Benefits and barriers of community participation in dengue control: A systematic review. (2024)

Introduction

Dengue is a global health issue, with approximately 104 million reported cases and 40,000 deaths worldwide, posing a risk in 128 countries (1). Apart from its impact on health and mortality, dengue also carries economic implications. Research in Latin America and the Caribbean indicates an annual cost of around 3 billion USD, with 70% attributed to inpatient care costs (2), Similarly, in Asia, the burden varies between approximately 6.7 to 1445.9 USD for inpatient and outpatient care respectively, and ranges from 12,035 to 1,453,237 USD for fatal dengue cases (3). The risk factors for dengue disease are associated with social and environmental factors such as population density, human mobility, access to water sources, water storage practices, climate conditions conducive to the proliferation of the dengue virus vector such as high temperature, high humidity, higher rainfall (4-6). There are other factors too, like knowledge, attitudes, and practices of mosquito control in the community, as well as the implementation of sustainable vector control activities in the community (7,8). Other studies have also identified factors related to the presence of the causative agent of the disease Ae. aegypti, such as housing conditions that support vector presence, negative risk perceptions of dengue fever, and impoverished and slum areas (9-11).

The World Health Organization (WHO) has designated dengue as a priority disease to be addressed in achieving the Sustainable Development Goals (SDGs) by 2030, aiming to reduce the number of cases to 2.35 million and achieve a 0% Case Fatality Rate (CFR). One of the five technical elements in the WHO Global Strategy for Dengue Prevention and Control 2021-2030 is to engage and mobilize communities (1). Community participation can be loosely defined as the involvement of people in a community in projects to solve their own problems (12). Community participation also means not only limited to physical involvement but also encompasses idea generation, contribution to decision-making, and sharing of responsibilities (13).The World Health Organization describes community participation as a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change (14). Active engagement of the community plays a crucial role in ensuring the efficient operation of health systems and serves as the initial stride towards authentic community empowerment in the realm of health (15-17). Community participation in dengue prevention and the control of dengue vector transmission involves the engagement of the community in dengue prevention efforts, including mosquito larvae monitoring, reporting, and the elimination of potential mosquito breeding sites. Strong community participation in these aspects can help reduce the risk and impact of dengue fever epidemics (18). As an example, the concept of community participation has been utilized in Mexico to enhance awareness of the consequences of dengue fever. "Patio Limpio" consists of training local communities to systematically identify, eliminate, monitor, and evaluate vector breeding sites within households under their supervision. The outcome of a community participation program in the state of Guerrero found that approximately 54% of households were clean and free from mosquito breeding sites, while households not visited and assessed were deemed to have a 2-4 times higher risk of contracting dengue fever compared to visited households (16).

Community plays a significant role in the success and sustainability of vector control. While coordination among various stakeholders is essential, vector control heavily relies on harnessing local knowledge and skills within the community. Engaging and mobilizing the community involves collaborating with local residents to enhance vector control and build resilience against future disease outbreaks (19). Our systematic review aims to assess the benefits and barriers of community participation in dengue control. Examining the specific benefits of community participation in dengue control is a step towards future planning to reduce the burden of dengue disease and identifying the barriers to community participation is necessary to develop effective and sustainable interventions in dengue control.

Methods

Search strategies

This study used the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guidelines (PRISMA) (20). The article search was carried out on 20 September-10 October 2023 and was carried out by the first researcher. The research used several journal databases: PubMed, ScienceDirect, Scopus, ProQuest, and Web of Science, as well as manual searches. The study was limited to papers published during the period 2013 to 2023, in order to engender recency of information. This Systematic Reviews has been registered on Prospero with number ID CRD42023479727. The search strategy for database journals is presented in Table 1.

Inclusion and exclusion criteria

The inclusion criteria used in this research include (1) original articles, (2) articles in English, and (3) open access, (4) article that involve community participation in dengue control, providing information on at least one benefit or barrier of community participation in dengue control. The exclusion criteria were already published on the subject matter as reviews, systematic reviews, or meta-analyses.

Data extraction

The first step in extracting data was to determine the same articles (duplicates) based on the article title, and then duplicate articles were deleted. The next step was to evaluate the articles based on the titles and abstracts. The titles and abstracts that did not meet the requirements according to the criteria were removed. Papers that meet the inclusion and exclusion criteria will be reviewed in full text. Articles were categorized into two groups--those that reported barriers and those that dealt with benefits. Reviewers worked independently to synthesize relevant information. Information about the authors, objectives, methods, key findings, and other pertinent data addressing the research objectives were extracted.

Results

Reporting results and study selection

The initial electronic search yielded 1622 articles, which were subsequently reduced to 714 after filtering based on keywords and criteria such as publication year, article type, language (English), and other relevant factors. Duplicate articles were also removed during this process. Following the screening of titles and abstracts, 58 articles were selected for more in-depth review by examining the full text, as depicted in Figure 1. After thorough scrutiny of the full texts, 16 articles met all the inclusion criteria for this review.

