The effectiveness of educational interventions aimed at agricultural workers' knowledge, behaviour, and risk perception for reducing the risk of pesticide exposure: a systematic review and meta-analysis.

Aim: The aim of this study was to determine the effectiveness of educational interventions aimed at agricultural workers' knowledge, behaviour, and risk perception for reducing the risk of pesticide exposure.

Method: All studies published in the English language between the years 2000 and 2020 were screened on relevant databases. The study protocol was registered on PROSPERO. Randomised controlled studies (RCTs) and quasi-experimental studies meeting the inclusion and exclusion criteria according to the PICOS criteria were included. In line with the PRISMA flow diagram, 38 studies were included in the systematic review and meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias assessment tool. A random-effects model was applied and Hedge's g was used to calculate effect size.

Findings: Five of the included studies are RCTs, two are cluster RCTs, 17 are quasi-experimental studies with experimental and control groups, and 14 have single-group pretest-posttest study designs. Educational interventions had a large effect on knowledge level (Hedge's g = 0.890), a medium effect on behaviour level (Hedge's g = 0.707), and a small effect on risk perception (Hedge's g = 0.377). No publication bias was detected. The largest effect of educational interventions on both knowledge and behaviour levels belonged to studies grounded on a theoretical basis and carried out between the years 2011 and 2020.

Conclusion: It was determined that educational interventions are an appropriate method for reducing the pesticide exposure risks of agricultural workers. To increase the effectiveness of these interventions, it is recommended that consideration is given to a theoretical basis, the use of multiple education components, and evidence-based practices.