Effectiveness of positive deviance, a behavior change approach, to improve knowledge, attitude and practices on dengue prevention and control in selected slums in Islamabad, Pakistan : a mixed-method study

Abstract

This is the first practical application of positive deviance on dengue in the two selected low-income slums of Islamabad which was conducted during June-October 2020. A total of 112 participants (56 for intervention and 56 for the control group) participated in the study. The intervention arm received the positive deviance intervention through the identified positive deviance role models during the regular PD sessions, role plays, illustration competitions, and songs for two months. Three surveys were conducted, before the intervention, after two months, and after four months to assess the changes in knowledge, attitude, and practices. At the baseline, no statistically significant differences in dengue knowledge were found between control (M=8.93, SD=3.107) and intervention (M=10.09, SD=3.549) groups (p=0.071). After two months, the intervention group demonstrated statistically significant improvements in dengue knowledge (M=19.00, SD=6.093) compared to the control group (M=13.13, SD=4.953) (p<0.001). After another two months at the end-line, dengue knowledge not only persisted but continued to improve with a statistically significant difference between control (M=14.30, SD=4.944) and intervention group (M=25.00, SD=9.607) (p<0.001). After two months, there were no statistically significant differences in dengue attitudes and practice between control and intervention groups. However, after four months, attitude towards dengue disease improved significantly in the intervention group (M=28.34, SD=3.604) compared to the control group (M=26.52, SD=4.343) (p=0.018). Similarly, after four months, at the end-line, practice regarding dengue disease improved significantly in the intervention group (M=13.77, SD=2.216) compared to the control group (M=11.37, SD=1.629) (p<0.001). The study revealed that positive deviance intervention had a significant impact on dengue knowledge, attitudes, and practices in the target communities.