Knowledge, Attitudes, Practices and Perceptions of the Eco-Bio-Social Determinants of Dengue Transmission in São Paulo, Brazil: A Mixed-Methods Study.

INTRODUCTION

Dengue is a mosquito-borne disease prevalent in Latin America and the Caribbean. Transmission is determined by ecological, biological and social (eco-bio-social) factors. Understanding the knowledge, attitudes, practices and perceptions of dengue's eco-bio-social factors among at-risk populations is essential for dengue prevention. We used the Ecohealth approach to investigate the socioeconomic and demographic factors associated with dengue knowledge, attitudes, practices and perceptions among residents of São Paulo.

METHODS

We conducted a concurrent nested mixed-methods study between May and November 2024 using an online knowledge, attitudes, practices and perceptions survey, focus group discussions and Photovoice activity. Quantitative data were analysed using descriptive statistics and multivariable logistic regressions. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Qualitative data were analysed thematically. Integration from both method strands used a weaving, narrative approach.

FINDINGS: Overall, 388 participants completed the knowledge, attitudes, practices and perceptions survey. Having some or a lot of vegetation around the home (aOR 2.63, 95% CI: 1.05-6.60; aOR 3.90, 95% CI: 1.57-9.69, respectively) and never having dengue (self-reported; aOR 1.80, 95% CI: 1.10-2.94) were associated with high knowledge scores. Higher education was associated with positive vaccine attitudes (aOR 2.04, 95% CI: 1.14-3.64). Women (aOR 1.57, 95% CI: 1.01-2.45) and individuals with three and more than three household members (aOR 2.04, 95% CI: 1.07-3.87; aOR 3.10, 95% CI: 1.62-5.94, respectively) had higher odds of using mosquito repellents at home. Those who earned more than R$6000 monthly had higher odds of having a high perception of self-efficacy to prevent dengue compared to those who earned less than R$2000 monthly (aOR 2.03, 95% CI: 1.08-3.82). Focus group discussions and Photovoice participants perceived climate change as a risk factor of dengue transmission. The high cost of mosquito repellents was a perceived challenge to prevention.

CONCLUSION

Several individual- and household-level factors were associated with dengue knowledge, attitudes, practices and perceptions in São Paulo. There is a need to increase public awareness about dengue and its vaccine. Future research should assess the effectiveness of community-tailored interventions to reduce dengue risk in this urban, climate-vulnerable setting.