Abstract
BackgroundAs the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies. To successfully achieve mosquito control, joint efforts of both communities and governments are essential. This study investigates this important, but by-and-large neglected topic.MethodsIn June and July 2015, a cross-sectional mixed methods study applying a survey questionnaire (response rate of 82.5%; n = 339), in-depth interviews (n = 20) and focus group discussions (n = 7; 50 participants) was performed in Curaçao. The study was designed based on an integrated theoretical framework of the Health Belief Model and the Theory of Planned Behaviour.ResultsParticipants showed a good knowledge of, and a high-level performance of mosquito breeding site control (MBSC) practices. Personal protection against mosquitoes (e.g. topical repellents) was perceived as relatively less effective thus practiced to lower extent compared to MBSC practices (i.e. larval source management). A lower intention to perform MBSC was independently associated with: (i) satisfaction on governmental MBSC (P = 0.012); (ii) barriers to perform MBSC practices, i.e. ‘Government doesn’t control other breeding sites’ (P = 0.005), ‘Don’t know how to control breeding sites’ (P = 0.041), and ‘a mosquito does not transmit dengue’ (P = 0.016), (iii) attitudes towards MBSC (P = 0.001) and self-efficacy (person’s perceived ability to act) to perform MBSC (P = 0.002). Mixed-methods evidence highlights three possible ways of improving community participation in MBSC. First, it highlights the need for ongoing media coverage, targeting (i) communities’ perceptions on transmission routes of dengue and chikungunya, and (ii) presence of car tires in yards. Secondly, it shows that promotion of governmental activities in MBSC can enhance MBSC of communities, if people develop a sense of responsibility to perform MBSC at their own properties. Thirdly, this study describes the presence of key persons in communities, who could be engaged in mosquito control policies to improve MBSC in neighbourhoods.ConclusionThis study reveals gaps between policy and communities’ lived realities. These gaps might be overcome with the proposed interventions, resulting in a higher performance of MBSC in the community in Curaçao. Furthermore, this study shows how interdisciplinary mixed methods research can provide important, comprehensive, and in-depth insights to inform mosquito control policies.
Highlights
As the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies
In Curaçao, where dengue is endemic for all four serotypes [12], chikungunya caused a major outbreak in 2014–2015 where approximately 50–75% of the population was infected [6]
No studies combining qualitative and quantitative research methods based on the Theory of Planned Behaviour (TPB) or Health Belief Model (HBM) to investigate community participation in mosquito breeding site control (MBSC) have been published to date. We address this knowledge gap here by (i) describing communities’ perceptions and practices of preventive behaviours in MBSC; (ii) analysing communities’ behavioural intentions to control mosquito breeding sites, based on the TPB and the HBM; and (iii) proposing targets for health interventions to enhance community participation in MBSC
Summary
As the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies. Zika is ill-famed for congenital Zika syndrome [7], Guillain-Barré syndrome frequency [8], sexual transmissibility [9] and a rare but life-threatening immuneinduced thrombocytopenia [10]. These viruses are transmitted by Aedes spp., mainly Ae. aegypti and Ae. albopictus, that flourish in large parts of Southeast Asia, the Americas and Africa, and beyond. In these regions, dengue outbreaks occur on a regular basis [11]. In January 2016, the first locally transmitted Zika case in Curaçao was reported, heralding an epidemic [13]
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