Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

Introduction: Control of triatomine infestation is a key strategy for the prevention of Chagas disease (CD). To promote this strategy, it is important to know which antecedents to behavioral change are the best to emphasize when promoting prevention. Objective: The aim of this study was to determine predictors for intention to prevent home infestation based on the Health Belief Model (HBM), a commonly used health intervention planning theory. Materials & methods: A cross-sectional study was conducted with 112 heads of household in six communities with endemic and high rates of triatomine infestation in Loja province, Ecuador. The data was collected by a questionnaire including perceived severity, susceptibility, benefits to action, barriers to action, and self-efficacy. These data were also used to predict actual infestation of homes. Results: Community members reported strong intentions to prevent home infestation. HBM constructs predicted about 14% of the observed variance in intentions. Perceived susceptibility and severity did not predict behavioral intention well; perceived barriers to small-scale action that reduce likelihood of infestation and self-efficacy in participating in surveillance systems did. Self-efficacy and perception of barriers were equally powerful predictors. The HBM constructs, however, did not predict well actual infestation. Conclusion: The findings supported the HBM as a way to predict intentions to prevent infestation of the home by triatomine bugs. The findings highlight that messages emphasizing self-efficacy in participating in surveillance systems and overcoming barriers to small-scale action that reduce likelihood of infestation, rather than a focus on risk, should be central messages when designing and implementing educational interventions for CD. The gap between behavioral intention and actual infestation reveals the need to assess home practices and their actual efficacy to fully enact and apply the HBM. Author summary: One risk factor for Chagas disease is whether its insect vector is present in a person’s home. Although excluding these vectors–triatomine bugs–is important, we will need to know what predicts a person’s intention to exclude bugs from their homes and what kinds of messages we should use to promote intentions to exclude bugs. This study applied the Health Belief Model to identify predictors of people’s intentions. We surveyed 112 heads of household in five communities in Loja province, Ecuador, to examine five predictors of people’s intentions. We looked at perceived severity (how bad people think bugs bits are), susceptibility (how likely they think a bite is), benefits to action, barriers to action, and self-efficacy (the feeling that they can act). Community members reported strong intentions to prevent bugs from entering homes. Perceived susceptibility and severity predict behavioral intention poorly; perceived barriers and self-efficacy are better predictors. These intentions, however, do not directly lead to lower rates of infestation. Based on these findings, if we want to persuade people to try to prevent infestation of the home, we should send messages about self-efficacy in participating in surveillance systems and overcoming barriers to small-scale action that reduce likelihood of infestation. A focus on risk should not be the central message when designing and implementing educational interventions. In addition to promoting better messages, we must also attend to people’s actual behaviors and the actual efficacy of these behaviors if we want the fullest enactment of the Health Belief Model in promoting effective change.