Among these, ten articles focused on highlighting the benefits of community participation in dengue control, with nine being quantitative studies (experimental) and two employing mixed methods. On the other hand, six articles concentrated on exploring the barriers to community participation in dengue control. The breakdown of these studies revealed that three were qualitative, one was observational, and two utilized mixed methods. The characteristics of the studies and their key findings are summarized in Table 2.

From the results of Table 3 above, it is shown that several studies have revealed various approaches involving community participation in dengue prevention and control, successfully reducing entomological indicators such as House Index (HI), Container Index (CI), Breteu Index (BI), Pupa per Person Index (PPI), and other entomological indicators, as well as improving knowledge, attitudes, and practices in dengue prevention among the community. Various community-based approaches are used, including the eco-bio-social approach, ecosystem-based interventions, positive deviance approach, community peer approach, formation of mosquito breeding site eradication groups, and involving communities in other activities such as community empowerment and community-based dengue fever reporting. In involving community participation in dengue control, there are various field barriers that must be overcome as the basis for future policymaking. These barriers include individual factors such as the level of knowledge, attitudes, self-efficacy, community trust, lack of interest, awareness, and community readiness, as well as low motivation among the community. Meanwhile, from the community factor perspective, there is a lack of support from community leaders and organizations, high insecticide use by the community, weak community efforts, weak community relations with the Department of Health/NGOs, and low social capital. The next factors based on the review results contributing to involving community participation in dengue control are societal factors such as excessive workload and lack of communication skills in the health sector, lack of detailed policy guidelines and weak enforcement of dengue-related policies or regulations, as well as limited budgets and resources.

Discussion

Community participation involves the direct involvement of communities or groups at risk of dengue impact (16). Community participation in dengue control can take various forms or approaches, including community-based environmental management and community empowerment programs (36,37).

Benefit of community participation

The review findings indicate that dengue control, employing various strategies along with community participation, yields benefits in the success of the conducted interventions. Numerous studies suggest that actively involving the community, whether through education, empowerment, or direct engagement in preventive activities, has a significant positive impact on reducing the Aedes aegypti mosquito population and enhancing community knowledge, attitudes, and behaviors related to dengue control. Another study reveals that, in addition to knowledge, the attitudes and behaviors of community involvement will facilitate acceptance and strengthen a sense of ownership in the community. With a sense of ownership, not only does it encourage communities to actively participate in developing plans, but it also helps sustain the intervention over time through the use of community-based monitoring and accountability mechanisms (38).

Dengue control through community participation can be carried out directly by empowering the community or combined with various other activities. Some examples of activities involving direct community empowerment include the positive deviance approach, where positive deviance groups are used as role models. This approach can be an effective tool for changing community knowledge, attitudes, and behaviors in efforts to prevent and control dengue (23). The next direct community empowerment activity involves enhancing the capacity of community peers to provide education and eradicate dengue-transmitting mosquito habitats (26). This includes forming vector control groups to be trained in and conduct vector control measures such as eliminating mosquito breeding sites, cleaning the environment, and covering water storage containers (22,25,27,28). As for empowerment activities combined with other measures, they include empowering communities in vector control combined with the distribution of larvivorous fish (24). as well as combined with the distribution of mosquito-repellent plants (29). Eco-biosocial interventions consist of school-based education, a program to eradicate mosquito breeding sites, and active community participation (21). Lastly, the ecosystem-based community participation program involves forming groups, identifying and prioritizing community problems, educating the community, collaborating between government and regional leaders to establish mosquito control regulations, and implementing community-based reporting of dengue fever cases (30).

Based on the points presented above, it is crucial to consistently involve the community in dengue control efforts. The expansion of public education programs on dengue and its prevention will enhance community understanding and awareness of the disease's dangers. Furthermore, the implementation of the positive deviance approach can serve as an effective intervention example that engages the community to encourage necessary behavioral changes in dengue prevention. The formation of strong and trained vector control groups is also necessary to effectively manage the environment and reduce populations of disease-carrying mosquitoes. Additionally, the integration of ecological solutions such as larvivorous fish or mosquito-repellent plants can provide an additional environmentally friendly approach to vector control. Close cooperation between the government, local leaders, and the community is required to coordinate dengue control efforts effectively. Finally, periodic evaluations of implemented programs will help identify successes and areas for improvement, enabling these programs to be continuously refined and adapted to meet community needs. By taking these steps, it is hoped that dengue control efforts can become more effective and sustainable in the future.

Barriers to community participation

Community participation plays a crucial role in dengue control practices. Various factors causing low community participation in dengue control efforts are important to identify for policy-making and future intervention planning. Several studies have revealed that the low community participation in dengue control is attributed to several factors. As for these factors, they belong to the individual factor category, which includes knowledge, attitude, selfefficacy, lack of interest, awareness, community readiness, trust, and low motivation within the community (31,32,34,35). The next factor is the community factor, which comprises lack of support from community leaders and organizations, high insecticide use by the community, weak community efforts, weak community relations with the Department of Health/NGOs, and low social capital (18,32,33). The next factors based on the review results contributing to involving community participation in dengue control are societal factors such as excessive workload and lack of communication skills in the health sector, lack of detailed policy guidelines and weak enforcement of dengue-related policies or regulations, as well as limited budgets and resources (32,34).

