Abstract
BACKGROUND AND OBJECTIVES: Given the widespread use of pesticides in agriculture and associated health risks, this study examined the psychosocial determinants of safety behaviors among Iranian farmers using the Health Action Model (HAM), a critical step for informing effective public health interventions. METHODS: This cross-sectional study applied the Health Action Model (HAM) to assess pesticide safety behaviors among 384 farmers in Northeast Iran, selected via multistage random sampling. Validated questionnaires measured knowledge, attitudes, and environmental factors affecting safety practices. Data were analyzed using descriptive and inferential statistics (SPSS v26). RESULTS: The sample was predominantly male (72.4%) with a mean age of 46.2 ± 15.3 years and limited formal education (59.6% with a diploma). Key findings revealed that: (1) Knowledge systems were strong predictors of safety intention (β = 0.39) and practice (β = 0.28), while environmental factors had a similar impact (β ≈ 0.32); (2) A strong relationship was found between behavioral intention and actual action (β = 0.47, p < 0.001); however, the moderate strength of this pathway indicates a significant intention-action gap; (3) The effectiveness of training followed a dose-response relationship, with multiple sessions having a significantly greater impact than a single session and (4) Gender and education differences were evident, and females showed significantly lower risky intention (β = -0.18) and action (β = -0.17) scores compared to males. CONCLUSIONS: The findings underscore that environmental factors and knowledge are the most robust predictors of safety behavior, suggesting that interventions must address both cognitive and structural barriers. This framework offers valuable guidance for implementing effective multi-component interventions, combining targeted education with infrastructural support, particularly in developing nations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-25643-3.