Impact of a Dengue Outbreak Experience in the Preventive Perceptions of the Community from a Temperate Region: Madeira Island, Portugal

The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier) decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island. After Madeira’s first dengue outbreak (2012) a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP)-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined ‘minimal understanding’’. Moreover, most of the population (95.5%) still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance of new myths within the population, apart from the expected increase of relevant concepts’ assimilation. Monitoring public perceptions is therefore crucial to make preventing dengue campaigns updated and worthy.Author Summary: Since there is no vaccine or treatment available for dengue fever, its prevention relies on community participation. Residents are asked to remove from their houses and gardens all receptacles where mosquitoes can breed. Exploring the public perception regarding dengue prevention is crucial for detecting obstacles to their participation in the proposed preventive activities. The authors explored and compared the community's perceptions before and after the first dengue outbreak in Madeira Island. For the first time it was possible to study the effect of a dengue outbreak in the public perceptions regarding its prevention. After the dengue outbreak, the authors found an improvement in the perception of the community. However, even after experiencing an outbreak, the majority of the residents still did not understand their role in the dengue prevention and, thus were not ready to adhere to it. Moreover, the authors also observed some new myths within the community after the outbreak (which were not present before the outbreak). The improvement of community perceptions was expected. However this search also revealed that this experience can surprisingly promote the emergence of new myths which may hamper the community engagement in the dengue prevention.