Strengthening the perception-assessment tools for dengue prevention: a cross-sectional survey in a temperate region (Madeira, Portugal)

BACKGROUND Community participation is mandatory in the prevention of Dengue outbreaks. Taking public views into account is crucial to guide more effective planning and quicker community participation in preventing campaigns. This study aims to assess community perceptions of Madeira population in order to explore their involvement in the A. aegypti's control and reinforce health-educational planning. Due to the lack of accurate methodologies for measuring perception, a new tool to assess the community's perceptions was built. METHODS A cross-sectional survey was performed in the Island's aegypti-infested area, exploring residents' perceptions regarding most critical community behaviour: aegypti-source reduction and their domestic aegypti-breeding sites. A novel tool defining five essential topics which underlie the source reduction's awareness and accession was built, herein called Essential-Perception (EP) analysis. RESULTS Of 1276 individuals, 1182 completed the questionnaire (92 · 6%). EP-Score analysis revealed that community's perceptions were scarce, inconsistent and possibly incorrect. Most of the population (99 · 6%) did not completely understood the five essential topics explored. An average of 54 · 2% of residents only partially understood each essential topic, revealing inconsistencies in their understanding. Each resident apparently believed in an average of four false assumptions/myths. Significant association (p<0.001) was found between both the EP-Score level and the domestic presence of breeding sites, supporting the validity of this EP-analysis. Aedes aegypti's breeding sites, consisting of décor/leisure containers, presented an atypical pattern of infestation comparing with dengue prone regions. CONCLUSIONS The studied population was not prepared for being fully engaged in dengue prevention. Evidences suggest that EP-methodology was efficient and accurate in assessing the community perception and its compliance to practices. Moreover, it suggested a list of myths that could persist in the community. This is the first study reporting an aegypti-entomological pattern and community's perception in a developed dengue-prone region. Tailored messages considering findings of this study are recommended to be used in future campaigns in order to more effectively impact the community perception and behaviour.