Effective Behaviors to Prevent Zika

The behaviors were selected based on reviews of evidence and analysis by Breakthrough ACTION + RESEARCH, the United States Agency for International Development (USAID), and other partner organizations. The behaviors that reduce the mosquito population or prevent them from biting can also help prevent viruses such as dengue and chikungunya, which are transmitted by the same species of mosquito as Zika. The instructions for each behavior must be followed carefully and consistently to maximize effectiveness in preventing Zika and related diseases.

Rationale

During the first year of the U.S. response to Zika in Latin America and the Caribbean, USAID found that its implementing partners were promoting more than 30 behaviors to prevent transmission of the virus. Such a large number challenged the success of social and behavior change efforts. When too many prevention behaviors are promoted or when they lack precision, people may not adopt them, or they may do them in a way that is ineffective or counterproductive. Further, individuals are far more likely to act if they are exposed to messages repeatedly and through multiple channels such as television, radio, posters, and interpersonal communication. The Zika response could therefore have greater potential for impact if the organizations involved spoke with one voice and promoted a prioritized set of effective behaviors to increase the chances the behaviors would be adopted and done correctly.

Process

To determine which of the many behaviors promoted have the greatest potential to prevent Zika transmission and therefore Congenital Zika Syndrome, the Breakthrough ACTION+RESEARCH project conducted a literature review and consultative process with USAID, UNICEF, and USAID’s partners in the U.S. Zika response, culminating in the creation of a Zika Prevention Behavior Matrix. 

The project team reviewed behaviors that would help reduce the mosquito population overall as well as those that would offer personal protection for pregnant women. Because research and data on Zika prevention are limited, the team also reviewed literature on dengue, chikungunya, and other diseases transmitted by the Aedes aegypti mosquito. Additionally, for a subset of behaviors, the team studied lessons learned and supporting evidence from the reproductive health field, including family planning, antenatal care, and prevention of HIV and other sexually transmitted infections.

Criteria

The project team developed five criteria, listed below, to determine which behaviors had the greatest potential to prevent Zika transmission: 

• Efficacy of the behavior to reduce exposure to mosquitos or their bites. 
• Potential to reduce Zika transmission at the population level.
• Frequency of the behavior required to be effective.
• Feasibility of the behavior. 
• Ease of access to the necessary materials.

In collaboration with USAID and implementing partners, the team assessed the behaviors according to each of the five criteria, drawing on evidence from the research literature, program experience (for assessing feasibility), and contextual information (for determining access to necessary materials). The resulting behavior matrix contains seven behaviors with high potential to prevent Zika transmission.