Can a behavioural intervention be effective in changing behavior in householders of a selected highly epidemic area of the Kurunegala district?

Study setting It will be conducted in the highly epidemic Medical Officers of Health (MOH) area in the Kurunegala district

Randomization The total number of households (those selected six pairs of matched clusters) belongs to the MOH area, will be randomized into two arms (intervention arm and the control arm) using the computer generator method (simple randomization) after selecting the participants in each cluster by third-party assignment to prevent the selection bias.

Intervention The overall goal of the intervention package is to “change the behaviours of the community to prevent dengue in a highly epidemic MOH area in Kurunegala district”. This is to be achieved using a Communication for behavioural Impact (COMBI) plan. Prior to developing a proper COMBI plan, Situational Market Analysis for Communication Keys (SMACK) was conducted to develop Specific Behavioural Objectives (SBOs). It was conducted by quantitative assessment (Part A) and qualitative assessment (Part B). Designing of the COMBI plan was done according to WHO 10 steps using the data from above assessments (Parks & Lloyd, 2004; The Communication Initiative Team, 2004; WHO et al., 2012; HEB, 2017).

Developed and piloted intervention will be implemented at the cluster level. A cluster will consist of 25 householders.25 householders from one randomly selected Grama niladhari division (GN division) will be gathered into a closest community gathering area and the sessions will be conducted. Altogether 150 (25x6) will be trained to change the behaviour to prevent dengue.

The intervention will be applied as a single session for each cluster of 25 householders and following up at the household level once a week for four weeks. Post-interventional assessment will be conducted after three months of completion of the intervention.

Details of intervention package

Introduction to dengue and prevention - by Consultant Community Physician

MODULE 01 The manifestation of dengue infection and vector bionomics by Medical Officer (MO)/ Vector born disease with the guidance of Provincial Consultant Community Physician

MODULE 02 Prevention of dengue through behaviour change by Consultant Community Physician, Health Promotion bureau.

MODULE 03 Methods of Behaviour change and importance of COMBI by Health Education Officer (HEO) What is COMBI and the COMBI plan for the area?. By the investigators

MODULE 04 Planning, Implementation and Monitoring of the Intervention plan By the investigators with multi-stakeholders ( Pradeshiya sabha, Agriculture department, NGOO) Q&A session by the investigators with multi-stakeholders

The control group will consist of randomly selected one GN division from each PHI area. It will have no special intervention. The control group are eligible for routine standards of dengue control activities. The current activities are house to house inspection by dengue field assistance and range Public Health Inspectors (PHII), monthly larval surveillance in identified sentinel surveillance sites by entomological assistance, fogging around 200m radius of the detected dengue case and time to time “shramadhana” campaigns in high risk areas.

Blinding. Healthcare providers including MOH/ Additional Medical Officer of Health (AMOH)/ Public Health Inspectors will be blinded on the recruitment of the study group and control group to prevent the potential bias. Outcome assessors will be blinded after assignment to interventions to prevent the detection bias. So, they will be kept blind to the status of the groups. Data entry operators also will be blinded for the status of the intervention.

Include all individuals in a selected single building households, age between 18 and 70 years both males and females.

The “study unit” will be formed by separate single building utilized as a household in Kurunegala district. A household is defined as “a place where a person, or a group of persons who usually live and have a common arrangement for the preparation and consumption of food” (SLDHS, 2016). If there are two or more families live in upstairs and downstairs or annexures in the same premises, those units will be taken as separate households because the behaviour and the premises vector indices will be different from one household to another. Because the primary and secondary outcome will be assessed at the individual level.

Temporary shelters which were built for the period of fewer than six months will be excluded