Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP)
Abstract
:1. Introduction
Approach
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Electronic Survey Development
2.4. Covariates and Outcomes
2.5. Statistical Analysis
2.6. Ethics and Data Confidentiality
3. Results
3.1. Survey Response Rates
3.2. Sociodemographic Characteristics of Participants
3.3. Knowledge, Attitudes, and Practices Toward Dengue
3.4. Capability, Opportunity, and Motivation Toward Dengue, Dengue Prevention, and Vaccinations
3.5. Willingness to Vaccinate Against Dengue Disease
3.6. Behavioral Levers That Can Potentially Drive Vaccine Acceptance
3.7. Trusted Channels for Healthcare Information
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographic | Sociodemographic | Global (N = 3800) | Argentina (N = 600) | Brazil (N = 600) | Colombia (N = 600) | Mexico (N = 600) | Indonesia (N = 600) | Malaysia (N = 400) | Singapore (N = 400) |
---|---|---|---|---|---|---|---|---|---|
Gender | Male | 48% | 49% | 46% | 49% | 45% | 51% | 46% | 47% |
Age | 18–30 years old | 35% | 36% | 34% | 38% | 39% | 31% | 40% | 23% |
31–40 years old | 26% | 25% | 26% | 25% | 24% | 28% | 26% | 26% | |
41–50 years old | 22% | 22% | 22% | 21% | 20% | 24% | 19% | 26% | |
51–60 years old | 18% | 17% | 18% | 16% | 17% | 18% | 15% | 26% | |
Household Size | Live alone | 7% | 15% | 9% | 5% | 5% | 4% | 4% | 8% |
1–2 members | 19% | 25% | 31% | 17% | 15% | 10% | 13% | 21% | |
3–4 members | 52% | 44% | 49% | 54% | 54% | 60% | 48% | 53% | |
5–6 members | 19% | 14% | 10% | 20% | 22% | 23% | 26% | 17% | |
>6 members | 4% | 3% | 1% | 4% | 5% | 3% | 9% | 3% | |
Religion | Christianity | 53% | 68% | 61% | 83% | 80% | 14% | 16% | 27% |
Islam | 18% | 0% | 0% | 0% | 0% | 81% | 43% | 7% | |
Buddhism or Taoism | 8% | 0% | 0% | 0% | 0% | 3% | 32% | 40% | |
Hinduism | 1% | 0% | 0% | 0% | 0% | 0% | 3% | 4% | |
Others | 6% | 8% | 20% | 4% | 4% | 2% | 1% | 2% | |
No religion | 14% | 25% | 19% | 13% | 16% | 0% | 5% | 20% | |
Education Level | No formal education | 0% | 1% | 1% | 0% | 0% | 0% | 0% | 0% |
Primary education | 2% | 3% | 6% | 2% | 1% | 1% | 0% | 0% | |
Secondary education | 31% | 46% | 50% | 27% | 20% | 31% | 18% | 14% | |
Tertiary education | 60% | 46% | 37% | 63% | 71% | 64% | 74% | 73% | |
Post-tertiary education | 7% | 4% | 6% | 8% | 8% | 4% | 8% | 13% | |
Level of Income | High | 14% | 10% | 8% | 5% | 17% | 15% | 20% | 30% |
Medium | 43% | 50% | 39% | 37% | 40% | 48% | 40% | 45% | |
Low | 43% | 40% | 53% | 58% | 43% | 38% | 40% | 25% | |
Prior Dengue Infection | Yes | 28% | 10% | 46% | 31% | 26% | 38% | 27% | 15% |
Vaccinated against COVID-19 | Yes | 94% | 91% | 94% | 94% | 94% | 95% | 97% | 93% |
Vaccinated against influenza | Yes | 52% | 53% | 80% | 57% | 76% | 21% | 24% | 37% |
Base | Mean | SD | High Willingness (Score: 10–8) | Medium Willingness (Score: 7–4) | Low Willingness (Score: 3–0) | |||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | |||||
Global | Global | 3800 | 7.3 | 2.4 | 1996 | 53% | 1513 | 40% | 291 | 8% |
Region | Latin America | 2400 | 7.6 | 2.4 | 1428 | 60% | 798 | 33% | 174 | 7% |
Asia Pacific | 1400 | 6.8 | 2.2 | 568 | 41% | 715 | 51% | 117 | 8% | |
