The development of a tool to assess community capacity of sustainable community-based dengue prevention and control : a study in Southern Thailand

Abstract

Addressing the sustainability of community-based dengue prevention and control needs to require specific assessment tool, there are few studies have examined the dengue community capacity-assessment tools in Thai communities. The objectives of this study were development and testing tool and application of a new tool for defining practice guideline to assess community capacity of sustainable community-based dengue prevention and control. Conducting on Southern Thailand, there were three phases: The first phase was defining meaning and themes of dengue community capacity domains by qualitative method, 10 initial dengue community domains were identified, by means of the three experts reviews with content analysis from literature reviews, in-depth interviews with 60 leaders, and 8 focus group discussions with 60 non–leaders, in 4 sub-districts of the 4 provinces. The second phase was developing items and testing tool phase. It was divided into dengue community capacity for leaders and non-leaders. Content validity was verified by a seven-expert review panel, which arrived at a total Content Validity Index (CVI) of leaders (0.90) and non-leaders (0.91). The items were measured with a 5-point rating scale. During the pilot-testing, the Cronbach alpha reliability coefficient for the leaders was 0.98 and the non-leaders it was 0.97. Items were revised leaders items 182 and non-leaders items 167. The testing tools were administered to 964 leaders and 1,248 non-leaders, throughout 8 sub-districts of the 8 provinces. Construct validity was analyzed by Exploratory Factor Analysis (EFA). Factor loading was 0.5, the Eigenvalue was greater than 2, and all the domains together explained in leaders 57.58% and non-leaders 57.11 % of the variance. Finally, the third phase was the application of using tool used community participatory approach and conducted on a sub-district which a high incidence of dengue. The findings were Dengue Community Capacity-Assessment Tool (DCCAT) of leaders and non-leaders. Assessment tool of leaders was 115 items within 14 domains i.e. 1)critical situation management (9-item), 2)personal leadership (12-item), 3)health care provider capacity (8-item), 4)needs assessment (8-tiem), 5)senses of community (11-item), 6)leader group networking (11-item), 7)communication of dengue information (10-item), 8)community leadership (8-item), 9)religious leader capacity (9-item), 10)leader group and community networking (7-item), 11)resources mobilization (4-item), 12)dengue working group (6-item), 13)community participation (6-item), and 14)continuing activities (6-item). Assessment tool of non-leaders was 11 domains (83-item) i.e. 1)critical situation management (13-item), 2)personal leadership (8-item), 3)religious leader capacity (10-item), 4)community leadership (8-item), 5)health care provider capacity (6-item), 6)senses of community (8-item), 7)communication of dengue information (7-item), 8)continuing activities (6-item), 9)dengue working group (7-item), 10)resources mobilization (5-item), and 11)needs assessment (5-item). The practical guideline of DCCAT consisted of five steps: 1)community preparation, 2)assessment, 3)community consensus, 4)strategies plan and implementation and 5)re-assessment. The Dengue Leader Group (DLG) was a key team which conducted on the application of the tool. Health care workers, researchers, and local administrative organization officers served as a support team. All stakeholders in community should use the new tool based on understanding of the dengue community capacity concept, measurement objectives and outcomes, and context of community. If the communities need develop dengue community capacity building, the designed pre-post intervention assessments or serial assessments are essential.