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INTRODUCTION Mosquito-transmitted dengue remains an endemic threat to population health in various tropical and subtropical regions. Recommended dengue prevention practices focus on vector control and reducing human–mosquito interactions, by practices such as removing standing water, wearing protective clothing and using repellent, as well as seeking medical care when symptomatic. Health workers in the community educate and empower citizens about recommended prevention practices, and thus are indispensable in implementing national dengue initiatives at the local level. However, their health messages may not resonate with all community members, resulting in low adherence to recommended prevention practices. Understanding the factors associated with low adherence to dengue prevention and control measures is essential for strengthening national dengue initiatives.

OBJECTIVE Identify health workers’ perceived challenges for dengue prevention and control strategies and describe their recommendations for strengthening dengue control in the Dominican Republic.

METHODS From January through March 2005, a qualitative study was conducted in five provinces of the Dominican Republic. Based on literature review and consultations with clinical specialists, a semistructured interview guide of nine questions was designed. A purposive sample of 19 health workers (10 men, 9 women) was interviewed, including public health practitioners, entomologists, educators, clinicians and an administrator. Question topics included occupational experiences in dengue prevention and control; views on vector control in communities; perceived challenges for citizens’ adherence to recommended practices; and suggested measures for strengthening adherence to vector control at local and national levels. Thematic analysis was used to identify salient themes.

RESULTS Health workers described the following perceived challenges: 1) limited individual economic resources; 2) individual lack of awareness, education or action; 3) limited cohesion among community members; and 4) limitations in sustainability of government interventions. They made 14 recommendations related to the 4 perceived challenges.

CONCLUSIONS These findings evince the complex interplay of economic, environmental, health, political and social factors that can directly or indirectly influence individual and community adherence to recommended dengue prevention measures. By understanding how these intrinsic and extrinsic factors hinder adherence, health authorities can adapt national policies to strengthen community participatory action in vector control, empower leadership potential by health workers and community members, and provide an appropriate systemic approach to preventing disease transmission.

KEYWORDS: Dengue, dengue virus, arbovirus, community health, prevention, control, communicable disease control, qualitative research, Dominican Republic

INTRODUCTION Health care workers have an increased risk of infection due to occupational Mycobacterium tuberculosis exposure, including multidrug-resistant strains. Health care workers’ risk of developing tuberculosis is greater than that of the general population, whether in low-, intermediate- or high-incidence countries. Adherence to infection control measures (administrative controls, environmental controls, and personal respiratory protection) is essential to reduce risk of disease transmission between suspected tuberculosis patients and health care workers, but for different reasons, both objective and subjective, adherence is low. Identifying the causes of low adherence is a prerequisite to effective programming to reduce risk.

OBJECTIVE Identify perceived barriers to adherence to tuberculosis infection control measures among health care workers in the Dominican Republic.

METHODS During August 2014, a qualitative study was conducted in two tertiary-level hospitals in different regions of the Dominican Republic. A semi-structured interview guide of nine questions was developed, based on the scientific literature and with consensus of clinical experts. Nine semi-structured interviews were conducted with a purposive sample of seven physicians (five men, two women) and two baccalaureate nurses (both women) working in the emergency medicine, internal medicine or nursing departments of those institutions. Question topics included clinical experience of M. tuberculosis infection and disease; knowledge of disease transmission and preventive practices; clinical management strategies; and perceptions of effectiveness of directly observed treatment, short-course, and disease coping strategies.

RESULTS Perceived barriers were described as: 1) sense of invincibility of health care workers; 2) personal beliefs of health care workers related to direct patient communication; 3) low provider-to-patient ratios in hospitals; 4) absence of tuberculosis isolation units for patients within hospitals; and 5) limited availability of protective masks for health care workers.

CONCLUSIONS Our results highlight that perceived barriers at the individual or institutional level may hinder how health care workers understand and comply with preventive strategies to reduce risk of tuberculosis transmission. Addressing these barriers by strengthening infection control program infrastructure and implementing educational interventions within institutions may reduce risk of nosocomial tuberculosis transmission to health care workers.

KEYWORDS Health care providers, infection control, infectious disease transmission, health care associated infection, nosocomial infection, Mycobacterium tuberculosis occupational exposure, occupational health, qualitative research, tuberculosis, Dominican Republic