Barriers in operating proactive source reduction informed by an early warning system for dengue prevention: A qualitative study from end-user perspectives in Vietnam
6 affiliations
- 1Faculty of Health, Medicine and Behavioural Science, University of Queensland, Brisbane, Australia
- 2Department of Disease Control, Institute Pasteur in Ho Chi Minh City, Ho Chi Minh City, Vietnam
- 3Queensland Alliance for Environmental Health Sciences, University of Queensland, Brisbane, Australia
- 4Centre for Environment and Population Health, Griffith University, Brisbane, Queensland, Australia
- 5School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- 6Center for Disease Control, Ho Chi Minh City, Vietnam
Abstract
Background: Dengue is a major vector-borne disease, with rising incidence driven by climate change, rapid urbanization, and increased international travel. Although early warning systems (EWSs) have shown promising predictive performance in endemic settings, limited evidence on implementation barriers from local end users hinders their integration into routine proactive vector control. Methods: A qualitative study with in-depth interviews was conducted with local end users, including local authorities, health practitioners, and health volunteers. A deductive approach utilizing a predefined conceptual framework was employed to code the verbatim transcripts. Inductive coding was subsequently incorporated to capture emerging concepts that were not represented in the initial framework. Thematic analysis was performed to analyse the collected data. To enhance the methodological rigor, interviews and coding were performed by multiple and diverse researchers from various academic and practice institutions, and the transcripts were validated through member checking with selected participants. Results: The lack of supportive policies, limited engagement from relevant stakeholders due to low familiarity with EWS concepts, and operational challenges were identified as critical barriers to implementing EWS-informed proactive source reduction. The perception that dengue risks were only during the rainy season, together with socio-economic constraints, water scarcity exacerbated by extreme weather events, and the application of inappropriate source reduction measures, further constrained household participation. The multi-level barriers collectively disrupted the translation of EWS alerts into proactive dengue prevention. Conclusions: Early warning information alone is insufficient to translate into effective and sustained proactive vector control for dengue prevention. Strengthening enabling policies, local stakeholder and community engagement, and awareness of EWS-informed risk management across multiple levels are essential to translate EWS alerts into timely and sustained vector control actions in dengue-endemic settings similar to Vietnam. Further studies across diverse settings are needed to assess the broader applicability of EWS-informed approaches. Author summary: Dengue is increasing worldwide. Early warning systems (EWS) have been developed to predict outbreaks before they occur. These systems can help authorities take early action before the emergence of outbreaks. However, little is known about why these EWSs have not operated in dengue prevention. In this study, we interviewed local authorities, health officials, community representatives, and health volunteers in Vietnam to understand barriers to operating proactive larval control informed by EWS. We found that the absence of supportive policies, weak stakeholder engagement due to limited understanding of EWS concepts, and operational challenges related to local socio-economic features and water scarcity reduced the usefulness of EWS alerts. Community members often perceived dengue as a seasonal problem occurring only during the rainy season, which limited proactive action informed by EWS. Many also viewed proactive source reduction activities as primarily the responsibility of health authorities and local governments, rather than a shared community responsibility, further reducing household engagement in self-practising early preventive measures. Our findings suggest that technological tools alone are not enough. Proactive intervention informed by EWS must be supported by strong policies, effective risk communication, and context-appropriate control measures. These lessons are relevant for dengue-endemic countries like Vietnam, seeking to translate predictive tools into disease prevention.
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BibTeX
@article{do2026barriers,
title = {{Barriers in operating proactive source reduction informed by an early warning system for dengue prevention: A qualitative study from end-user perspectives in Vietnam}},
author = {Kien Quoc Do and Ha Thu Nguyen and Thi Thanh Thao Nguyen and Cong Tuan Pham and Nguyen T. T. K and Dang Khanh Linh Vien and Dung Phung},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014754},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014754},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Barriers in operating proactive source reduction informed by an early warning system for dengue prevention: A qualitative study from end-user perspectives in Vietnam
AU - Kien Quoc Do
AU - Ha Thu Nguyen
AU - Thi Thanh Thao Nguyen
AU - Cong Tuan Pham
AU - Nguyen T. T. K
AU - Dang Khanh Linh Vien
AU - Dung Phung
PY - 2026
DA - 2026/09/25
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014754
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014754
AB - Background: Dengue is a major vector-borne disease, with rising incidence driven by climate change, rapid urbanization, and increased international travel. Although early warning systems (EWSs) have shown promising predictive performance in endemic settings, limited evidence on implementation barriers from local end users hinders their integration into routine proactive vector control. Methods: A qualitative study with in-depth interviews was conducted with local end users, including local authorities, health practitioners, and health volunteers. A deductive approach utilizing a predefined conceptual framework was employed to code the verbatim transcripts. Inductive coding was subsequently incorporated to capture emerging concepts that were not represented in the initial framework. Thematic analysis was performed to analyse the collected data. To enhance the methodological rigor, interviews and coding were performed by multiple and diverse researchers from various academic and practice institutions, and the transcripts were validated through member checking with selected participants. Results: The lack of supportive policies, limited engagement from relevant stakeholders due to low familiarity with EWS concepts, and operational challenges were identified as critical barriers to implementing EWS-informed proactive source reduction. The perception that dengue risks were only during the rainy season, together with socio-economic constraints, water scarcity exacerbated by extreme weather events, and the application of inappropriate source reduction measures, further constrained household participation. The multi-level barriers collectively disrupted the translation of EWS alerts into proactive dengue prevention. Conclusions: Early warning information alone is insufficient to translate into effective and sustained proactive vector control for dengue prevention. Strengthening enabling policies, local stakeholder and community engagement, and awareness of EWS-informed risk management across multiple levels are essential to translate EWS alerts into timely and sustained vector control actions in dengue-endemic settings similar to Vietnam. Further studies across diverse settings are needed to assess the broader applicability of EWS-informed approaches. Author summary: Dengue is increasing worldwide. Early warning systems (EWS) have been developed to predict outbreaks before they occur. These systems can help authorities take early action before the emergence of outbreaks. However, little is known about why these EWSs have not operated in dengue prevention. In this study, we interviewed local authorities, health officials, community representatives, and health volunteers in Vietnam to understand barriers to operating proactive larval control informed by EWS. We found that the absence of supportive policies, weak stakeholder engagement due to limited understanding of EWS concepts, and operational challenges related to local socio-economic features and water scarcity reduced the usefulness of EWS alerts. Community members often perceived dengue as a seasonal problem occurring only during the rainy season, which limited proactive action informed by EWS. Many also viewed proactive source reduction activities as primarily the responsibility of health authorities and local governments, rather than a shared community responsibility, further reducing household engagement in self-practising early preventive measures. Our findings suggest that technological tools alone are not enough. Proactive intervention informed by EWS must be supported by strong policies, effective risk communication, and context-appropriate control measures. These lessons are relevant for dengue-endemic countries like Vietnam, seeking to translate predictive tools into disease prevention.
SN - 1935-2735
ER -