Customization plan to enhance rational drug use literacy among the general population and health influencers: a structural equation modeling

Background: Irrational drug use remains a persistent public health challenge in Thailand, leading to adverse health outcomes, antimicrobial resistance, and economic losses. Rational Drug Use Literacy (RDUL) is a critical determinant in addressing this issue, especially among the general population and community-based health influencers. Despite national efforts to promote Rational Drug Use (RDU), RDUL levels remain critically low in provinces like Pathum Thani.Objective: This study aimed to assess RDUL levels, identify influencing factors, analyze group differences, and develop a customized plan to enhance RDUL among the general population and five groups of health influencers in Pathum Thani Province.Methods: A cross-sectional quantitative design was employed, recruiting 968 participants from six target groups: the general population, Village Health Volunteers (VHVs), community leaders, health volunteer monks, Young FDA teachers, and health personnel. Quota sampling was used for the general population, while simple random sampling was applied to health influencers. The validated RDUL tool developed by HSRI was used. Descriptive statistics (frequency, percentage, mean, standard deviation) examined the levels and distribution of Rational Drug Use Literacy (RDUL) across groups. One-way ANOVA compared RDUL differences among groups, and Structural Equation Modeling (SEM) analyzed the influence of personal, situational, and socio-environmental factors on RDUL.Results: The study revealed that the Rational Drug Use Literacy (RDUL) levels among the general population and health volunteer monks were insufficient, whereas health influencers, including health personnel, young FDA teachers, and community leaders, demonstrated adequate levels of RDUL. Structural Equation Modeling (SEM) confirmed that personal, situational, and socio-environmental factors significantly influenced RDUL, with socio-environmental factors exerting the strongest overall effect. The general population was found to be more sensitive to situational factors, such as access to community resources and social support, than health influencer groups. In contrast, health influencers were more responsive to socio-environmental contexts, including social services, communication, and consultation with other health influencers, in enhancing their RDUL. Despite these distinct patterns, the current national RDUL initiatives did not adequately reflect these group-specific needs.Conclusion: The findings underscore the necessity of a differentiated, evidence-based customization plan tailored to each group’s specific influencing factors. The proposed customization plan addresses key literacy dimensions (Access, Understand, Interaction, Decision, Self-management, and Share) and aligns with the Thai Ministry of Public Health’s strategy for building RDU communities. This study provides a practical framework for localized, equity-driven RDUL interventions that can be integrated into national RDU policy for sustainable health outcomes.