It is important in the future in health interventions especially in dengue control to involve and empower the community, in community empowerment for example it is very important to consider factors that affect the ability of the community to fully engage in information, consultation, participation, and empowerment initiatives (39). Furthermore, communities reside in areas with barriers to vector control participation are highly vulnerable to future outbreaks. Moving forward, control strategies should target these at-risk areas as well as regions within dengue transmission zones (40).

Conclusion

Various activities involving community participation in dengue fever control have proven effective in reducing entomological indicators such as House Index (HI), Container Index (CI), Breteau Index (BI), Pupa Index per person (PPI), and other entomological indicators, while also positively impacting the knowledge, attitudes, and practices of the community in dengue control. Barriers to community participation in dengue control include individual factors, community factors, and societal factors. In developing dengue prevention and control programs, it is important to involve the community and address these various barriers.

Contribution of authors

All Authors participated in the study. IA: analysed data, LS: conceptualized and designed the study, MS: Reviewing the article before submission, FS: Reviewing the article before submission, HJ: collected data, AR: Taking responsibility in the construction of the whole or body of the manuscript. All authors have read and approved the final manuscript.

Acknowledgement

The author would like to express his deepest gratitude to Airlangga University, Muhammadiyah University Pontianak, Indonesian Education Scholarship (BPI) who have been an integral part of all the assistance and support to this article.

References

(1.) WHO. Ending the Neglect to Attain the Sustainable Development Goals - A Road Map for Neglected Tropical Diseases 2021-2030. 2021. Accessed August 26, 2023. https://www.who.int/publications/i/item/9789240010352

(2.) Laserna A, Barahona-Correa J, Baquero L, Castaneda-Cardona C and Rosselli D. Economic impact of dengue fever in Latin America and the Caribbean: a systematic review. Revista Panamericana de Salud Publica. 2018;42. https://doi.org/10.26633/RPSP.2018.111

(3.) Hung TM, Shepard DS, Bettis AA, Nguyen HA, McBride A, Clapham HE and Turner HC. Productivity costs from a dengue episode in Asia: A systematic literature review. BMC Infect Dis. 2020;20(1):1-18. https://doi.org/10.1186/s12879-020-05109-0

(4.) WHO. Dengue and severe dengue. Published 2022. Accessed February 6, 2023. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

(5.) Pham H V., Doan HTM, Phan TTT and Tran Minh NN. Ecological factors associated with dengue fever in a central highlands province, Vietnam. BMC Infect Dis. 2011;11(1):1-6. https://doi.org/10.1186/1471-2334-11-172

(6.) Ramadhani SN and Latif MT. Impact of Climate Change on Dengue Hemorrhagic Fever (DHF) in Tropical Countries: A Literature Review. Jurnal Kesehatan Lingkungan. 2021;13(4):219-226. https://doi.org/10.20473/JKL.V13I4.2021.219-226

(7.) Arfan I, Rizky A and Hernawan AD. Factors associated with dengue fever prevention practices in endemic area. Int J Publ Health Sci. 2022;11(4):1184-1189. https://doi.org/10.11591/ijphs.v11i4.21784

(8.) Nguyen-Tien T, Do DC, Le XL, Thi HD, Mats L, Hung NV, Ake L, Delia G and Johanna L.. Risk factors of dengue fever in an urban area in Vietnam: a casecontrol study. BMC Public Health. 2021;21(1):664. https://doi.org/10.1186/s12889-021-10687-y

(9.) Ryan SJ, Lippi CA, Nightingale R, Gabriela H, Mercy JBC, Marilyn CB, Fernando O, Renato L, Egan W and Anna MSI. Socio-Ecological Factors Associated with Dengue Risk and Aedes aegypti Presence in the Gal pagos Islands, Ecuador. International Journal of Environmental Research and Public Health 2019, Vol 16, Page 682. 2019;16(5):682. https://doi.org/10.3390/IJERPH16050682

(10.) Tellekolay B, Kumar V, Benkimoun S, Rupali P, Nagpal BN and Richard EP. Social and environmental risk factors for dengue in Delhi city. A retrospective study. PLoS Negl Trop Dis. 2021;15(2):e0009024. https://doi.org/10.1371/JOURNAL.PNTD.0009024

(11.) Rahman MS, Ekalaksananan T, Zafar S, Petchaboon P, Oleg S, Ubydul H, Richard P, Joacim R, Chamsai P and Hans JO. Ecological, Social, and Other Environmental Determinants of Dengue Vector Abundance in Urban and Rural Areas of Northeastern Thailand. Int J Environ Res Public Health. 2021;18(11). https://doi.org/10.3390/IJERPH18115971

(12.) Harvey P, Baghri S and Reed B. Emergency Sanitation: Assessment and Programme Design. WEDC, Loughborough University; 2002.

(13.) Departement Of Health & Human Service USA. Principles Of Community Engagement : Second Edition.; 2011.

