The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65724

Julia Rosenbaum, MSC, CHANGE Project, Academy for Educational Development, 1825 Connecticut Ave. NW, Washington, DC 20009, 202-884-8838, jrosenba@aed.org, Carlos Marin, MD, CHANGE Dengue Project El Salvador, Calle La Ceiba #272, Col. Escalon, San Salvador, El Salvador, Elli Leontsini, MD, MPH, School of Public Health/Department of International Health, Johns Hopkins University, 615 N. Wolfe Street.- E8008, Baltimore, MD 21205, and Guillermo Gonzalez, MD, Center for Tropical Disease Prevention, Ministry of Health, Dominican Republic, c/o AED 1825 Connecticut Ave. NW, Santo Domingo, Dominican Republic.

Show how the TIPS (Trials of Improved Practices) methodology was adapted in two country settings (El Salvador and the Dominican Republic) to negotiate dengue control strategies with community members and vector control personnel. Demonstrate how the planning methodology evolved into an effective intervention strategy to negotiate instead of promote or impose solutions. Social scientists and health educators working with national and local dengue programs involved communities and health planners in developing integrated control strategies through multiple phases of participatory research. NEPRAM, the Spanish acronym from Negotiating Improved Practices, builds on existing practices and beliefs about water, mosquitos and dengue fever to identify control practices that are not only efficacious, but also feasible and effective in the community setting. The four phases of formative research were: in-depth interviews and observations; idea generation and efficacy testing; negotiation/effectiveness and feasibility trials; and involvement of community-based organizations. Research identified new Aedes control strategies based on community practice. NEPRAM was adapted by National Dengue Programs, municipal health teams and community health workers as an intervention technique to negotiate improved behaviors with residents. Health workers are no longer just educators, but facilitators of change on an individual basis. In both settings, Aedes larval infestation was significantly lower than in control households.

Learning Objectives:

• Describe and apply the methodology of negotiating behavior change as a research methodology to develop interventions.
• Name advantages of community workers applying negotiating techniques as part of their intervention approach instead of more traditional health promotion approaches.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.