Putting behaviors into context for vector-borne diseases: Examining behaviors that may reduce exposure to disease vectors.

Understanding why people adopt or ignore vector-borne disease (VBD) preventive measures is key to better risk assessment and control. However, little is known about why some households adopt preventive practices while others do not, which is particularly striking in this era of One Health's attention to human, environmental, and animal health. We examined what household factors are linked to practices that may reduce exposure to disease vectors, with a focus on Chagas disease (CD) and American Cutaneous Leishmaniasis (ACL) vectors. We surveyed 204 households in 12 rural communities in Coclé Province, Republic of Panama, between March 2022 and December 2023. We used logistic regression models to explore the association between household contextual elements, such as respondents' sex, wealth (consumer goods and agricultural), knowledge about ACL and CD, feelings about insects, and perceptions of control over health outcomes, and personal (use of repellents, and hand protection before touching a CD vector) and property-based behaviors (use of insecticides in the house, use of windows/doors screens, and cleaning peridomestic debris) that may reduce exposure to disease vectors. We found mixed associations between protective behaviors and the contextual household elements. Participants who reported feeling bothered by insects were more likely to use repellents (Odds Ratio [OR]: 2.97 95% Confidence Interval [95%CI]: 1.47-6.20), whereas those who reported being in control of their health were less likely to use protection before touching a CD vector (OR = 0.8, CI: 0.67-0.95). Window/door screens were associated with more household consumer goods wealth (OR: 1.44; CI: 1.23-1.71), while households with a history of ACL cases were more likely to have peridomestic debris accumulation (OR: 2.33; CI: 1.17-4.75). Additionally, householders bothered by insects were less likely to have peridomestic debris (OR: 0.42; CI: 0.20-0.84), as well as those who believe health outcomes happen by chance (OR: 0.89; CI: 0.82-0.98). Our findings emphasize the importance of considering a more comprehensive household background and attention to cultural values to foster context-sensitive strategies for vector-borne pathogen prevention and control.