Effectiveness of health education on arboviral diseases in urban Bengaluru: A quasi-experimental study

Effectiveness of health education on arboviral diseases in urban Bengaluru: A quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of health education on arboviral diseases in urban Bengaluru: A quasi-experimental study Sneha Singh, Dr Denny John This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6919266/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Aims Arboviral diseases such as dengue and malaria remain significant public health concerns in urban Bengaluru, primarily due to urbanization, poor vector control, and inadequate community awareness. Despite being preventable, gaps in knowledge, attitudes, and practices (KAP) hinder effective disease prevention. This study aimed to evaluate the effectiveness of a structured health education intervention in improving KAP related to arboviral diseases among parents of adolescents in urban Bengaluru. Methods A quasi-experimental study design was employed in 2025, involving 60 participants (30 in the intervention group and 30 in the comparator group). Participants were selected based on scoring below 75% on a baseline KAP assessment. The intervention group received two structured in-person educational sessions over three weeks, covering causes, transmission, symptoms, and prevention strategies for dengue and malaria. Data were collected using validated KAP and EQ-5D-5L tools, administered pre- and post-intervention. Statistical analyses were conducted using Wilcoxon Signed-Rank and Mann-Whitney U tests. Results Post-intervention, the intervention group showed a significant increase in KAP scores (pre: 20.9 ± 2.23; post: 26.6 ± 2.08; Z = 4.70, p < 0.001; r = 0.873), while no improvement was seen in the comparator group. Between-group analysis also indicated a significant difference (U = 18, p < 0.001; r = 0.828). However, no significant changes were observed in quality of life (QoL) scores in either group (p = 1.000). Conclusions The structured health education intervention effectively improved participants’ knowledge, attitudes, and practices related to arboviral disease prevention. However, short-term changes in QoL were not observed. These findings support integrating targeted health education into urban public health programs to reduce the burden of mosquito-borne diseases. Infectious Diseases Epidemiology Arboviral diseases LMIC KAP EQ-5D-5L health education quasi experimental study dengue malaria Introduction Arboviral diseases, particularly dengue and malaria, continue to pose a critical public health threat globally, especially in low- and middle-income countries (LMICs) like India. These diseases are primarily transmitted by mosquitoes: dengue by the Aedes aegypti mosquito and malaria by Anopheles species(Dash et al., 2008 ; Garcia, 2010 ). The Aedes aegypti mosquito is highly adaptive, thriving in urban environments where stagnant water accumulates in artificial containers such as discarded tires, uncovered water tanks, and plastic bins (Mobin et al., 2022 ). This urban-friendly vector has significantly expanded its range due to climate change, increasing urbanization, and poor waste and water management systems(Arnold, 2020 ; (Carreto et al., 2022 ). Dengue is caused by the dengue virus (DENV), which has four distinct serotypes (DENV-1 to DENV-4), and infection with one serotype does not confer immunity to the others. As a result, reinfections are common and often lead to more severe forms such as dengue haemorrhagic fever or dengue shock syndrome(Halstead, 2019 ; Hasan et al., 2016 ). Globally, an estimated 390 million dengue infections occur annually, with nearly 96 million showing clinical symptom (Bhatt et al., 2013 ). The World Health Organization (WHO) reported a steep rise in dengue cases—from fewer than 500,000 in 2000 to over 3.34 million in 2016—highlighting a global trend toward increasing outbreaks, particularly in tropical and subtropical urban areas(Bhatt et al., 2013 ; Soni et al., 2023 ). Asia bears the brunt of this burden, accounting for approximately 70% of all dengue cases worldwide. Clinical manifestations of dengue include high-grade fever (39–40°C), intense headache, muscle and joint pain, pain behind the eyes, anorexia, nausea, and severe fatigue. In more critical cases, patients may experience bleeding, circulatory failure, or multi-organ dysfunction, which can be fatal if not treated promptly (Hasan et al., 2016 ). Malaria, in contrast, is caused by Plasmodium parasites, primarily P. falciparum and P. vivax . These are transmitted to humans through the bites of infected female Anopheles mosquitoes. Malaria remains endemic in many