Community beliefs and practices about dengue in Puerto Rico.

OBJECTIVE In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices. METHODS From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), >or= 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory. RESULTS Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, "invisibility" of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention. CONCLUSIONS Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.