(14.) Heritage Z and Dooris M. Community participation and empowerment in Healthy Cities. Health Promot Int. 2009;24 Suppl 1. https://doi.org/10.1093/HEAPRO/DAP054

(15.) Rosato M, Laverack G, Grabman LH, Prasanta T, Nirmala N, Charles M, Kishwar A, Joanna M, Zulfiqar B, Henry P, Susan R and Anthony C. Community participation: lessons for maternal, newborn, and child health. Lancet. 2008;372(9642):962-971. https://doi.org/10.1016/S0140-6736(08)61406-3

(16.) Tapia-Conyer R, Mendez-Galvan J and Burciaga-Zuniga P. Community participation in the prevention and control of dengue: the patio limpio strategy in Mexico. Paediatr Int Child Health. 2012;32 Suppl 1(s1):10-13. https://doi.org/10.1179/2046904712Z.00000000047

(17.) Sri-Pathmanathan C, Bao H, Diluka PAE, Alan M, Bekti A, Saunders E, Wijegunawardana A, Indika W, Nimalka PH, Sudath S, Weiming T and Joseph DT. Enhancing Community Participation in Dengue Control Through Digital Crowdsourcing: An Analysis of a World Mosquito Program Digital Open Call in Sri Lanka. J Infect Dis. 2023;228(11):1482-1490. https://doi.org/10.1093/INFDIS/JIAD439

(18.) Zahir A, Ullah A, Shah M and Mussawar A. Community Participation, Dengue Fever Prevention and Control Practices in Swat, Pakistan. Int J MCH AIDS. 2016;5(1):39. https://doi.org/10.21106/IJMA.68

(19.) WHO. Engaging communities to sustain dengue vector control. Published 2023. Accessed December 13, 2023. https://www.who.int/activities/engaging-communities-to-sustain-dengue-vector-control

(20.) Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Roger C, Julie Glanville, Grimshaw JM, Asbjorn H, Manoj ML, Tianjing L, Elizabeth WL, Evan MW, Steve M, Luke AM, Lesley AS, James T, Andrea CT, Welch VA, Penny W and David M. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/BMJ.N71

(21.) Mitchell-Foster K, Ayala EB, Breilh J, Jerry S, Wilches AA, Tania OL and Jefferson AD. Integrating participatory community mobilization processes to improve dengue prevention: An eco-bio-social scaling up of local success in Machala, Ecuador. Trans R Soc Trop Med Hyg. 2015;109(2):126-133. https://doi.org/10.1093/trstmh/tru209

(22.) Basso C, da Rosa EG, Romero S, Gonzalez C, Lairihoy R, Ingrid R, Ruben MC, Ricardo dR, Marisel C, Eduardo AS, Max P, Axel K and Johannes S. Improved dengue fever prevention through innovative intervention methods in the city of Salto, Uruguay. Trans R Soc Trop Med Hyg. 2015;109(2):134-142. https://doi.org/10.1093/trstmh/tru183

(23.) Shafique M, Mukhtar M, Areesantichai C and Perngparn U. Effectiveness of Positive Deviance, an AssetBased Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study. Insects. 2022;13(1). https://doi.org/10.3390/insects13010071

(24.) Hustedt JC, Doum D, Keo V, Ly S, Sam B, Chan V, Alexander N, Bradley J, Liverani M, Prasetyo DB, Rachmat A, Shafique M, Lopes S, Rithea L and Hii J.. Field Efficacy of Larvivorous Fish and Pyriproxyfen Combined with Community Engagement on Dengue Vectors in Cambodia: A Randomized Controlled Trial. Am J Trop Med Hyg. 2021;105(5):1265-1276. https://doi.org/10.4269/AJTMH.20-1088

(25.) Gopalan RB, Babu BV, Sugunan AP, Murali A, Ma MS, Balasubramanian R and Philip S.. Community engagement to control dengue and other vector-borne diseases in Alappuzha municipality, Kerala, India. Pathog Glob Health. 2021;115(4):258-266. https://doi.org/10.1080/20477724.2021.1890886

(26.) Healy K, Hamilton G, Crepeau T, Healy S, Unlu I, Farajollahi A and Fonseca DM. Integrating the Public in Mosquito Management: Active Education by Community Peers Can Lead to Significant Reduction in Peridomestic Container Mosquito Habitats. PLoS One. 2014;9(9). https://doi.org/10.1371/JOURNAL.PONE.0108504

(27.) Bigio J, Braack L, Chea T, Set S, Suon S, Echaubard P, Hustedt J, Debackere M, Ramirez B, Prasetyo DB, Bunleng S, Wharton-Smith A and Hii J.. Entomological outcomes of cluster-randomised, community-driven dengue vector-suppression interventions in Kampong Cham province, Cambodia. PLoS Negl Trop Dis. 2022;16(1). https://doi.org/10.1371/JOURNAL.PNTD.0010028

(28.) Andersson N, Nava-Aguilera E, Arostegui J, Morales-Perez A, Suazo-Laguna H, Legorreta-Soberanis J, Hernandez-Alvarez C, Fernandez-Salas I, Paredes-Solis S, Balmaseda A, Cortes-Guzman AJ, Serrano de Los Santos R, Coloma J, Ledogar RJ and Harris E.Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial. BMJ. 2015;351. https://doi.org/10.1136/BMJ.H3267

