Implementation of a community participation project for dengue prevention in Puerto Rico

Purpose Dengue is a mosquito-borne viral disease of the tropics and Aedes aegypti is the most important vector worldwide. In the absence of a vaccine, dengue prevention efforts emphasize control of the mosquito. The limited efficacy of current control programs, often emphasizing insecticides, has prompted the search for alternative methods to prevent dengue involving community participation. The goal of this project is to develop a novel approach to community participation by developing a model that involves the active participation of community residents in the planning and conduction of activities to reduce Aedes aegypti infestations. Methods Initial steps in project development included identification of intervention and control communities with similar community environment and organizational level capable of supporting a community participation project, entomologic inspections of 20% of the houses (comparable baseline Breteau Index ≥ 50 was required), and determination of community characteristics. To promote community participation we also required a community inventory, partnership identification, and in-depth and informal interviews with gatekeepers and community leaders in the intervention community to determine project viability. Results We evaluated communities in 22 of the 78 municipalities of Puerto Rico. Thirteen communities were selected for further evaluation. From these, two communities (≈200 houses in each) with similar organizational level and comparable larval indices (house index 67.5% and 75%, respectively; p-value = 0.46) were chosen. Three informal and 7 in-depth interviews were conducted during December 2003. Content analysis of these interviews indicated that interviewees viewed dengue as a disease of interest but only when there were cases in the community. Correct dengue knowledge was mixed with misconceptions and the community had a well-organized health committee. Conclusion We identified incorrect knowledge and nonsustained interest in dengue preventive behavior and our model will address these issues in the intervention community.