Country | Argentina | 600 | 7.2 | 2.7 | 319 | 53% | 216 | 36% | 65 | 11% |
Brazil | 600 | 8.0 | 2.2 | 393 | 66% | 179 | 30% | 28 | 5% | |
Colombia | 600 | 7.4 | 2.5 | 333 | 56% | 215 | 36% | 52 | 9% | |
Mexico | 600 | 7.9 | 2.2 | 383 | 64% | 188 | 31% | 29 | 5% | |
Indonesia | 600 | 7.3 | 2.1 | 307 | 51% | 259 | 43% | 34 | 6% | |
Malaysia | 400 | 6.8 | 2.0 | 161 | 40% | 211 | 53% | 28 | 7% | |
Singapore | 400 | 6.0 | 2.2 | 100 | 25% | 245 | 61% | 55 | 14% | |
Gender | Male | 1811 | 7.4 | 2.3 | 988 | 55% | 696 | 38% | 127 | 7% |
Pregnant women | 109 | 7.4 | 2.2 | 60 | 55% | 43 | 39% | 6 | 6% | |
Non-pregnant women | 1880 | 7.2 | 2.5 | 948 | 50% | 774 | 41% | 158 | 8% | |
Age | Legal age–30 yo | 1316 | 7.2 | 2.2 | 633 | 48% | 593 | 45% | 90 | 7% |
31–40 yo | 977 | 7.4 | 2.4 | 529 | 54% | 381 | 39% | 67 | 7% | |
41–50 yo | 837 | 7.5 | 2.5 | 482 | 58% | 288 | 34% | 67 | 8% | |
51–60 yo | 670 | 7.2 | 2.6 | 352 | 53% | 251 | 37% | 67 | 10% | |
Endemic Region | Endemic | 2318 | 7.3 | 2.3 | 1217 | 53% | 942 | 41% | 159 | 7% |
Low- or non-endemic | 1482 | 7.3 | 2.5 | 779 | 53% | 571 | 39% | 132 | 9% | |
Wolbachia Region | Wolbachia cities | 615 | 6.9 | 2.3 | 268 | 44% | 249 | 48% | 53 | 9% |
Non-Wolbachia cities | 3185 | 7.4 | 2.4 | 1728 | 54% | 1219 | 38% | 238 | 7% | |
No. of Children | No children | 1514 | 7.0 | 2.5 | 703 | 46% | 662 | 44% | 149 | 10% |
1–2 children | 1912 | 7.5 | 2.3 | 1084 | 57% | 712 | 37% | 116 | 6% | |
3–4 children | 333 | 7.4 | 2.4 | 186 | 56% | 124 | 37% | 23 | 7% | |
>4 children | 41 | 7.4 | 2.2 | 23 | 56% | 15 | 37% | 3 | 7% | |
Education Level | No formal education | 13 | 7.4 | 2.1 | 6 | 46% | 6 | 46% | 1 | 8% |
Primary education | 84 | 7.4 | 2.6 | 46 | 55% | 32 | 38% | 6 | 7% | |
Secondary education | 1165 | 7.2 | 2.5 | 607 | 52% | 450 | 39% | 108 | 9% | |
Tertiary education | 2273 | 7.3 | 2.3 | 1196 | 53% | 918 | 40% | 159 | 7% | |
Post-tertiary education | 265 | 7.4 | 2.3 | 141 | 53% | 107 | 40% | 17 | 6% | |
Income | Low income | 1651 | 7.3 | 2.5 | 871 | 53% | 634 | 38% | 146 | 9% |
Medium income | 1618 | 7.3 | 2.3 | 848 | 52% | 652 | 40% | 118 | 7% | |
High income | 531 | 7.4 | 2.2 | 277 | 52% | 227 | 43% | 27 | 5% | |
Dengue Exp. | Previously contracted | 1065 | 7.7 | 2.1 | 630 | 59% | 393 | 37% | 42 | 4% |
No dengue history | 2735 | 7.2 | 2.5 | 1366 | 50% | 1120 | 41% | 249 | 9% | |
Level of Perceived Risk | Very high risk | 1010 | 8.1 | 2.2 | 691 | 68% | 279 | 28% | 40 | 4% |
High risk | 1200 | 7.3 | 2.1 | 614 | 51% | 509 | 42% | 77 | 6% | |
Medium risk | 1074 | 6.8 | 2.4 | 452 | 42% | 517 | 48% | 105 | 10% | |
Low risk | 265 | 6.8 | 2.6 | 117 | 44% | 117 | 44% | 31 | 12% | |
Very low risk | 185 | 6.8 | 2.9 | 88 | 48% | 69 | 37% | 28 | 15% | |
No risk | 66 | 6.8 | 3.2 | 34 | 52% | 22 | 33% | 10 | 15% | |
Vaccine Exp. (Influenza) | Vaccinated | 1961 | 7.8 | 2.2 | 1219 | 62% | 637 | 32% | 105 | 5% |
Not vaccinated | 1839 | 6.8 | 2.4 | 777 | 42% | 876 | 48% | 186 | 10% | |
Vaccine Exp. (COVID-19) | Vaccinated | 3559 | 7.4 | 2.3 | 1941 | 55% | 1397 | 39% | 221 | 6% |
Not vaccinated | 241 | 5.2 | 3.1 | 55 | 23% | 116 | 48% | 70 | 29% | |
Opinion Toward Vaccine | Very useful | 2088 | 8.2 | 2.1 | 1480 | 71% | 532 | 25% | 76 | 4% |
