Comparative Study On Dengue Fever Prevention Behavior And Related Factors Among Residents In Different Risk Areas

BackgroundDengue fever is an arbovirus infection transmitted to humans through Aedes mosquitoes.Dengue fever spreads rapidly and has a high incidence rate,which can cause a large-scale epidemic.In the past 50 years,the global incidence rate of dengue fever has increased 30 times.Dengue fever is an imported epidemic in China,and its international epidemic situation will have a huge impact on the outbreak and prevalence of dengue fever in China.According to the severity of the dengue fever epidemic and the distribution of vector Aedes mosquitoes,different provinces in China are divided into three types of dengue fever epidemic risk areas.In recent years,the dengue fever epidemic has gradually spread from the more severe southeastern coastal and southwestern border areas to the northern inland provinces,with an increased frequency of local outbreaks and an increase in affected areas and populations.At present,mosquito vector control is still the most important measure for preventing and controlling dengue fever,and community mobilization and residents’ participation play an important role in mosquito vector control.The risk of dengue fever outbreaks varies in different regions of China,and the prevention and control capabilities also vary.The vast majority of people in areas with low prevalence of dengue fever have not experienced dengue fever infection,have low antibody levels,and lack awareness of dengue fever.In this case,once an imported case occurs,it is highly likely to spread quickly in a short period of time,leading to local outbreaks of dengue fever.Health education and health promotion can improve residents’ awareness and prevention behavior of dengue fever,but currently,China has not developed a mature and effective population dengue fever prevention and control behavior model.At present,the main behavior theories include the theory of knowledge,belief and action,the health belief model,the Stage theory of behavior change,and the theory of rational action and theory of planned behavior.The structural equation model can quantify information,motivation and behavior,and has certain advantages in theoretical assumptions and model fitting.Building a structural equation model based on past behavioral theory patterns can analyze the interaction mechanisms of dengue fever prevention behavior models.ObjectivesThis study analyzed the relationship between residents’ dengue cognitive pathways,cognitive levels,prevention motivations,and prevention behaviors by understanding the level of dengue awareness and prevention behaviors of residents in different risk areas in China.By comparing the differences between different risk areas,it clarified the focus of health intervention and health promotion for residents in different risk areas,and analyzed the influencing factors of residents’ dengue prevention behaviors,so as to provide scientific basis for improving residents’ dengue prevention behavior and strategies for dengue community prevention and control mobilization.MethodsThis study adopted a cross-sectional study design.Through cluster sampling,at least two communities and natural villages were selected from Jinan City,Shandong Province,and Hangzhou City,Zhejiang Province.With the help of local disease prevention and control centers and street staff,a questionnaire survey was used to investigate the residents of the selected communities and natural villages through a combination of online and offline methods.SPSS 24.0 software was used for statistical analysis.Continuous variables that conform to normal distribution are described using mean± standard deviation(X±S),and counting data are described using frequency or constituent ratio.Chi-square test,Fisher’s exact probability method,or rank sum test were used to test the differences in dengue awareness,cognitive pathways,prevention motivation,and prevention behavior among residents in different risk areas and populations with different characteristics.Comparison of dengue fever prevention behavior scores among different characteristic populations using ttest or analysis of variance.The structural equation model was constructed using AMOS 26.0 software,and the fitting results of the structural equation model were evaluated using model fitness indicators.Results1.A total of 1288 subjects were surveyed online in this study,including 696 in Shandong Province and 592 in Zhejiang Province.The age range of the respondents was 18 to 80 years old,with an average age of 36.81 ± 11.56 years.The proportion of respondents who have heard of dengue fever accounted for 62.2%of the online respondents,of which 53.7%had heard of dengue fever in Shandong Province and 72.1%had heard of dengue fever in Zhejiang Province.The proportion of residents who had heard of dengue fever in Zhejiang Province was higher than that in Shandong Province(χ2=46.023,P<0.001).The lowest awareness rate of dengue fever is among people aged 18-35,with rural areas,primary school and below diplomas,students,and monthly income≤2000 yuan.2.The severity,fear,and prevention initiative of dengue fever among residents in Shandong Province were higher than those in Zhejiang Province(P<0.05).The highest rates of prevention behavior formation among residents in terms of indoor mosquito