Behavioral, Sociocultural, and Institutional Barriers to Dengue Prevention and Control Among Rural Communities in the...

Background/Objectives: Dengue prevention in rural Amazonian communities is shaped by knowledge, household feasibility, sociocultural dynamics, institutional continuity, and trusted communication. This study explored behavioral, sociocultural, and institutional barriers to dengue prevention and control in rural communities of the Peruvian Amazon. Methods: An exploratory qualitative study with an ethnographic orientation, informed by the Communication for Behavioural Impact (COMBI) framework, was conducted in three anonymized rural settlements in San Martín, Peru. The qualitative corpus included 120 adults, 84 in-depth interviews, six focus group discussions with 36 participants, 22 household and community observation records, 13 institutional communication materials, and seven local operational documents. Data were analyzed using an inductive thematic approach and triangulated across participant profiles, settlements, and sources. Results: Dengue was widely recognized as a mosquito-borne disease, but the central finding was a gap between general awareness and practical, routine application. Participants' understanding of breeding sites, warning signs, and feasible source reduction was uneven. Prevention was mainly reactive, increasing after nearby cases, alerts, or fumigation, but weakening when risk was not visible. Irregular water supply, water storage, waste accumulation, gendered domestic labor, competing household priorities, reluctance to confront neighbors, and intermittent institutional action limited sustained prevention. Fumigation was perceived as the most visible institutional response, while communication was more credible when mediated by trusted local actors. Conclusions: Dengue prevention requires locally feasible household practices, safe water-storage guidance, trusted communicators, neighborhood coordination, continuous pre-outbreak engagement, and intersectoral support.