Research Article: Impact of a Dengue Outbreak Experience in the Preventive Perceptions of the Community from a Temperate Region: Madeira Island, Portugal

Date Published: March 13, 2015

Publisher: Public Library of Science

Author(s): Teresa Nazareth, Carla Alexandra Sousa, Graça Porto, Luzia Gonçalves, Gonçalo Seixas, Luís Antunes, Ana Clara Silva, Rosa Teodósio, Oladele B. Akogun.

Abstract: The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier) decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island. After Madeira’s first dengue outbreak (2012) a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP)-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined ‘minimal understanding’’. Moreover, most of the population (95.5%) still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance of new myths within the population, apart from the expected increase of relevant concepts’ assimilation. Monitoring public perceptions is therefore crucial to make preventing dengue campaigns updated and worthy.

Partial Text: Most of the 2011 worldwide major causes of death (MCD), rely on behaviour changes for their prevention [1]. Increasing physical activity, fruits/vegetables intake, hand-washing, use of condoms, and decreasing not only fat, salt and sugar intake but also smoking habits, are crucial in the control of heart disease (1st MCD), stroke (2nd MCD), chronic obstructive lung disease (4th MCD), diarrhoea (5th MCD), HIV (6th MCD), or diabetes (8th MCD). Behaviour changes are increasingly relevant to attain and maintain a good health status, especially when facing health threats for which there is no efficient or timely treatment. This is the case for dengue fever that such as other mosquito-borne diseases, requires a good compliance to certain preventive, protective or therapeutic actions. Moreover, since there is no vaccine or treatment for dengue fever, neither 100% effective insecticides, community behaviour has a huge impact on its prevention and control [2].

As subsequently explained, methodology of the present survey (herein stated as POST-outbreak study) followed as much as possible the methodology used in the prior-to-the outbreak survey (herein mentioned as PRE-outbreak study) [17]. This ensured an accurate comparison between public perceptions before and after the dengue outbreak in Madeira Island.

A total of 154 female Extended-AEGYPTI residents answered the complete questionnaire in the present POST-outbreak survey. A total of 90 pairs resulted from the adjusted matching between 154 female from the POST-outbreak survey and 1145 subjects who participated in the PRE-outbreak study. Each pair composed of an individual from the PRE-outbreak study and an individual from the POST-outbreak study with equivalent personal-socio-demographic characteristics. Nine individuals out of those surveyed had dengue and five were paired. The personal-socio-demographic feature of the studied sample populations is described in Table 2. When not mentioning subsequent paragraphs as well as the data presented in Figs. 2, 3, 4 and 5, and Tables 2, 3, 4 and 5 present results from the adjusted matching.

In general, the community perception regarding preventive domestic practices improved within female residents of most aegypti-infested areas in Madeira Island after they experienced a dengue outbreak. By analysing how and how much assimilation of each ‘Essential-concept’ has changed, crucial information can be retrieved regarding people´s perceptions about this experience and their future role in its prevention.



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