Although a large part of the population knows that it is necessary to “avoid standing water” to prevent the spread of diseases such as dengue, zika and chikungunya, investing only in communication strategies focused on this message is not enough to bring about significant changes in the fight against arboviruses. This is what reveals a study by the United Nations Children’s Fund (Unicef), launched this Thursday (24), with support from biopharmaceutical company Takeda.
“Common sense says that when someone has information about what is good for themselves and their family, they adopt a behavior or habit. But there is a difference between what people say they do and the habits they actually incorporate into their daily routines. Doing or not doing something depends on a huge confluence of factors, behaviors, social norms, infrastructure and access to public policies. These are the aspects that we revealed in this study”, says Luciana Phebo, head of health at Unicef in Brazil.
After an extensive literature review, followed by field research and interviews, the study explains which aspects motivate or hinder the adoption of Aedes aegypti prevention practices. The research organizes these aspects into three levels, according to a Unicef methodology for working with social and behavioral changes: psychological, sociological and structural.
Among the psychological factors related to mosquito prevention, the study highlights the history of infection and risk perception: those who have never had the disease tend not to believe in its severity. Risk perception and prevention practices may increase in an epidemic situation, but relax when there is not.
Another factor is effort: preventive practices – including cleaning gutters, water tanks and hard-to-reach places – are seen as something difficult, time-consuming, complex, for which people do not have time or availability.
Financial costs are also taken into account, especially in more vulnerable locations, where spending resources to clean water tanks, purchase repellents, among others, may not be viable.
Among the sociological factors, collective organization was identified. Participating in neighborhood organizations is associated with increased prevention practices. But in many regions, many people don’t know their neighbors, they don’t see themselves as part of a group, and there is no collective organization to take care of the neighborhood.
Another factor is community influence. Many people feel morally obligated to comply with prevention practices that they believe are expected of them.
Structural factors such as urban structure were also raised. The lack of garbage collection and the presence of vacant land encourages inappropriate waste disposal.
The action of the agents is associated with a reduction in arboviruses. In some places, however, there may not be enough agents, or there may be obstacles in the agents’ relationship with the community. Low trust in government bodies can be a barrier to following health and prevention guidelines, says Unicef.
Recommendations
Each of these factors, combined, impacts the population’s attitudes towards preventing – or not – arboviruses. To address them, the research provides recommendations. One of them is to associate vector control with behaviors seen as “desirable” by the population.
Some useful practices for mosquito control, such as keeping the house clean or not throwing trash in the street, are already carried out with other motivations, linked to organization, cleanliness and aesthetics.
Another recommendation is to increase risk perception, especially in relation to children. The study observed that there is a high perception of the risk of infection by parents when related to children, for fear that their children will be infected. This insight could be used more effectively in risk communication campaigns and community involvement in preventive actions.
The study also recommends reducing costs and efforts associated with adopting prevention behaviors and increasing investments in infrastructure. Investing in public policies that reduce the cost and efforts of prevention practices can have a significant effect on reducing arboviruses.
Furthermore, investing in improvements in infrastructure and urban cleaning can strengthen the population’s adherence to prevention measures.
“Finally, it is important to strategically evaluate how to engage the community and carry out community actions. There is room to adopt more community engagement policies, in addition to stimulating and mediating discussions on the topic in communities”, states Unicef.
“We know the importance of guaranteeing, for each boy and girl, the right to live in an environment free from diseases that can affect not only their physical health, but also impact a child’s school attendance and routine, such as playing, eating appropriately, among other activities. We hope that the findings of this study can contribute to public policies and communication actions nationally and in each municipality, focusing on behavioral changes necessary to combat Aedes”, says Luciana Phebo.
