Adequate health literacy is recommended to promote improvements in health outcomes. This study aimed to examine the effects of participant characteristics and health literacy on participation in health behaviours in rural Thai adults with prehypertension. A cross-sectional survey was conducted in Chiang Mai province, Thailand. Stratified random sampling was used to recruit participants from seven villages, with a total of 244 participants included. Logistic regression tests were performed to examine the influence of participant characteristics on health literacy, and health behaviours. One-way ANOVAs and the Tukey HSD technique were used to measure the influence of participants' health literacy levels on health behaviours. The results show that the majority of participants (90.6%) had good/very good levels of health literacy, while 9.4% had poor/fair health literacy. In contrast, 61.5% of participants self-reported participation in regular exercise and 66.8% reported self-report uptake of a healthy diet. Although many participants reported adequate health literacy, gaps persisted in translating health information into lifestyle change. These findings highlight the need for public health programmes to address both individual and community barriers to lifestyle change. Important issues to be addressed include overcoming the barriers that individuals living in rural areas experience in accessing good health information and applying this in their daily lives. At a community level the importance of healthy food retail environments and access to safe areas to exercise need to be addressed.