In this pilot-study, we have described the framework of behaviour-change intervention using mobile devices aimed to prevent mosquito-borne arboviruses. In the literature, most studies describe perceptions and knowledge about mosquito-borne arbovirus prevention [16–23] with few reports of interventions using ICTs and behaviour-change theories. Here, as the bivariate and multivariate statistics analysis showed, the pattern of students' attitudes (learners) and behaviours prior to the intervention was quite different from that of the health workers (experts); however, students were able to learn and to perform the target behaviours to control vector mosquito populations. The preliminary outcomes showed significant difference in the prevalence of target behaviour among college students after the behaviour-change intervention.
The review and choice of the theories of behaviour on which the research was based was carried out after an extensive literature review. In fact, some models and theories of behaviour change have been revised in the last decade; however, the WHO guideline continues to be used as reference worldwide [1].
The stage of defining the target behaviours of the intervention involved the participation of managers and workers in the Health Surveillance area, as described in the first pilot study conducted by the group [18]. In this work, we defined 10 target behaviours for educational actions; however, most participants suggested reducing this number focusing on what was most relevant. In addition, the health workers also emphasized, in their evaluation comments, the importance of highlighting window screening and the valorisation of recycling and donation of recyclable materials to collectors, activities that are not the target of the more traditional actions of Health Surveillance. Besides this, the health workers pointed out that most of the mosquito breeding is found in water containers; especially water tanks that stay in the backyards and are used during the dry season, when the water service is offered only two of the seven days of the week.
The use of the distance-learning platform has not been well evaluated by the participants for use with high school students, since it is quite complex and with multiple functionalities; for this reason, and to facilitate the monitoring of the competition activities, the group decided to develop a software (ZikaMob), that can also account for interactions on social networks. The health workers have produced videos explaining the target behaviours for the prevention of mosquito-borne arboviruses and have published them on social networks. This strategy had never been used before by these professionals. In fact, the experiences of using social networks to perform health education actions by Health Surveillance services in Brazil are still very much incipient.
Regarding the preliminary results, as already pointed out in the literature, the main predictor of behaviour change is already having previously targeted behaviour or related behaviours [1, 2, 4, 5]. Mangueira et al. (2019) [12], for example, found that military police officers, who are trained to keep everything clean and organized, inspect their homes to identify mosquito breeding sites more often than do college students. The present work, however, shows that stimulating domestic activities among young people can contribute to them developing arboviral prevention behaviours as adults.
The educational intervention did not contribute to increasing the students' fear; on the contrary, they felt safer and the perception of susceptibility decreased over time. The fact that students perform preventive actions may have contributed to reduce their fear of acquiring the disease. In fact, data on the mortality rates of mosquito-borne arboviruses or information that made students reflect on the severity of these diseases were not included in educational activities. Other published studies have shown that some risk groups, such as pregnant women, have a different perception of susceptibility to mosquito-borne arboviruses [24].
Whether or not living at home and in a region most at risk for mosquito breeding sites did not imply more behaviours that are preventive. In fact, in the health workers group, participants with higher household risk showed more target behaviours in relation to the elimination of mosquito breeding sites. In the literature, some studies have shown that the perception of those residing in risk areas is different from those in areas with lower risk [25], and there are differences between those who live in urban and rural areas [22]. Further studies should explore the factors that influence the feeling of being at risk of acquiring mosquito-borne arboviruses to support the planning of behaviour-change interventions.
Finally, the main limitation of this pilot study was the sample. The Health Department of Campina Grande did not allow the participation of more than 50 health workers, because they needed to spend some time of the week to perform the educational activities of the course, so they could not work. At the university, first-year college students had to perform preventive activities during the weekends because of their university agenda. Further studies involving high-school students should consider the time needed to perform the activities at home, to produce the videos and to publish on social media as a limitation for engagement.