Health workers' perceived challenges for dengue prevention and control in the Dominican Republic

Abstract

INTRODUCTION: Mosquito-transmitted dengue remains an endemic threat to population health in various tropical and subtropical regions. Recommended dengue prevention practices focus on vector control and reducing human-mosquito interactions, by practices such as removing standing water, wearing protective clothing and using repellent, as well as seeking medical care when symptomatic. Health workers in the community educate and empower citizens about recommended prevention practices, and thus are indispensable in implementing national dengue initiatives at the local level. However, their health messages may not resonate with all community members, resulting in low adherence to recommended prevention practices. Understanding the factors associated with low adherence to dengue prevention and control measures is essential for strengthening national dengue initiatives. OBJECTIVE: Identify health workers' perceived challenges for dengue prevention and control strategies and describe their recommendations for strengthening dengue control in the Dominican Republic. METHODS: From January through March 2005, a qualitative study was conducted in five provinces of the Dominican Republic. Based on literature review and consultations with clinical specialists, a semistructured interview guide of nine questions was designed. A purposive sample of 19 health workers (10 men, 9 women) was interviewed, including public health practitioners, entomologists, educators, clinicians and an administrator. Question topics included occupational experiences in dengue prevention and control; views on vector control in communities; perceived challenges for citizens' adherence to recommended practices; and suggested measures for strengthening adherence to vector control at local and national levels. Thematic analysis was used to identify salient themes. RESULTS: Health workers described the following perceived challenges: 1) limited individual economic resources; 2) individual lack of awareness, education or action; 3) limited cohesion among community members; and 4) limitations in sustainability of government interventions. They made 14 recommendations related to the 4 perceived challenges. CONCLUSIONS: These findings evince the complex interplay of economic, environmental, health, political and social factors that can directly or indirectly influence individual and community adherence to recommended dengue prevention measures. By understanding how these intrinsic and extrinsic factors hinder adherence, health authorities can adapt national policies to strengthen community participatory action in vector control, empower leadership potential by health workers and community members, and provide an appropriate systemic approach to preventing disease transmission.