Useful | 1066 | 6.8 | 2.0 | 412 | 39% | 569 | 53% | 85 | 8% | |
Somewhat useful | 460 | 5.6 | 2.2 | 78 | 17% | 313 | 68% | 69 | 15% | |
Slightly useful | 127 | 5.1 | 2.4 | 20 | 16% | 79 | 62% | 28 | 22% | |
Not useful | 42 | 3.6 | 2.7 | 3 | 7% | 19 | 45% | 20 | 48% | |
Not useful at all | 17 | 2.2 | 3.9 | 3 | 18% | 1 | 6% | 13 | 76% |
COM-B | Covariates 1 | Global | Argentina | Brazil | Colombia | Mexico |
---|---|---|---|---|---|---|
(N = 3800) | (N = 600) | (N = 600) | (N = 600) | (N = 600) | ||
COEFF | COEFF | COEFF | COEFF | COEFF | ||
Capability (Physical) | I am afraid of needles | −0.006 | 0.004 | −0.034 | 0.026 | −0.010 |
Number of dengue transmission activities currently practicing 2 | 0.043 | 0.044 | −0.036 | 0.098 | 0.038 | |
Capability (Psychological) | I do not think there is a vaccine that can prevent dengue | 0.140 | 0.180 | −0.320 | 0.375 | −0.002 |
I don’t know if there is a vaccine that can prevent dengue | −0.089 | −0.184 | −0.839 | 0.205 | 0.511 | |
There is a vaccine that can prevent dengue | Reference | |||||
Dengue is very severe | 0.162 | 0.147 | 0.146 | 0.118 | 0.272 | |
Opportunity (Physical) | The government has made it easy for people to get vaccinated by offering it at convenient locations | 0.065 | 0.059 | 0.064 | 0.156 | −0.043 |
It is easy to schedule a vaccination appointment | 0.091 | 0.041 | 0.106 | 0.057 | 0.175 | |
I believe that the vaccine should be made accessible to the public including myself | 0.262 | 0.328 | 0.253 | 0.261 | 0.223 | |
Opportunity (Social) | The threat of dengue is or has been exaggerated by the media | −0.039 | −0.038 | −0.093 | −0.017 | −0.040 |
The threat of dengue is or has been exaggerated by the government | −0.015 | −0.079 | 0.004 | 0.042 | −0.024 | |
My doctor recommends vaccines for me and my family for several health conditions, as appropriate | 0.183 | 0.194 | 0.138 | 0.185 | 0.098 | |
I receive reminders from doctors/the government about my upcoming vaccinations | 0.047 | 0.092 | 0.051 | 0.050 | 0.007 | |
The government has broadcast education campaigns for people to get vaccinated | 0.036 | 0.049 | −0.016 | 0.169 | −0.002 | |
My community/government leader(s) promote the importance of vaccines | −0.006 | −0.136 | 0.111 | −0.031 | 0.008 | |
My favorite influencer(s) promotes the importance of vaccines | 0.012 | 0.086 | 0.014 | −0.088 | 0.005 | |
My community organizes events promoting health | 0.047 | 0.057 | 0.032 | 0.071 | 0.067 | |
My influencer(s) organizes events promoting good/improved health and well-being | 0.035 | 0.043 | −0.002 | 0.085 | 0.035 | |
Motivation (Automatic) | If I have to pay for the vaccination, I will not do it | −0.074 | −0.094 | −0.079 | −0.044 | −0.050 |
I will be more willing to get vaccinated if there are incentives (cash, points, or a gift) | 0.043 | 0.109 | 0.015 | 0.067 | 0.006 | |
Motivation (Reflective) | There is a high likelihood that people can contract dengue | 0.156 | 0.139 | 0.161 | 0.033 | 0.186 |
There is nothing we can do to treat dengue | 0.017 | 0.019 | 0.044 | 0.030 | 0.005 | |
There is nothing we can do to prevent dengue | 0.044 | 0.031 | 0.007 | 0.066 | 0.004 | |
