BACKGROUND: Melioidosis, an often fatal infectious disease in Northeast 
Thailand, is caused by skin inoculation, inhalation or ingestion of the 
environmental bacterium, Burkholderia pseudomallei. The major underlying risk 
factor for melioidosis is diabetes mellitus. Recommendations for melioidosis 
prevention include using protective gear such as rubber boots and gloves when in 
direct contact with soil and environmental water, and consuming bottled or 
boiled water. Only a small proportion of people follow such recommendations.
METHODS: Nine focus group discussions were conducted to evaluate barriers to 
adopting recommended preventive behaviours. A total of 76 diabetic patients from 
northeast Thailand participated in focus group sessions. Barriers to adopting 
the recommended preventive behaviours and future intervention strategies were 
identified using two frameworks: the Theoretical Domains Framework and the 
Behaviour Change Wheel.
RESULTS: Barriers were identified in the following five domains: (i) knowledge, 
(ii) beliefs about consequences, (iii) intention and goals, (iv) environmental 
context and resources, and (v) social influence. Of 76 participants, 72 (95%) 
had never heard of melioidosis. Most participants saw no harm in not adopting 
recommended preventive behaviours, and perceived rubber boots and gloves to be 
hot and uncomfortable while working in muddy rice fields. Participants reported 
that they normally followed the behaviour of friends, family and their 
community, the majority of whom did not wear boots while working in rice fields 
and did not boil water before drinking. Eight intervention functions were 
identified as relevant for the intervention: (i) education, (ii) persuasion, 
(iii) incentivisation, (iv) coercion, (v) modeling, (vi) environmental 
restructuring, (vii) training, and (viii) enablement. Participants noted that 
input from role models in the form of physicians, diabetic clinics, friends and 
families, and from the government via mass media would be required for them to 
change their behaviours.
CONCLUSION: There are numerous barriers to the adoption of behaviours 
recommended for melioidosis prevention. We recommend that a multifaceted 
intervention at community and government level is required to achieve the 
desired behaviour changes.