prevention,outdoor mosquito prevention,and breeding prevention were the installation of screen doors and windows(83.5%),the use of mosquito repellent products such as toilet water(76.7%),and the cleaning of stagnant water in their residential areas(69.3%).The lowest rates of prevention behavior formation were the use of air conditioners(22.0%),the use of fans(46.7%),and the addition of mosquito repellents to water(24.5%).The score of dengue prevention and control behavior among residents in Shandong Province is higher than that of residents in Zhejiang Province(P=0.008).The lowest score of dengue prevention behavior was found among the characteristic population aged≥ 54 years,male,rural,primary school or below,farmers,and monthly income≤2000 yuan.3.The proportion of residents who learned about dengue fever through the internet was the highest(60.5%),while the proportion of people who learned about dengue fever through relevant books was the lowest(15.2%).Among the expected cognitive pathways,the proportion of residents wishing to learn about dengue fever through community promotion was the highest(56.7%),followed by the proportion of residents wishing to learn about dengue fever through television/radio(53.7%)and internet(53.6%).In family or friends,television/radio,magazines/newspapers,community propaganda,mobile phone text messages,lectures/conferences,school or unit organization propaganda,and medical and health institutions propaganda,Shandong residents have a higher proportion of expected cognition than Zhejiang residents(P<0.05).4.In this study,there are 1266 respondents in Shandong Province,including 696 online respondents and 570 offline respondents.The age range of the respondents was 18 to 87 years old,with an average age of 39.56 ± 12.93.There are significant differences between online and offline respondents in terms of age,gender,educational level,occupation,and monthly income.The proportion of online respondents who have heard of dengue fever is higher than that of offline respondents(χ2=155.650,P<0.001)。The average score of mosquito prevention behavior among online respondents was higher than that of offline respondents(t=13.263,P<0.001).The proportion of online respondents who recognized dengue fever through television/radio,magazines/newspapers,the Internet,mobile phone text messages,posters/flyers,community propaganda,and related books was higher than the proportion of residents surveyed offline(P<0.001).5.Through the analysis of structural equation model construction,it is found that cognitive pathways have a positive impact on the cognitive level,prevention motivation,and prevention behavior of dengue fever,with standardized path coefficients of 0.306,0.140,and 0.520,respectively.The cognitive level and prevention motivation of dengue fever also have a positive impact on prevention behavior,with standardized path coefficients of 0.225 and 0.098,respectively.The path coefficient between dengue fever cognitive level and prevention motivation was not statistically significant(P=0.290).After testing,the fitness indicators all meet the standards(CIMN/DF=2.296,RMSEA=0.038,IFI=0.940,CFI=0.940,NNFI=0.932,PGFI=0.769,PNFI=0.793),and the model fitting effect is good.6.Cognitive level and preventive motivation have a mediating role in the impact of cognitive pathways on preventive behavior.The direct effect of cognitive pathways on preventive behavior is 87.9%,the indirect effect of cognitive level is 10.06%,the indirect effect of preventive motivation is 2.04%,and the total indirect effect is 12.10%.Conclusions1.In addition to the fact that the proportion of residents who actually recognize dengue fever through online channels is higher than the expected proportion,the proportion of residents who actually recognize dengue fever through other cognitive channels is lower than the expected proportion,which indicates that in reality,the promotion of dengue fever fails to meet the knowledge needs of residents for dengue fever.2.Residents under the age of 18 to 35 years old,rural,primary school and below with educational background,occupation as students,and monthly income≤2000 yuan have a lower awareness rate of dengue fever related knowledge,while residents aged 54 and above,male,rural,primary school and below,and monthly income≤2000 yuan have a lower level of preventive behavior.3.According to the different cognitive levels and preventive behaviors of residents in different risk areas,the promotional content should be focused and targeted.For residents with low awareness of dengue fever in medium risk areas,the focus of publicity should include relevant knowledge about the symptoms,transmission routes,and preventive measures of dengue fever,so as to enable residents to have a deeper understanding of dengue fever and thereby improve their awareness of dengue fever.For residents with low prevention motivation and behavior in high-risk areas,the publicity content should focus on describing the severity and susceptibility of dengue fever,in order to enhance the enthusiasm and prevention initiative of residents and enhance prevention motivation.Health promotion and health intervention should also increase the relevant content of mosquito vector control to promote the formation of mosquito control behavior among residents,thereby improving the level of dengue fever prevention behavior among residents.