Understanding risk communication for prevention and control of vector-borne diseases: A mixed-method study in Curaçao

Assessing knowledge gaps and empowering Extension workers in Illinois with information on ticks and tickborne diseases through KAP surveys

Tickborne diseases (TBDs) are increasingly prevalent in Illinois and the Upper Midwest region. People who work in occupations that require time outdoors in agricultural or natural settings, such as some Extension workers, are at risk of tick bites and TBDs. Additionally, Extension workers are often a primary source of information about ticks and TBDs in rural communities. However, there is limited information on the level of awareness about ticks and TBDs in the Extension community. The goals of this study were to sequentially i) determine the baseline awareness of Extension workers in Illinois about ticks and TBDs using a knowledge, attitudes, and practices (KAP) survey tool, ii) provide comprehensive training on ticks and TBDs to this demographic, and iii) measure the uptake of knowledge after the training intervention through a post-training survey. The study period was from June 2022 until May 2023. We received 233 pre-training and 93 paired post-training survey responses. Most survey respondents were Extension volunteers, identified as women, and were over 50 years old. Knowledge about ticks and TBDs varied. We identified several gaps in their current tick awareness, most importantly, in tick prevention measures, tick identification, and TBDs in general. TBD knowledge, attitude, and practice scores all significantly improved after training (p < 0.001), with a mean difference of 10.47, 1.49, and 2.64 points, respectively. Additionally, both Extension professionals (79.2 %) and Extension volunteers (66.7 %) were more likely to feel confident in engaging with their stakeholders on ticks and TBDs after participating in training. Poisson models revealed that higher attitude and practice scores and greater self-reported knowledge were the factors most significantly associated with higher TBD knowledge. We found that greater concern for ticks and TBD (attitudes) and adherence to science-based prevention and management methods (practices) were also associated with higher knowledge scores. To our knowledge, this is the first study in Illinois to capture Extension workers' awareness of ticks and TBDs. The results highlight Extension workers' interest in filling knowledge gaps through learning, and the importance of training Extension workers to disseminate reliable and updated information on ticks and TBDs to their constituents, a critical step in preventing TBDs.

Contexts motivating protective behaviours related to Aedes-borne infectious diseases in Curaçao

BACKGROUND

Aedes aegypti, the vector of arboviral diseases such as dengue and Zika virus infections, is difficult to control. Effective interventions must be practicable, comprehensive, and sustained. There is evidence that community participation can enhance mosquito control. Therefore, countries are encouraged to develop and integrate community-based approaches to mosquito control to mitigate Aedes-borne infectious diseases (ABIDs). Health professionals must understand the contexts motivating individuals' behaviour to improve community participation and promote behavioural change. Therefore, this study aimed to determine how contexts shaped individuals' protective behaviours related to ABIDs in Curaçao.

METHODS

From April 2019 to September 2020, a multi-method qualitative study applying seven (n = 54) focus group discussions and twenty-five in-depth interviews with locals was performed in Curaҫao. The study was designed based on the Health Belief Model (HBM). Two cycles of inductive and deductive coding were employed, and Nvivo software was used to manage and analyse the data.

RESULTS

In this study, low media coverage (external cue to action) and limited experience with the symptoms of ABIDs (internal cue to action) were linked with a low perceived susceptibility and severity of ABIDs (low perceived threat). The low perceived threat was linked with reduced health-seeking behaviour (HSB) to prevent and control ABIDs. We also found that the perceived barriers outweigh the perceived benefits of ABID prevention and control interventions, obstructing HSB. On the one hand, insufficient knowledge reduced self-efficacy but contrary to expected, having good knowledge did not promote HSB. Lastly, we found that our participants believe that they are responsible for preventing ABIDs (internal locus of control) but at the same time indicated that their success depends on the efforts of the community and the health system (external locus of control).

CONCLUSIONS

This study used the HBM to explain individual changes in HSB concerning ABIDs prevention and control in Curaçao. We can conclude that the perceived threat (perceived susceptibility and severity) and perceived barriers played an essential role in changing HSB. Health professionals must consider these two concepts' implications when designing a bottom-up approach for ABIDs control; otherwise, community participation will remain minimal.

Interpersonal risk communication matters more than media risk communication in its impact on individuals' trust and preventive behaviors during COVID-19

A cross-sectional survey study from 1496 respondents was conducted to investigate how interpersonal risk communication and media risk communication foster individuals' interpersonal trust and trust in scientists during the ongoing COVID-19 pandemic. Findings reveal that interpersonal risk communication is significantly related to interpersonal trust and trust in scientists, but have no direct association with preventive behaviors. Media risk communication is significantly associated with preventive behaviors and increases individuals' trust in scientists while having no effect on interpersonal trust. Preventive behaviors are significantly influenced by both interpersonal trust and trust in scientists. In addition, trust mediated the association between risk communication and preventive behaviors.

