N., Sujirarat, D., Siri, S., Suwannapong, N., 2010.
Serum cholinesterase levels of Thai chilli-farm workers exposed to chemical
pesticides: prevalence estimates and associated factors. J. Occup. Health 52 (1),
89–98.
Kamel, F., Hoppin, J.A., 2004. Association of pesticide exposure with neurologic
dysfunction and disease. Environ. Health Perspect. 112 (9), 950–958.
Journal of the Saudi Society of Agricultural Sciences xxx (xxxx) xxx
Khan, M., Husnain, I., Mahmood, H., Akram, W., 2013. Understanding pesticide use
safety decisions: Application of health behavior theory. Am. Eurasian J. Agric.
Environ. Sci. 13 (4), 440–448.
Kori, R.K., Thakur, R.S., Kumar, R., Yadav, R.S., 2018. Assessment of adverse health
effects among chronic pesticide-exposed farm workers in Sagar District of
Madhya Pradesh, India. Int. J. Nutrit. Pharmacol. Neurol. Dis. 8 (4), 153–161.
Levesque, D.L., 2011. Behavioral, Environmental, and Psychosocial Risk Factors
Associated With Pesticide Exposure Among Farmworkers in North Carolina
(Doctoral dissertation). Walden University.
Litchfield, M.H., 2005. Estimates of acute pesticide poisoning in agricultural workers
in less developed countries. Toxicol. Rev. 24 (4), 271–278.
MacFarlane, E., Chapman, A., Benke, G., Meaklim, J., Sim, M., McNeil, J., 2008.
Training and other predictors of personal protective equipment use in
Australian grain farmers using pesticides. Occup. Environ. Med. 65, 141–146.
Maiman, L.A., Becker, M.H., 1974. The health belief model: Origins and correlates in
psychological theory. Health Educ. Monogr. 2 (4), 336–353.
Maumbe, B.M., Swinton, S.M., 2003. Hidden health costs of pesticide use in
Zimbabwe’s smallholder cotton growers. Soc. Sci. Med. 57 (9), 1559–1571.
Mayer, B., Flocks, J., Monaghan, P., 2010. The role of employers and supervisors in
promoting pesticide safety behavior among Florida farmworkers. Am. J. Ind.
Med. 53 (8), 814–824.
Mills, P.K., Dodge, J., Yang, R., 2009. Cancer in migrant and seasonal hired farm
workers. J. Agromed. 14 (2), 185–191.
Noorhosseini-Niyaki, S.A., 2010. Decline of pesticides application by using biological
control: The case study in North of Iran. Middle-East J. Sci. Res. 6, 166–169.
Norkaew, S., Siriwong, W., Siripattanakul, S., Robson, M.G., 2010. Knowledge,
attitude, and practice (KAP) of using personal protective equipment (PPE) for
chilli-growing farmers in Huarua Sub-District, Mueang District, Ubonrachathani
Province, Thailand. J. Health Res. 24 (2), 83–86.
Petro-Nustas, W., 2001. Young Jordanian women’s health beliefs about
mammography. J. Community Health Nurs. 18 (3), 177–194.
Phung, D.T., Connell, D., Miller, G., Rutherford, S., Chu, C., 2013. Needs assessment
for reducing pesticide risk: a case study with farmers in Vietnam. J. Agromed. 18
(4), 293–303.
Rimer, B.K., Glanz, K., 2005. Theory at a glance: A guide for health promotion
practice. US Department of Health and Human Services, Washington, DC.
Rosenstock, I.M., 1974. Historical origins of the health belief model. Health Educ.
Monogr. 2 (4), 328–335.
Salari, R., Filus, A., 2017. Using the health belief model to explain mothers’ and
fathers’ intention to participate in universal parenting programs. Prev. Sci. 18
(1), 83–94.
Schenker, M.B., Orenstein, M.R., Samuels, S.J., 2002. Use of protective equipment
among California farmers. Am. J. Ind. Med. 42 (5), 455–464.
Sharifzadeh, M.S., Abdollahzadeh, G., Damalas, C.A., Rezaei, R., Ahmadyousefi, M.,
2019. Determinants of pesticide safety behavior among Iranian rice farmers. Sci.
Total Environ. 651, 2953–2960.
Strong, L.L., Thompson, B., Coronado, G.D., Griffith, W.C., Vigoren, E.M., Islas, I., 2004.
Health symptoms and exposure to organophosphate pesticides in farmworkers.
Am. J. Ind. Med. 46 (6), 599–606.
Thornton, S., Calam, R., 2011. Predicting intention to attend and actual attendance
at a universal parent-training programme: A comparison of social cognition
models. Clin. Child Psychol. Psychiatry 16 (3), 365–383.
Tsakirakis, A.N., Kasiotis, K.M., Anastasiadou, P., Machera, K., 2010. Determination of
operator exposure levels to pesticides during greenhouse applications with new
type multi-nozzle equipment and the use of two different protective coverall
types. Hellenic Plant Prot. J. 3, 9–16.
Walton, A.L., LePrevost, C., Wong, B., Linnan, L., Sanchez-Birkhead, A., Mooney, K.,
2016. Observed and self-reported pesticide protective behaviors of Latino
migrant and seasonal farmworkers. Environ. Res. 147, 275–283.
Weng, C.Y., Black, C., 2015. Taiwanese farm workers’ pesticide knowledge, attitudes,
behaviors and clothing practices. Int. J. Environ. Health Res. 25 (6), 685–696.
Yassin, M.M., Mourad, T.A., Safi, J.M., 2002. Knowledge, attitude, practice, and
toxicity symptoms associated with pesticide use among farm workers in the
Gaza Strip. Occup. Environ. Med. 59 (6), 387–393.
Yazdanpanah, M., Tavakoli, K., Marzban, A., 2016. Investigating factors influence
framers’ intention regarding safe use of pesticides through health belief model.
Iran. Agric. Extens. Educ. J. 11 (2), 21–29.
Yuantari, M.G., Van Gestel, C.A., Van Straalen, N.M., Widianarko, B., Sunoko, H.R.,
Shobib, M.N., 2015. Knowledge, attitude, and practice of Indonesian farmers
regarding the use of personal protective equipment against pesticide exposure.
Environ. Monit. Assess. 187 (3), 142.