We will all be completely powerless when it comes to dengue prevention | 0.016 | 0.047 | −0.013 | −0.023 | 0.007 | |
We must accept it (dengue) | −0.019 | −0.047 | 0.035 | 0.015 | 0.039 | |
I think vaccines are harmful | −0.090 | −0.147 | −0.091 | −0.035 | −0.080 | |
I trust the healthcare system and professionals in my country to deliver the vaccine and manage its side effects | 0.236 | 0.179 | 0.293 | 0.262 | 0.224 | |
If the risk of contracting dengue is low, I may not get the dengue vaccine | −0.095 | −0.073 | −0.083 | −0.086 | −0.086 | |
My religious beliefs guide my health decisions | −0.013 | 0.058 | −0.009 | −0.022 | −0.018 | |
The opinion of my community/government leader(s) is important to me | 0.071 | 0.112 | 0.085 | 0.074 | 0.065 | |
The opinions of my influencer(s) are important to me | 0.067 | 0.058 | 0.010 | 0.084 | 0.003 |
COM-B | Covariates 1 | Global | Indonesia | Malaysia | Singapore |
---|---|---|---|---|---|
(N = 3800) | (N = 600) | (N = 400) | (N = 400) | ||
COEFF | COEFF | COEFF | COEFF | ||
Capability (Physical) | I am afraid of needles | −0.006 | −0.026 | −0.026 | 0.004 |
Number of dengue transmission activities currently practicing 2 | 0.043 | −0.033 | 0.015 | 0.079 | |
Capability (Psychological) | I do not think there is a vaccine that can prevent dengue | 0.140 | 0.246 | 0.150 | 0.160 |
I don’t know if there is a vaccine that can prevent dengue | −0.089 | −0.365 | 0.137 | −0.200 | |
There is a vaccine that can prevent dengue | Reference | ||||
Dengue is very severe | 0.162 | 0.103 | 0.157 | 0.187 | |
Opportunity (Physical) | The government has made it easy for people to get vaccinated by offering it at convenient locations | 0.065 | 0.187 | 0.239 | −0.075 |
It is easy to schedule a vaccination appointment | 0.091 | −0.040 | 0.036 | 0.183 | |
I believe that the vaccine should be made accessible to the public including myself | 0.262 | 0.295 | 0.200 | 0.248 | |
Opportunity (Social) | The threat of dengue is or has been exaggerated by the media | −0.039 | −0.004 | −0.020 | −0.015 |
The threat of dengue is or has been exaggerated by the government | −0.015 | 0.024 | 0.027 | −0.029 | |
My doctor recommends vaccines for me and my family for several health conditions, as appropriate | 0.183 | 0.170 | 0.100 | 0.180 | |
I receive reminders from doctors/the government about my upcoming vaccinations | 0.047 | 0.126 | −0.021 | 0.067 | |
The government has broadcast education campaigns for people to get vaccinated | 0.036 | 0.141 | 0.215 | −0.012 | |
My community/government leader(s) promote the importance of vaccines | −0.006 | −0.045 | −0.012 | 0.001 | |
My favorite influencer(s) promotes the importance of vaccines | 0.012 | −0.026 | 0.014 | −0.017 | |
My community organizes events promoting health | 0.047 | 0.176 | 0.033 | 0.144 | |
My influencer(s) organizes events promoting good/improved health and well-being | 0.035 | 0.034 | 0.045 | 0.022 | |
Motivation (Automatic) | If I have to pay for the vaccination, I will not do it | −0.074 | −0.107 | −0.043 | −0.090 |
I will be more willing to get vaccinated if there are incentives (cash, points, or a gift) | 0.043 | 0.087 | 0.093 | 0.127 | |