(29.) Farich A, Lipoeto NI, Bachtiar H and Hardisman H. The effects of community empowerment on preventing dengufever in Lampung Province, Indonesia. Open Access Maced J Med Sci. 2020;8:194-197. https://doi.org/10.3889/oamjms.2020.4192

(30.) Newton-Sanchez OA, de la Cruz Ruiz M, Torres-Rojo Y, Ochoa-Diaz-L pez H, Delgado-Enciso I, Hernandez-Suarez CM and Espinoza-Gomez F. Effect of an ecosystem-centered community participation programme on the incidence of dengue. A field randomized, controlled trial. Int J Public Health. 2020;65(3):249-255. https://doi.org/10.1007/S00038-020-01345-Y

(31.) Elsinga J, van der Veen HT, Gerstenbluth I, Burgerhof JGM, Dijkstra A, Grobusch MP, Tami A and Bailey A. Community participation in mosquito breeding site control: an interdisciplinary mixed methods study in Cura ao. Parasit Vectors. 2017;10(1). https://doi.org/10.1186/S13071-017-2371-6

(32.) Nguyen-Tien T, Probandari A and Ahmad RA. Barriers to engaging communities in a dengue vector control program: An implementation research in an urban area in Hanoi city, Vietnam. American Journal of Tropical Medicine and Hygiene. 2019;100(4):964-973. https://doi.org/10.4269/ajtmh.18-0411

(33.) Asri, Nuntaboot K and Festi Wiliyanarti P. Community social capital on fighting dengue fever in suburban Surabaya, Indonesia: A qualitative study. Int J Nurs Sci. 2017;4(4):374. https://doi.org/10.1016/J.IJNSS.2017.10.003

(34.) Allen T, Crouch A, Russell TL and Topp SM. Factors influencing the community participation approaches used in Aedes mosquito management in the Torres Strait, Australia. BMC Public Health. 2023;23(1). https://doi.org/10.1186/S12889-023-16942-8

(35.) Sulistyawati S, Dwi Astuti F, Rahmah Umniyati S, Tunggul Satoto TB, Lazuardi L, Nilsson M, Rocklov J, Andersson C and Holmner A. Dengue vector control through community empowerment: Lessons learned from a community-based study in Yogyakarta, Indonesia. Int J Environ Res Public Health. 2019;16(6). https://doi.org/10.3390/ijerph16061013

(36.) Lin H, Liu T, Song T, Lin L, Xiao J, Lin J, He J, Zhong H, Hu W, Deng A, Peng Z, Ma W and Zhang Y. Community Involvement in Dengue Outbreak Control: An Integrated Rigorous Intervention Strategy. PLoS Negl Trop Dis. 2016;10(8):e0004919. https://doi.org/10.1371/JOURNAL.PNTD.0004919

(37.) Vanlerberghe V, Toledo ME, Rodr guez M, Gomez D, Baly A, Benitez JR and Van der Stuyft P. Community involvement in dengue vector control: cluster randomised trial. BMJ. 2009;338(7709):1477-1479. https://doi.org/10.1136/BMJ.B1959

(38.) Okonofua F, Ugiagbe R and Ntoimo L. Fostering sustainable malaria prevention and elimination in Africa. Afr J Reprod Health. 2022;26(1). https://doi.org/10.29063/ajrh2022/v26i1.1

(39.) Mthembu Z and Chimbari M. Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community. Front Public Health. 2023;11. https://doi.org/10.3389/FPUBH.2023.1050589

(40.) Lee SA, Economou T, Catao R de C, Barcellos C and Lowe R. The impact of climate suitability, urbanisation, and connectivity on the expansion of dengue in 21st century Brazil. PLoS Negl Trop Dis. 2021;15(12) https://doi.org/10.1371/JOURNAL.PNTD.0009773.

Iskandar Arfan (1,7), Lilis Sulistyorini (2*), Muji Sulistyowati (3), Fariani Syahrul (4), Hasrah Junaidi (5) and Ayu Rizky (6)

Doctorate Degree Program in Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya, 60115, Indonesia (1); Department of Environmental Health, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia (2); Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Universitas Airlangga, Surabaya, 60115, Indonesia (3); Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, 60115, Indonesia (4); Department of Public Health, Universitas Teuku Umar, Aceh, 23681, Indonesia (5); Department of Health Administration, Institut Teknologi dan Kesehatan Muhammadiyah Kalimantan Barat, Kuburaya, 78117, Indonesia (6); Department of Public Health, Universitas Muhammadiyah Pontianak, 78123, Indonesia (7)

(*) For Correspondence: Email: [emailprotected]; Phone: +6285231118222

DOI: 10.29063/ajrh2024/v28i10s.49

Table 1: Search strategy in selected databaseDatabase Search strategy (((((((("community participation") OR ("community-based")) OR ("community engagement")) OR ("communityPubMed involvement")) OR ("community empowerment")) OR ("community mobilization")) AND (dengue)) OR ("dengue fever")) AND (barriers) ("community participation" OR "community-based" ORScienceDire "community engagement" OR "community involvement" ORct "community empowerment" OR "community mobilization") AND (dengue OR "dengue fever") AND (barriers) TITLE-ABS-KEY ("community participation") OR ( "community-based") OR ("community engagement") OR (Scopus "community involvement") OR ("community empowerment" ) OR ("community mobilization") AND (dengue) OR ( "dengue fever") AND (barriers) ((((((((ALL=("community participation")) OR ALL=("community-based")) OR ALL=("communityWeb of engagement")) OR ALL=("community involvement")) ORScience ALL=("community empowerment")) OR ALL=("community mobilization")) AND ALL=(dengue)) OR ALL=("dengue fever")) AND ALL=(barriers) ("community participation" OR "community-based" OR "community engagement" OR "community involvement" ORProQuest "community empowerment" OR "community mobilization" ) AND (dengue OR "dengue fever") AND (barriers) NOT ("meta-analysis" OR review)Database Filter Number of Articles Year: 2013-- 2023, Language:PubMed English 54 Text availability: Full Text Year:2013--ScienceDire 2023, Research 134ct article 2018-2023, Document type: ArticleScopus Source type: 376 Jurnal Language: English Year:2013-- 2023, DocumentWeb of Type: ArticleScience Language: English Year:2013-- 2023,ProQuest Full text 42 Article Language English

Table 2: Results of journal collection and analysisNo First Author, (Year) Study AimsBenefit 1 Kendra Mitchell- Researching the effectiveness Foster et al (2015) (21). of the eco-bio-social approach for dengue fever prevention compared to the existing insecticide and biolarvicide- based programs in an endemic area in Machala, Ecuador. 2 Cesar Basso et al The research aims to develop (2015) (22). and evaluate innovative intervention methods for preventing Dengue in Salto, Uruguay. 3 Muhammad Shafique Testing the effectiveness of et al. (2022) (23). the positive deviance approach in enhancing knowledge, attitudes, and practices related to dengue prevention in the impoverished community of Islamabad, Pakistan. 4 John Christian Hustedt Evaluating the effectiveness of et al. (2021) (24). utilizing larvivorous fish (guppy) in conjunction with the use of pyriproxyfen larvicide and community involvement in reducing the entomological indices of Aedes mosquitoes in Kampong Cham, Cambodia. 5 Retheesh Babu Evaluating the effectiveness of Gopalan et al. community-based (2021) (25). interventions to control vector- borne diseases such as dengue fever and other illnesses in Alappuzha municipality, Kerala, India. 6 Kristen Healy et al Testing the effectiveness of a (2014) (26). community peer education program in reducing mosquito habitats of various types, especially Aedes albopictus. 7 Jacob Bigio.et al To assess the impact of an (2022) (27). ecological-based (biophysical) and socially-involved (community engagement) dengue vector control strategy in schools and household communities in Kampong Cham Province, Cambodia. 8 Neil Andersson, et al. To test whether community (2020) (28). mobilization can enhance the effectiveness of dengue control. 9 Achmad Farich et al This study aims to analyze the (2020) (29). effects of community empowerment in preventing dengue fever in Lampung Province, Indonesia.10 Oscar Alberto Analyzing the impact of an Newton-Sanchez et al ecosystem-based community (2020) (30). participation program on dengue fever incidence in urban communities in the state of Colima, Mexico.Barriers11 Abdul Zahir et al Determining the role of (2016) (18). community participation in dengue prevention in the Swat District located in the Northern Region of Khyber Pakhtunkhwa, Pakistan.12 Jelte Elsinga et al. This study aims to explore (2017) (31). community participation in efforts to enhance Mosquito Breeding Site Control (MBSC) and to design interventions that can improve community involvement in mosquito breeding site control in Curacao.13 Thang Nguyen-Tien et Exploring barriers in al. (2019) (32). implementing dengue vector control programs in urban areas in Hanoi.14 Asri et al. (2017) (33). To describe the social capital within a community in combating Dengue Hemorrhagic Fever (DHF)15 Tammy Allen et al To explore community (2023) (34). participation approaches used in the management of Aedes mosquitoes and the factors influencing the choice of these approaches in Torres Strait, Australia.16 Sulistyawati et al Identifying the knowledge, (2019) (35). attitudes, and practices of the community regarding dengue prevention and testing the community empowerment- based control card intervention to improve container cleaning practices.No DesignBenefit 1 Cluster randomized controlled trial 2 Cluster randomized controlled trial 3 Mixed method 4 A Randomized Controlled Trial 5 Quasy-eksperimental design 6 Quasi-experimental design 7 Cluster-randomised trial 8 Cluster randomized controlled trial 9 Quasi-eksperimental10 Randomized controlled trialBarriers11 Crossectional12 Mixed Methods13 Qualitative Research14 Qualitative Reseach15 Qualitative Reseach16 Mixed method Phase 1 Crossectional Phase 2 ExperimentsNo ResultBenefit 1 The eco-bio-social approach, consisting of three key intervention programs school- based education, mosquito breeding site eradication program, and active community participation has successfully reduced the Pupa per Person Index (PPI) and increased community awareness in the prevention and control of dengue fever. 2 Ecosystem-based intervention involving community participation (removal of unused water containers, improved environmental management, and covering large water tanks) conducted in Salto, Uruguay, reduced the number of breeding sites for Aedes aegypti mosquitoes compared to the control group implementing routine measures in the dengue prevention program although not to statistically significant levels). A larger sample size is needed to obtain a statistically significant difference. 3 The Positive Deviance (PD) approach can enhance knowledge, attitudes, and behaviors related to dengue in communities by utilizing positive deviant groups as role models. Research results also indicate that the PD approach can be adopted as an effective tool for community engagement and behavior change related to health in communities in Indonesia and potentially elsewhere. 4 The combination of using larvivorous fish, pyriproxyfen larvicide (Sumilarv[R] 2MR), and community involvement is an effective method in reducing the Aedes mosquito population in the Kampong Cham region, Cambodia. 5 Community-based interventions involving the formation of community groups engaged in vector control, such as the establishment of resident committees and activities aimed at reducing mosquito breeding sites, can enhance community involvement in vector control activities and reduce vector indices before and after interventions. 6 Empowering trained volunteers (community peers) to provide education and encourage the community to take significant actions in reducing mosquito habitats has led to a substantial decrease in the number of mosquito breeding sites in residential areas. 7 The intervention involving biophysical methods (biological larval control, adult Aedes control, breeding site container covers, solid waste management) and community engagement (education and training, communication and behavior change, participatory mapping) successfully reduced entomological indicators more effectively than the control group. 8 Community mobilization interventions (group discussions, formation of intervention design groups, community volunteer training) are effective in dengue control. The intervention group shows a lower risk of dengue virus infection in children, fewer reports of dengue cases, fewer houses with larvae or pupae among visited homes (house index), fewer containers with larvae or pupae among inspected containers (container index), fewer containers with larvae or pupae among visited homes (Breteau index), and fewer pupae per person. 9 That there is a positive effect of community empowerment (building capacity and planting mosquito-repelling plants) on knowledge, attitudes, and behaviors as well as entomological indicators (larval-free houses, house index, Breteau index) in the intervention group, while no difference was found in the container index between the intervention and control groups. 10 That the implementation of an ecosystem- based community participation program (formation of specialized groups, identification of issues in each community and prioritization of these issues, community education, government and local leader cooperation in creating mosquito control regulations, community- based reporting of dengue cases) can reduce Aedes aegypti larvae in the intervention group measured by the Breteau Index, but has a limited impact on dengue incidence.Barriers 11 Several community participation factors influencing control practices include community organization for dengue mosquito eradication, community leaders, community efforts, insecticide use by the community, and community involvement in awareness campaigns, dissemination of information among the community, community relations with health departments/NGOs, and other institutions for dengue control. 12 Barriers to practicing MBSC include government support, knowledge, attitudes, and self-efficacy (individual's perception of their ability to act) in conducting MBSC. Interventions (using media and education, enhancing government actions, involving key individuals in the community to motivate) can improve MBSC in the environment. 13 The barriers to implementing effective community engagement are as follows: 1) lack of interest and dependence on actions from the local health sector committee, 2) lack of enthusiasm from mass organizations and community leaders, 3) excessive workload and lack of communication skills from the health sector, 4) low awareness and readiness of the community, 5) lack of detailed policy guidelines and low enforcement of related policies, and 6) limited budget. 14 Social Capital: Forming social groups, Sector collaboration, Community voluntary work, Support from local leaders. 15 The research results indicate that various community participation approaches are employed in two main Aedes mosquito management programs in Torres Strait, namely the Aedes albopictus Elimination Program and the Torres Strait Regional Island Council Environmental Health Program. These approaches are chosen for reasons related to regulations, attitudes and beliefs, and resources. 16 Community knowledge about preventing dengue fever is quite low. The attitudes and practices of the community in preventing dengue fever are relatively good, although there are still some areas that need improvement. The use of control cards as a standalone intervention is not effective in enhancing container cleaning practices. Active community participation in dengue vector control programs needs improvement, involving the community in campaigns and education.No Key FindingBenefit 1 The eco-bio-social approach, involving active community participation, can be an effective alternative for dengue fever prevention and control programs. 2 Ecosystem-based interventions involving active community participation can reduce the population of Aedes aegypti mosquitoes, but statistically significant evidence is lacking and larger samples are needed to prove it 3 The implementation of the Positive Deviance approach as a form of participatory approach in the community can enhance knowledge, attitudes, and practices for preventing the spread of dengue fever in impoverished communities in Islamabad, Pakistan. 4 The intervention involving the use of larvivorous fish, larvicides, and community engagement is an effective method in reducing the population of Aedes mosquitoes. 5 Community-involved interventions result in positive changes in community behavior towards vector control and can reduce vector indices before and after the intervention. 6 The approach involving trained volunteers (community peers) actively providing education and encouraging action has successfully engaged the community in mosquito control, ultimately leading to a reduction in the number of adult mosquitoes in the area. 7 This combined package of biophysical interventions and community engagement is highly effective in reducing the entomological indices that contribute to dengue fever. 8 Community mobilization (group discussions, formation of intervention design groups, community volunteer training) can enhance the effectiveness of dengue control. 9 That community empowerment (building capacity and planting mosquito-repelling plants) can enhance knowledge, attitudes, and behaviors in preventing dengue fever. Community empowerment also aids in improving entomological factors (larval-free houses, house index, Breteau index). 10 Community participation programs with an ecosystem approach can reduce Aedes larvae, measured through the Breteau Index.Barriers 11 Organizing, community leaders, community efforts, insecticide use by the community, and community involvement in awareness campaigns, dissemination of information among the community, community relations with health departments/NGOs, and other institutions have an impact on dengue control practices. 12 Several barriers to community involvement in dengue control include inadequate government support, low knowledge, attitudes, and the community's low self-efficacy in engaging in dengue control. 13 Lack of community interest and attitude, insufficient enthusiasm from mass organizations and community leaders, heavy workload and lack of communication skills from the health sector, low awareness and readiness of the community, lack of detailed policy guidelines and low enforcement of policies, and limited budget are barriers to enhancing participation in dengue control. 14 social capital dapat digunakan untuk memperkuat keterlibatan komunitas dalam pencegahan demam berdarah dengue. 15 The study also provides recommendations on how to enhance community participation in Torres Strait, which may also be considered in similar tropical regions. The community participation approaches are selected based on considerations related to regulations, attitudes and beliefs, as well as resources. 16 Interventions involving the community are not successful when community participation is low. There is a need to enhance community participation through campaigns and education. Communities not only require knowledge but also strong motivation to engage in vector control activities, making it essential to implement bottom-up strategies involving the community in the design, implementation, and evaluation of each health intervention.