Level of dengue preventive practices and associated factors in a Malaysian residential area during the COVID-19 pandemic: A cross-sectional study

Background

Dengue fever is a mosquito-borne viral infection that is endemic in more than 100 countries and has the highest incidence among infectious diseases in Malaysia. The increase of dengue fever cases during the COVID-19 pandemic and the movement control order (MCO) highlighted the necessity to assess the dengue preventive practices among the population. Thus, this study aimed to determine the level of dengue preventive practices and its associated factors among residents in a residential area in Johor, Malaysia during the COVID-19 pandemic.

Method

A community-based cross-sectional study was conducted on 303 respondents from a Johor residential area between May and June 2021. A validated self-administered questionnaire was created using google forms and distributed to the respondents via WhatsApp. The questionnaire consisted of three sections: (i) Sociodemographic characteristics and history of dengue fever, (ii) dengue preventive practices, and (iii) six constructs of the Health Belief Model (HBM). The association between the dependent and independent variables were examined using multiple logistic regression with a significant level set at less than 0.05.

Result

About half of the respondents have a good level of dengue preventive practices. Respondents with a history of dengue fever (aOR = 2.1, 95% CI: 1.1–4.2, p = 0.033), low perceived susceptibility (aOR = 1.8, 95% CI: 1.1–3.0, p = 0.018), high self-efficacy (aOR = 1.7, 95% CI: 1.0–2.8, p = 0.045), and high cues to take action (aOR = 2.5, 95% CI: 1.5–4.2, p < 0.001) had higher odds of practicing good dengue preventive measures.

Conclusion

This study demonstrated a moderate level of dengue preventive practices during the COVID-19 pandemic. Therefore, a stronger dengue control programme is recommended by focusing on cues to take action, self-efficacy, and recruiting those with a history of dengue fever to assist health authorities in promoting good dengue preventive practices in the community.

Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases

Background

Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks.

Methods

From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data.

Results

This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance).

Conclusions

This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-05011-x.

The Impact of Health Risk Communication: A Study on the Dengue, Chikungunya, and Zika Epidemics in Curaçao, Analyzed by the Social Amplification of Risk Framework (SARF)

Epidemics of dengue, chikungunya, and Zika have been threatening the Caribbean. Since risk communication (RC) plays a fundamental role in preventing and controlling diseases understanding how RC works is essential for enabling risk-reducing behavior. This multimethod qualitative study compares news reports with local's and health professional's perspectives, currently lacking in RC research. It was found that RC strategies were obstructed by a lack of governmental structure, organization, and communication. The content analysis showed that the majority of newspaper articles contained negative reporting on the government. Furthermore, this study shows how trust and heuristics attenuate or amplify people's risk perceptions and possibly positively and negatively influence people's risk-reducing behavior. A transcending approach (e.g., structural, cooperative, and multidisciplinary) of the prevention and control of vector-borne diseases and the corresponding RC is recommended.

An Experimental Evidence on Public Acceptance of Genetically Modified Food through Advertisement Framing on Health and Environmental Benefits, Objective Knowledge, and Risk Reduction

Owing to the emerging challenges on global food security and the decade of controversies over genetically modified food (hereafter GMF), the present study aims to explore the effects of advertisement framing on health and environmental benefits, sources of perceived risk reduction, and domain-specific knowledge on the acceptance of GMF. The study conducted a quasi-experimental factorial 2 (advertisement message framing: health vs. environmental benefits) × 2 (expert endorsement: present vs. absent) between-subject design involving 300 adult participants from Pakistan. Using a multi-group structural equation model, the four conditions were assigned to each participant group (n = 75) to test the hypothesized relationships. The quasi-experiment results suggested that the advertisement messages (ad-framed) incorporated with the health and environmental benefits, as delineated by experts, can be a viable communication strategy in developing effortless cognitive cues towards GMF acceptance. The pioneer findings validate the significant efficacy of advertisement messages (ad-framed with expert opinions) in reducing perceived risk through augmented objective knowledge that activates the mechanism of favorable development of attitude and acceptance of GMF. The study findings offer strategic directions to policymakers, marketers, and food technologists in raising greater awareness and acceptance towards GMF products.

Knowledge and practice on prevention of mosquito-borne diseases in livestock-keeping and non-livestock-keeping communities in Hanoi city, Vietnam: A mixed-method study

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p<0.05). Both household categories had low score, 3.5 out of 11, regarding preventive practices against MBDs. The negative binomial model showed that occupation and location of living were factors associated to the knowledge on MBDs. Farmers were likely to have better preventive practices as compared to office workers (p<0.05). Those who had better knowledge also had more adequate preventive practices against MBDs (p<0.001). The qualitative survey revealed that livestock keeping was determined as increasing risks of MBDs due to the increase of mosquito population. It is recommended that community campaigns to raise the awareness and change behavior on MBDs should be organized based on collaboration between the health sector and the veterinary sector for households with and without livestock living in central urban and peri-urban areas. Further studies are needed to confirm the association between urban livestock keeping and potential increasing risks of MBDs such as dengue and Japanese encephalitis.