Motivation (Reflective) | There is a high likelihood that people can contract dengue | 0.156 | −0.027 | −0.045 | 0.251 |
There is nothing we can do to treat dengue | 0.017 | 0.052 | 0.030 | 0.088 | |
There is nothing we can do to prevent dengue | 0.044 | 0.031 | 0.071 | 0.043 | |
We will all be completely powerless when it comes to dengue prevention | 0.016 | 0.008 | −0.016 | −0.054 | |
We must accept it (dengue) | −0.019 | 0.002 | 0.007 | −0.046 | |
I think vaccines are harmful | −0.090 | −0.134 | −0.099 | 0.021 | |
I trust the healthcare system and professionals in my country to deliver the vaccine and manage its side effects | 0.236 | 0.165 | 0.237 | 0.348 | |
If the risk of contracting dengue is low, I may not get the dengue vaccine | −0.095 | −0.040 | −0.072 | −0.232 | |
My religious beliefs guide my health decisions | −0.013 | 0.021 | 0.008 | −0.031 | |
The opinion of my community/government leader(s) is important to me | 0.071 | 0.192 | 0.047 | 0.065 | |
The opinions of my influencer(s) are important to me | 0.067 | 0.045 | 0.048 | 0.122 |
Channels | Global (N = 3800) | Argentina (N = 600) | Brazil (N = 600) | Colombia (N = 600) | Mexico (N = 600) | Indonesia (N = 600) | Malaysia (N = 400) | Singapore (N = 400) | |
---|---|---|---|---|---|---|---|---|---|
Channels for health-related information | Search engines | 82% | 81% | 83% | 81% | 81% | 88% | 85% | 77% |
Social media | 62% | 53% | 57% | 55% | 60% | 84% | 75% | 48% | |
Television | 44% | 38% | 54% | 47% | 41% | 54% | 36% | 30% | |
Government or health agency websites | 40% | 26% | 42% | 35% | 35% | 42% | 54% | 59% | |
Websites specializing in health-related information | 36% | 28% | 36% | 36% | 36% | 40% | 41% | 38% |
Stakeholders | Global (N = 3800) | Argentina (N = 600) | Brazil (N = 600) | Colombia (N = 600) | Mexico (N = 600) | Indonesia (N = 600) | Malaysia (N = 400) | Singapore (N = 400) | |
---|---|---|---|---|---|---|---|---|---|
Trusted stakeholders for health-related information | Doctors | 91% | 91% | 92% | 93% | 92% | 94% | 90% | 81% |
Nurses or paramedics | 45% | 44% | 49% | 43% | 47% | 55% | 44% | 28% | |
Pharmacists | 36% | 37% | 43% | 35% | 26% | 35% | 52% | 27% | |
Government | 34% | 20% | 32% | 24% | 25% | 48% | 39% | 66% | |
Scientific org. | 34% | 30% | 40% | 39% | 35% | 26% | 34% | 32% |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Shafie, A.A.; Moreira, E.D., Jr.; Di Pasquale, A.; Demuth, D.; Yin, J.Y.S. Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP). Vaccines 2023, 11, 575. https://doi.org/10.3390/vaccines11030575
Shafie AA, Moreira ED Jr., Di Pasquale A, Demuth D, Yin JYS. Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP). Vaccines. 2023; 11(3):575. https://doi.org/10.3390/vaccines11030575
Chicago/Turabian StyleShafie, Asrul Akmal, Edson Duarte Moreira, Jr., Alberta Di Pasquale, Dirk Demuth, and Joanne Yoong Su Yin. 2023. "Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP)" Vaccines 11, no. 3: 575. https://doi.org/10.3390/vaccines11030575
APA StyleShafie, A. A., Moreira, E. D., Jr., Di Pasquale, A., Demuth, D., & Yin, J. Y. S. (2023). Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP). Vaccines, 11(3), 575. https://doi.org/10.3390/vaccines11030575