Use of technology for social mobilization to improve the prevention and control of Aedes borne diseases (Dengue, Zika and Chikungunya) in Colombia

Arboviral diseases such as dengue, Zika, and chikungunya (DZC), transmitted by Aedes mosquitoes, are a global public health concern. Recently, mobile apps are receiving special attention for the prevention of these diseases. Few studies, however, have explored the use of these apps in DZC prevention. Therefore, this research aimed to test and evaluate the use of a popular mobile app, WhatsApp, as additional tool to enhance community involvement in DZC prevention. A mixed-method approach was employed, starting with a scoping review aimed at understanding global experiences with mobile phone-based interventions. This was followed by a cross-sectional study and a pilot study to determinate the entomological indices, technological preferences and test the app with endemic communities. Finally, a WhatsApp-based mHealth intervention was conducted in two municipalities in Colombia using a cluster design. The scoping review identified a total of 36 studies from 20 different countries. These studies focused on surveillance, prevention, communication and, diagnosis of arboviral diseases. Results from this review showed that mobile applications demonstrated good feasibility and performance in terms of data quality and processing speed, accurate mosquito species identification, and precise geographical location. These apps, mostly used for surveillance, were highly accepted by general population and health workers, although their use was influenced by factors such as connectivity and socioeconomic status. SMS-based interventions were also effective and well-accepted by communities, despite technical barriers. Overall, these mobile technologies can be effectiveness for surveillance and disease prevention when integrated with traditional methods. An initial entomological analysis was conducted in eight high-endemic clusters within two municipalities in Colombia: Villa del Rosario (VdR) and Los Patios (LP). The clusters were selected based on dengue incidence data and historical reports from 2008 to 2018 provided by the local Ministry of Health (MoH). A total of 250 households per cluster were selected using a systematic random sampling method (K=8), resulting in 2,000 households in both municipalities. Entomological surveys and household questionnaires were used to collect demographic and larval/pupal data. This analysis showed high vector infestation rates in the target areas (House Index, HI = 25.1%, Container Index, CI = 12.3%, and Breteau Index, BI = 29.6). More than 90% of households (1,834 out of 2,000) had at least one mobile phone, and more than 80% of them (1,606 out of 1,834) wanted to participate in the proposed digital strategy for the DZC prevention. Based on these initial results, WhatsApp messages were designed and pre-tested by health experts using the WhatsApp Business version. A short questionnaire based on the 5-point Likert scale for mobile apps was used to assess the messages. Experts reported high acceptability scores (>4.0 out of 5) regarding user-friendliness, speed, message usefulness, message quality and satisfaction. Subsequently, a pilot study was conducted with 50 community women, who tested the WhatsApp messages through pre-and post-intervention surveys. In general, WhatsApp was found as a feasible and highly accepted media by health experts and community women. The WhatsApp-based mHealth intervention was implemented in three clusters within the same municipalities. Approximately 300 households per cluster were selected using the same systematic random sampling method (K=8). The full intervention was the delivery of WhatsApp messages combined with community strategies (Cluster 1), while the partial intervention was only community strategies (Cluster 2). Cluster 3 was the control group. Each household was inspected before and after the intervention by an interviewer and a health worker to collect demographic and larval/pupal data using pre- and post-intervention surveys, which also assessed changes in preventive practices and entomological indices (HI, CI, BI, Pupal per person index). After the intervention, interviews were conducted to explore the perceptions of stakeholders. In addition, compliance with the application of the protective coating (PC) in laundry tanks, the main preventive practice in this study, was assessed by measuring the proportion of households that applied the product and followed the instructions. Results from this study showed that using WhatsApp improves certain practices towards the DZC prevention such as cleaning of water tanks (pre-survey 61.9% to post-survey 81.3%, p