Nurses at the Frontline of Dengue Prevention : Insights from Brunca, Costa Rica

Sammanfattning

Background: Costa Rica is a tropical country where dengue is endemic, and outbreaks are influenced by environmental conditions, urbanization, and socioeconomic disparities. Although the country has a universal healthcare system, structural inequalities and limited resources affect prevention efforts. Aim: The aim of this study was to explore how nurses in the Brunca region of Costa Rica experience and describe their work with dengue prevention, focusing on preventive strategies, practical challenges, and perceived community attitudes. Method: The study used a qualitative design with semi-structured interviews. Seven registered nurses with experience in dengue prevention within the public healthcare system participated. Data were analyzed using deductive thematic analysis, guided by the Social Ecological Model (SEM). Results: Dengue prevention is a complex process shaped by interacting factors across multiple levels of SEM. At the individual level, nurses described strong responsibility, high workload, and a meaningful professional role. Health education and communication emerged as central strategies at the interpersonal level, while resistance to behavior change, distrust in healthcare services, and cultural factors were described as barriers. Collaboration supported prevention efforts at the institutional level, although these were limited by resource constraints and organizational challenges. At the community level, preventive capacity was also influenced by socioeconomic conditions, migration, and varying awareness. Established systems and guidelines were described at the policy level, but implementation was challenged by structural and geographical disparities, particularly in border areas. Conclusion: Effective dengue prevention cannot rely solely on education or individual responsibility, but must be understood as an interplay between organizational, social, and structural factors. The study highlights the importance of context-adapted and intersectoral approaches to strengthen preventive work. Further research is needed on how preventive strategies can be implemented in resource-limited and cross-border settings.