Educational frameworks for zoonotic malaria prevention: a narrative review integrating behavioural theory, participatory design, and instructional models for Plasmodium knowlesi in Southeast Asia

Abstract

Background: While global malaria burden has declined over the past two decades, zoonotic malaria-particularly Plasmodium knowlesi in Southeast Asia-remains a persistent threat to elimination. Conventional control tools, such as indoor residual spraying and insecticide-treated nets, are less effective where outdoor-biting vectors and forest-fringe livelihoods dominate. Education and behaviour change are therefore critical adjuncts to biomedical and vector-control strategies.

Objective: This narrative review synthesises evidence on educational interventions for malaria prevention, examines behavioural and instructional frameworks underpinning these efforts, translates lessons for zoonotic malaria, with a focus on P. knowlesi in Southeast Asian region, and, discusses policy, implementation and future research directions necessary to support sustainable elimination strategies.

Methods: A narrative review approach was used to synthesise empirical studies on malaria education and behavioural interventions published within the past decade. Literature searches were conducted in PubMed, Scopus, Web of Science and Google Scholar, supplemented by key policy documents from the World Health Organization and the Ministry of Health Malaysia. Included sources comprised educational interventions, theory-informed programmes, participatory qualitative studies and review articles conducted in malaria-endemic settings. Studies were implemented in school, community and occupational contexts and targeted populations including rural households, indigenous communities, migrant workers, students and forest-exposed adults. Findings were synthesised thematically to inform an integrated educational framework applicable to P. knowlesi-endemic settings.

Results: Educational interventions consistently improved malaria knowledge and, in many cases, preventive practices across school, community, and household platforms, with stronger effects when grounded in behavioural theory. However, most programmes lacked explicit instructional design and rarely addressed the ecological, occupational, and cultural dimensions central to zoonotic malaria. Evidence from P. knowlesi-endemic settings in Malaysia highlights forest-edge work, land-use change, social inequities, and persistent misconceptions as key drivers of residual risk. A hybrid framework integrating behavioural models (e.g. HBM), community-based participatory research, and structured instructional design (ADDIE, CTML) offers a promising architecture for learner-centred, context-specific modules.

Conclusion: Education should be treated as a core public health technology for zoonotic malaria-designed intentionally from theory through participatory co-production and pedagogical structure, and embedded within One Health and climate-change frameworks. We propose "zoonotic literacy" -linking ecological awareness, behavioural adaptation, and community empowerment-that may support sustainable prevention of P. knowlesi malaria in Southeast Asia and similar settings.

Keywords: Plasmodium knowlesi; Behavioural theory; Health education; Instructional design; One health; Southeast Asia; Zoonotic literacy; Zoonotic malaria.