title: The relationship between economic status, knowledge on dengue, risk perceptions and practices.
abstract: The reemergence of dengue as an important public health problem reflects the difficulties in sustaining vertically organized, effective, control programs and the need for community-based strategies for Aedes aegypti control that result in behavioral change. We aimed to disentangle the relationships between underlying determinants of dengue related practices. We conducted a cross-sectional study in 780 households in La Lisa, Havana, Cuba. A questionnaire and an observation guide were administrated to collect information on variables related to economic status, knowledge on dengue, risk perception and practices associated with Aedes aegypti breading sites. To test a conceptual model that hypothesized direct relationships among all these constructs, we first used Exploratory Factor Analysis with Principal Component Analysis to establish the relationship between observed variables and the underlying latent variables. Subsequently, we tested whether the observed data supported the conceptual model through Confirmatory Factor Analysis. Exploratory Factor Analysis indicated that the items measured could be reduced into five factors with an eigenvalue >1.0: Knowledge on dengue, Intradomiciliar risk practices, Peridomiciliar risk practices, Risk perception and Economic status. The proportion of the total variance in the data explained by these five factors was 74.3%. The Confirmatory Factor Analysis model differed from our hypothesized conceptual model. Only Knowledge on dengue had a significant, direct, positive, effect on Practices. There was also a direct association of Economic status with Knowledge on dengue, but not with Risk perception and Practices. Clarifying the relationship between direct and indirect determinants of dengue related practices contributes to a better understanding of the potential effect of Information Education and Communication on practices and on the reduction of Aedes aegypti breeding sites and provides inputs for designing a community based strategy for dengue control.
authors.affiliation: Epidemiology Division, Institute of Tropical Medicine "Pedro Kouri", Havana, Cuba.
authors.forename: Marta
authors.initials: M
authors.lastname: Castro
authors.affiliation: Clinical Research Direction, Center of Molecular Immunology, Havana, Cuba.
authors.forename: Lizet
authors.initials: L
authors.lastname: Sánchez
authors.affiliation: Epidemiology Division, Institute of Tropical Medicine "Pedro Kouri", Havana, Cuba.
authors.forename: Dennis
authors.initials: D
authors.lastname: Pérez
authors.affiliation: Department of Mathematics, José Martí University, Sancti Spirítus, Cuba.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sebrango
authors.affiliation: Center for Statistics, Hasselt University, Diepenbeek, Belgium.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Shkedy
authors.affiliation: Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium ; Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D000293:Adolescent; D000328:Adult; D000330:Aedes / Q000502:physiology*; D000818:Animals; D003462:Cuba; D003715:Dengue / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D005191:Family Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007303:Insect Vectors; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control; D025341:Principal Component Analysis; D012306:Risk; D012938:Social Perception; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires