Factors Associated with Dengue Hemorrhagic Fever Prevention Behavior in Paniki Bawah, North Sulawesi, Indonesia

Abstract

Dengue hemorrhagic fever (DHF) remains a persistent public health problem in Indonesia, including Manado City, where Paniki Bawah has been identified as one of the higher-burden areas. This study examined factors associated with DHF prevention behavior and explored the contextual conditions that either support or hinder routine prevention practices at household level.
A sequential explanatory mixed-methods design was applied. The quantitative phase used a cross-sectional survey of 56 community respondents selected through simple random sampling, followed by in-depth interviews with 8 purposively selected informants, consisting of 6 community members and 2 health workers, to help explain the survey findings. The questionnaire assessed knowledge, attitude, perception, and prevention behavior. Quantitative data were analyzed using chi-square tests and odds ratios (ORs), while qualitative data were transcribed, coded, categorized, and triangulated with observation notes.
Good prevention behavior was reported by 29 of 56 respondents (51.8%). Knowledge was associated with prevention behavior (OR 26.00, 95% CI 3.08-219.39, p < 0.001); attitude was also associated with prevention behavior (OR 4.13, 95% CI 1.28-13.35, p = 0.015); and perception was associated with prevention behavior (OR 8.98, 95% CI 2.68-30.12, p < 0.001). Qualitative findings further showed that preventive behavior was shaped not only by what people knew or believed, but also by infrastructure availability, family support, and the role of health workers. At the same time, fogging and abate distribution were often described as reactive measures introduced after cases had already occurred. In summary, knowledge, attitude, and perception were significantly related to DHF prevention behavior, while enabling and reinforcing factors influenced whether prevention efforts were maintained consistently at household level.