Factors Predicting Self-Protective Behaviors from Exposure to Particulate Matter 2.5 Microns or Less among Community-Dwelling Older Adults

Abstract

 
The modern world faces air pollution from exposure to particulate matter 2.5 microns or less (PM2.5), which significantly impacts health and mortality. Older adults are particularly at risk due to age-related physiological decline, pre-existing chronic diseases, weakened immune systems,and limited mobility,all of which reduce their ability to protect themselves from PM2.5 exposure.Such exposure is associated with respiratory diseases, cardiovascular diseases, mental health issues, and other chronic conditions.Therefore, older adults must adopt self- protective  behaviors against PM2.5 exposure to prevent severe health complications or even death.These behavioral measures include wearing protective masks, monitoring air pollution levels, avoiding outdoor activities,staying in well-sealed indoor environments, using air purifiers, regularly cleaning living spaces, refraining from smoking or engaging in activities that generate dust,staying hydrated,ensuring the availability of necessary medications and medical equipment,and being aware of abnormal health symptoms. However, there is still a lack of direct research on the self-protective behaviors of older adults regarding PM2.5 exposure, as well as the factors predicting these behaviors in community settings. Identifying such predictive factors could help design activities or programs to promote self-protective behaviors among older adults in communities, ultimately reducing the health risks associated with PM2.5 exposure. This study aimed to 1) examine self-protective behaviors from exposure to PM2.5 among community-dwelling older adults and 2) identify the factors that predict self-protective behaviors from exposure to PM2.5 among community-dwelling older adults. This cross-sectional study examined predictive factors based on the Health Belief Model proposed by Rosenstock, Strecher , and Becker. The sample consisted of older adults aged 60 years who met the following inclusion criteria: 1) residing in Nong Tao Subdistrict for at least one year, 2) having a normal cognitive function, assessed by the Clock Drawing Test score of at least 6 out of a full score of 10, 3) being able to read and write Thai, and 4) providing written informed consent to participate in the study. The sample size was determined using the G*Power program with the following parameters: an effect size of 0.15, an alpha of 0.05,a statistical power of 0.95,and six predictor variables,resulting in a required sample size of 161 participants. The sample was selected using systematic random sampling. The research instruments included 1) a general information questionnaire for older adults, 2) the Health Belief Questionnaire, and 3) the Self-Protective Behavior from Exposure to PM2.5 Questionnaire. Data collection was conducted from January to April 2024 through structured interviews. Data were analyzed using descriptive statistics, spearman rank correlation coefficient, and multiple linear regression analysis.Most of the sample were female, with an average age of 70.33 years.Most had completed primary education and were married.Nearly half relied onolder living allowances as their primary source of income, and two-thirds had sufficient income for daily living.Additionally, almost two-thirds had no chronic diseases and were not on regular medication.The majority were primarily cared for by family members. The sample demonstrated a moderate level of self-protective behaviors from exposure to PM2.5 and a moderate level of some predictors—perceived susceptibility,perceived severity, and perceived barriers to self-protection. However, they had a high level of perceived benefits of self-protection,perceived self-efficacy, and cues to action.The variables of  cues to action,perceived self-efficacy,perceived benefits of self-protection, and perceived severity of PM2.5 exposure were significantly related to self-protective behaviors from exposure toPM2.5 (r = .54,.53, .39, .18, p < .05, respectively). On the other hand, perceived susceptibility and perceived barriers to self-protection were not significantly related to self-protective
behaviors from exposure to PM2.5 (r = .13, .01, p > .05, respectively). The predictive factors collectively explained 41.00% of the variance in self-protective behaviors from exposure to PM2.5 (adjusted R² = .41,p = .009). The significant predictors were cues to action (Beta =.35,p<.001), perceived self-efficacy (Beta = .29,p<.001),perceived benefits of self-protection (Beta = .26, p = .001), and perceived susceptibility (Beta =-0.19,p = .009). Therefore, community nurses should encourage older adults to protect themselves from PM2.5 exposure through activities that enhance self-efficacy in practice.This can be achieved by integrating content on the benefits of self-protective behaviors, highlighting the risks of non-adherence to self-protection measures,and fostering motivation through support from nurses and family members.
Keywords: Community, Health belief model, Older adults Particulate matter 2.5,Self- protective behaviors