Indian cities such as Mangaluru, where poor sanitation, standing water, and high humidity create ideal conditions for mosquito breeding(Dayanand et al., 2017 ;Savi, 2022 ). Recently, Plasmodium knowlesi , a zoonotic malaria species, has emerged as a fifth human malaria parasite, adding a new layer of complexity to disease surveillance and diagnosis(Sabbatani, Fiorino and Manfredi, no date; (Savi, 2022 ). The situation is further complicated by co-infection scenarios. In some patients, malaria and dengue infections occur simultaneously, making differential diagnosis difficult and increasing the risk of clinical mismanagement(Mohapatra et al., 2012 ); (Zdrodowska et al., 2006 ); Zhao et al., 2024). Despite governmental and non-governmental efforts in India to reduce the burden of mosquito-borne diseases, persistent gaps in community knowledge, attitudes, and practices (KAP) hinder effective disease prevention. While awareness of arboviral diseases may be present, it does not necessarily translate into consistent behaviour such as using mosquito repellents, emptying stagnant water, or maintaining environmental cleanliness(Ghimire & Pangeni, 2024 ); (Mobin et al., 2022 ). This disconnect underscores the need for structured health education that goes beyond information dissemination and actively promotes behavioural change. Health education interventions, especially those rooted in behavioural science theories, have proven to be impactful in driving community-level change. Structured education programs in schools and community settings have led to marked improvements in dengue awareness and prevention. For instance, school-based sensitization workshops for teachers in New Delhi resulted in enhanced knowledge and transmission of health messages to students and families (Kumar, Rathi, Lal and S. K. Goel, 2018. In West Java, Indonesia, a targeted dengue education program decreased the proportion of children with poor knowledge from 90–50%(Kosasih et al., 2021 ). Likewise, the Integrated Dengue Education and Learning (iDEAL) module implemented in Malaysian schools led to improvements in students' knowledge, attitudes, and environmental cleanliness, along with a measurable reduction in dengue incidence (Dapari et al., 2024 ).. Among the various theoretical frameworks used in designing health interventions, the Health Belief Model (HBM) is one of the most widely applied. HBM posits that health behaviour is determined by individual beliefs about a disease’s risk and severity, the perceived benefits and barriers to preventive action, cues to act, and one’s confidence in their ability to take action (self-efficacy) (Shafique et al., 2024 ; Hasan et al., 2016 ). It has been particularly effective in explaining preventive behaviours related to mosquito-borne diseases like dengue. For instance, if an individual perceives a high risk of contracting dengue (susceptibility), believes it is a serious illness (severity), sees the benefit of using repellents (benefits), faces few obstacles in doing so (barriers), and feels confident in maintaining such practices (self-efficacy), they are more likely to adopt and sustain preventive behaviours. In India, however, most studies examining arboviral diseases are either cross-sectional or observational, with little emphasis on theory-based intervention or longitudinal outcomes. Furthermore, while KAP assessments are commonly used, there is limited exploration of broader impacts such as health-related quality of life (QoL). Tools like EQ-5D-5L, which assess mobility, self-care, pain/discomfort, and anxiety/depression, offer valuable insights into how diseases and preventive efforts affect overall well-being (Jyani et al., 2022 ). Given the high burden of arboviral diseases in urban Bengaluru, characterized by socio-economic heterogeneity, poor sanitation, and limited access to health services, context-specific and evidence-based interventions are urgently needed. Schools serve as effective platforms to reach parents and families through educational campaigns, given their established trust and accessibility within communities. This quasi-experimental study, grounded in the Health Belief Model, was conducted to evaluate the effectiveness of a structured health education intervention in improving knowledge, attitudes, and practices (KAP) among parents of adolescents aged 12–15 years in urban Bengaluru. The study also assessed changes in quality of life as a secondary outcome using the EQ-5D-5L instrument. By targeting parents—who are decision-makers within the household—this intervention aimed to promote lasting behavioural change and contribute to community-level prevention of dengue and malaria. The