Table 3: Summary of selected documentAuthor YearBenefitsKendra 2015Mitchell-Foster et alCesar Basso et 2015alMuhammad 2022Shafique et al.John Christian 2021Hustedt et alRetheesh 2021Babu Gopalanet alKristen Healy 2014et alJacob Bigio et 2022alNeil 2020Andersson, etalAchmad 2020Farich et alO A Newton- 2020Sanchez et alBarriersAuthor YearAbdul Zahir et 2016alJelte Elsinga 2017et alThang 2019Nguyen-Tienet alAsri et al. 2017Tammy Allen 2023et alSulistyawati et al. 2019Author Community Participation ApproachBenefitsKendra Eco Bio Social Approach (school-based education,Mitchell- mosquito breeding site eradication program, and activeFoster et al community participation)Cesar Basso et Ecosystem-based intervention (removal of unused wateral containers, improved environmental management, and covering large water tanks)Muhammad Positive Deviance Approach (utilizing positive deviantShafique et al. groups as role models)John Christian Combination Community involvement and usingHustedt et al larvivirous fishRetheesh Community group vector control (establishment ofBabu Gopalan resident committees and activities aimed at reducinget al mosquito breeding sites)Kristen Healy Community Peers to provide education and encourage theet al community to take significant actions in reducing mosquito habitatsJacob Bigio et Community engagement and biopshysical methodsal (biological larval control, adult Aedes control, breeding site container covers)Neil Community mobilization interventions (group discussions,Andersson, et formation of intervention design groups, communityal volunteer training)Achmad community empowerment (building capacity and plantingFarich et al mosquito-repelling plants)O A Newton- ecosystem-based community participation programSanchez et al (formation of groups, identification and prioritization of community problems, community education, collaboration between government and regional leaders to create mosquito control regulations, community-based reporting of dengue fever cases)BarriersAuthor Individual FactorsAbdul Zahir et -alJelte Elsinga Knowledge, attitudes, self-et al efficacyThang Lack of interest, awarenessNguyen-Tien and readiness of theet al communityAsri et al. -Tammy Allen Attitude and Belief ofet al communitySulistyawati Motivation of communityet al.Author Benefit Community Participation for Dengue Reducing Entomological IndicatorsBenefitsKendra [check]Mitchell-Foster et alCesar Basso et [check]alMuhammad -Shafique et al.John Christian [check]Hustedt et alRetheesh [check]Babu Gopalanet alKristen Healy [check]et alJacob Bigio et [check]alNeil [check]Andersson, etalAchmad [check]Farich et alO A Newton- [check]Sanchez et alBarriersAuthor Community FactorsAbdul Zahir et Community Leader,al insecticide use by the community, community effort, community relationship with health department/NGOsJelte Elsinga -et alThang Lack of enthusiasm fromNguyen-Tien mass organizations andet al community leadersAsri et al. Social Capital: Forming social groups, Sector collaboration, Community voluntary work, Support from local leadersTammy Allen -et alSulistyawati et al. -Author Increase Knowledge/ Attitude/ PracticeBenefitsKendra [check]Mitchell-Foster et alCesar Basso et -alMuhammad [check]Shafique et al.John Christian -Hustedt et alRetheesh -Babu Gopalanet alKristen Healy -et alJacob Bigio et -alNeil -Andersson, etalAchmad [check]Farich et alO A Newton- -Sanchez et alBarriersAuthor Societal FactorsAbdul Zahir et -alJelte Elsinga -et alThang excessive workload and lackNguyen-Tien of communication skills fromet al the health sector, lack of detailed policy guidelines and low enforcement of related policies, limited budget.Asri et al. -Tammy Allen Regulation, Resourceet alSulistyawati et al. -