Zoonotic diseases have increasingly commanded global attention over the past four decades, with studies indicating that approximately 60% of emerging infectious diseases originate from animals and around 70% are linked to wildlife reservoirs (1). Among these pathogens, avian influenza is particularly concerning in the 21st century due to its ability to cause severe respiratory infections and its potential to mutate via antigenic drift or shift—processes that not only precipitate outbreaks in domestic poultry but also raise the risk of interspecies transmission (2, 3). These events have profound implications for both human health and economic stability worldwide (4).

Migratory birds are recognized as natural reservoirs of avian influenza viruses and play a crucial role in their dissemination (5). Since these birds generally do not exhibit any symptoms during migration, they can both carry and spread the virus, thereby complicating detection efforts. When the virus contaminates water sources in their habitats, it becomes highly likely to infect nearby domestic poultry, establishing a transmission chain at the regional level (6). Moreover, the high variability of avian influenza viruses raises the potential for cross-species transmission to humans, which can ultimately lead to influenza outbreaks (7). Although the transmission of avian influenza viruses from birds to humans is rare, documented cases indicate that certain subtypes like H5N1, H5N8, H7N9, and H9N2 can infect humans and even facilitate human-to-human spread (8, 9). For example, migratory birds spreading the H5 influenza virus, causing three waves of influenza outbreaks across various regions (1, 3). Since 2003, several H5N1 outbreaks in South Korea have been linked to migratory birds (10). Additionally, between 2018 and 2020, 19 strains of the H7N7 avian influenza virus were identified in migratory birds in eastern China (11). The avian influenza viruses carried by migratory birds pose a significant threat to the poultry industry along their migration routes.

China lies along three major migratory flyways, posing unique challenges for avian disease prevention and control, especially in regions where poultry rearing is ubiquitous (12). To address this, we focus on Guidong County, Hunan Province. (The geographical coordinates are 113°37′ east longitude—114°14′, 25°44′ —26°13′ north latitude) —located along a central migratory flyway known as the “Millennium Bird Passage”—exacerbates the challenges of preventing and controlling avian diseases. Here, nearly every household engages in poultry rearing, and the close proximity of wild birds to domestic flocks increases the risk of virus recombination and potential transmission to humans (13–15). Although no major outbreaks have been reported in Guidong County to date, sporadic human infections (e.g., cases involving H3N8 in nearby cities) and genetic evidence suggesting mixed infections from wild and domestic birds underscore the latent risk (16, 17). Despite these risks, no studies have systematically investigated prevention behaviors in such ecologically vulnerable populations—a gap this study aims to fill.

The Knowledge-Attitude-Practice (KAP) model provides a robust framework for understanding health behavior determinants, proposing that individuals first acquire knowledge, which shapes their attitudes and beliefs, and ultimately drives practice (18). Numerous studies have investigated KAP regarding avian influenza prevention among general populations and poultry-related occupational groups in countries such as China, Nigeria, and India (18–22). For example, during five outbreaks in China between 2013 and 2017, 91 of 695 infected cases involved occupational poultry contact (20), yet many live-bird market workers still underestimate their risk and rarely adopt recommended preventive measures (23). Despite sustained efforts by Chinese authorities—including health education campaigns, market closures, and mandatory culling of infected flocks, the persistence of noncompliance among some farmers has limited these measures’ effectiveness (24, 25). Systematically employing the KAP (Knowledge, Attitude, and Practice) framework in avian influenza research, we explicitly test three hypotheses: (1) Knowledge-Action Disconnect: High-risk poultry farmers exhibit poorer KAP compliance compared to general occupational groups, despite comparable avian influenza knowledge levels. (2) Geographic Determinants: Proximity to migratory corridors directly correlates with risk perception and protective behavior adoption. (3) Attitude Mediation: Attitudes mediate the knowledge-to-practice relationship, explaining persistent prevention gaps.

To test these hypotheses, we implemented a cross-sectional study in Guidong County (July 2021) employing structural equation modeling to decode latent relationships between avian influenza knowledge, attitudes, and protective behaviors. This methodology extends conventional KAP research through dual innovations: first, by targeting high-risk populations at the human-wildlife interface; second, by enabling quantitative prioritization of modifiable behavioral factors—providing evidence-based guidance for optimizing prevention protocols in ecologically sensitive zones.

In this study, we conducted the first systematic KAP assessment among poultry farmers in Guidong County—an ecologically vulnerable node along central China’s migratory bird flyway. The complex relationships among knowledge, attitudes, and preventive behaviors were analyzed. The findings revealed that the overall KAP score was only 51.51%, indicating a poor level. Specifically, the knowledge score was 57.20%, the attitude score 52.58%, and the behavior score merely 47.42%. These low scores may be attributed to the underdeveloped economy of Guidong County and its insufficient investment in public health infrastructure. Migratory birds are known vectors for the transregional spread of avian influenza viruses, such as H5N1 and H7N9 subtypes (26). Their frequent presence significantly increases the exposure risk for local poultry (27). While our observational design precludes causal claims, the observed deficiencies in both awareness and protective behaviors among farmers suggest a potential transmission chain of “migratory birds – domestic poultry – humans.” These insights are crucial for optimizing prevention and control strategies in high-risk areas.

Although a majority of participants (74.2%) were aware of the proper disposal methods for sick or dead birds, only 30.8% recognized early avian influenza symptoms, and 66.1% overestimated human-to-human transmission risk. These figures exceed those reported in a similar study from India (28). Such gaps in knowledge pose dual threats: delayed symptom recognition may hinder early detection and isolation, while exaggerated fears of human transmission could provoke irrational responses, such as the misuse of antibiotics. Therefore, in migratory bird regions, health education should emphasize the cognitive chain of “symptom recognition — timely reporting — scientific disposal.”

The significant disparity between attitude and behavior scores highlights a deeper issue: while 85.07% of participants acknowledged the importance of protective measures, only a small fraction reported using personal protective equipment (PPE) such as masks and gloves when handling poultry. This aligns with findings by Ayim-Akonor et al. (19). Evidence shows that using personal protective equipment (PPE) such as masks and gloves reduces avian influenza virus transmission (29). Yet, only 12.22% of participants perceived themselves at risk, indicating a “knowing-but-not-doing” phenomenon (30). This discrepancy may be explained through the lens of the Health Belief Model (HBM), where low perceived susceptibility (“I am unlikely to get infected”) and perceived barriers (e.g., cost or discomfort of PPE use) outweigh perceived benefits (31). Misunderstandings about avian influenza may result in inappropriate behaviors, undermining disease prevention efforts and potentially exacerbating risks (12). Hence, future health education should not only focus on disseminating accurate information but also improve risk perception, practical skills, and rectify flawed attitudes.

Structural equation modeling demonstrated that both knowledge and attitudes were associated with preventive behaviors toward avian influenza. Previous studies have confirmed that individuals with higher levels of awareness are more likely to adopt appropriate preventive attitudes and behaviors (32) In line with the KAP framework, insufficient knowledge, low perceived risk, and inadequate practices collectively contribute to increased infection risk (15). Knowledge influences behavior indirectly via attitude, and this indirect effect was found to be stronger than the direct effect. However, as this cross-sectional study cannot establish temporal precedence, alternative interpretations remain plausible. As a necessary condition for behavioral change, knowledge must be coupled with favorable attitudes to foster practice improvement (22, 33). Therefore, avian influenza health education should emphasize not only knowledge dissemination but also attitudinal transformation to bridge the gap between awareness and action.

Our study was conducted during a distinctive phase of China’s COVID-19 pandemic management. The research period (July 2021) coincided with a time when nationwide pandemic control measures had been fully lifted, resulting in minimal COVID-19-related restrictions. This operational context allowed uninterrupted implementation of household surveys along migratory bird routes, where investigators conducted door-to-door questionnaires with poultry farmers. A key strength of this study lies in its systematic spatial coverage of farming communities adjacent to migratory pathways, which reduced selection bias. Furthermore, this research represents the first KAP investigation explicitly linking avian biogeography (e.g., Central Asian Flyway dynamics) with human behavioral determinants—an underexplored interface in poultry worker studies.

This study has several limitations. Due to its cross-sectional design, causal relationships among knowledge, attitudes, and practices cannot be firmly established. For instance, inadequate protective behavior may demotivate individuals from acquiring relevant knowledge. Future studies should consider a longitudinal design with intervention-control components to evaluate the effectiveness of health education. Second, while our survey encompassed most poultry farmers along migratory routes, some individuals were unavailable during data collection. This convenience sampling approach may have led to an overestimation of the population’s KAP levels. It is recommended that future research expand the sampling scope and incorporate contextual environmental variables such as migratory bird activity and poultry density to construct a multi-level risk prediction model. Finally, given the study’s timing during pandemic normalization, subsequent research should track behavioral changes across post-COVID recovery phases to clarify lasting impacts on biosecurity practices, particularly regarding sustained mask usage and risk perception evolution.

In conclusion, poultry farmers in Guidong County’s migratory bird habitats exhibit suboptimal KAP levels regarding avian influenza. Accurate knowledge and a positive attitude are crucial for improving farmers’ preventive behaviors. Based on the ecological characteristics of migratory birds, and the study population predominantly comprised individuals aged 45 years and older, with most having attained junior high school education or lower, a “three-in-one” intervention strategy is proposed: (1) Knowledge Enhancement: Develop dialect-specific multimedia educational materials in local dialects focusing on symptom recognition and common misconceptions; (2) Behavior Promotion: Provide governmental subsidies for PPE and include masks and gloves in essential farming supplies, coupled with training programs to improve protective awareness and skills; (3) Institutional Support: Establish a joint prevention mechanism including “risk alerts during migratory seasons – routine disinfection – behavioral monitoring,” with implementation responsibilities delegated to village committees. This integrated model may not only reduce zoonotic transmission risks but also enhance biosecurity in farming and support rural revitalization initiatives.