findings are expected to provide actionable insights for policymakers, educators, and public health planners striving to curb the spread of mosquito-borne diseases in India’s growing urban centres. Methods 2.1 | Design of Study This study employed a quasi-experimental, pretest-post-test design with a comparator group to assess the impact of a structured health education intervention on the prevention of arboviral diseases in an urban Indian setting. The intervention was evaluated among parents of school-going adolescents in Bengaluru, India, during March to May 2025. The design involved two parallel arms: an intervention group, which received structured in-person health education sessions, and a comparator group, which did not receive any form of educational input during the intervention period. Both groups completed identical assessments before and after the intervention to allow comparison of outcomes. The primary outcome assessed was change in Knowledge, Attitudes, and Practices (KAP) regarding arboviral diseases such as dengue and malaria, and the secondary outcome was change in quality of life, measured using a standardized instrument. The quasi-experimental nature of the study, though lacking randomisation, allowed for pragmatic implementation within a real-world school setting, with careful steps taken to ensure equivalence of groups at baseline. 2.2 | Participants The study population included parents of adolescents aged 12 to 15 years, residing in urban areas of Bengaluru. Participants were recruited from schools purposively selected based on criteria such as the number of eligible students, geographical accessibility for the research team, and administrative willingness to support the study. All participants were required to provide informed consent and to demonstrate a basic understanding of English or Kannada to ensure effective communication during the sessions and questionnaire administration. Only those participants who scored less than 75 percent on the baseline KAP questionnaire were included in the study, thus targeting those with comparatively low initial awareness and knowledge levels. Parents who had previously participated in any form of arboviral disease awareness or health education programs were excluded from the study in order to avoid potential bias due to prior exposure. Sample size was calculated using statistical parameters relevant to quasi-experimental designs. An expected effect size of 0.67 was assumed, reflecting a moderate-to-large effect. The estimated standard deviation was set at 15, with a minimum detectable difference of 10. Based on these values, and using a standard normal deviate (Z) for a power of 80% and significance level of 5%, the calculated sample size was 27 participants per group. To account for potential attrition, a 10% increase was applied, resulting in a final sample size of 30 per group, or 60 participants in total. This calculation aligned with similar studies assessing behavioural interventions for mosquito-borne diseases (Abamecha et al., 2021 ).. 2.3 | Sampling Method The sampling method combined purposive and random selection strategies. Initially, schools were purposively selected within Bengaluru city based on their demographic composition, accessibility, and administrative cooperation. Within these schools, participants were randomly approached, and those meeting the eligibility criteria and providing consent were enrolled. After baseline assessment, 60 participants were selected, with 30 assigned to the intervention group and 30 to the comparator group. The grouping was based on logistic feasibility rather than random allocation; however, care was taken to ensure that both groups were similar in sociodemographic characteristics and baseline KAP scores. Importantly, there were no participant dropouts in either group throughout the duration of the study, ensuring the integrity of the data. 2.4 | Data Collection Data collection was conducted in two phases: prior to the intervention (pretest) and after the intervention (post-test). Two primary tools were used for measurement. The first was a structured Knowledge, Attitudes, and Practices (KAP) questionnaire adapted from validated instruments used in prior Indian studies, including those by (Kumar et al., 2018b) This questionnaire assessed participants’ knowledge about arboviral diseases, their perceived risk and severity, their attitudes toward preventive actions, and their reported practices such as use of mosquito repellents or eliminating stagnant water. The second instrument used was the EQ-5D-5L tool, developed by the EuroQol Group and validated in the Indian context by (Jyani et al., 2022 ). This tool assessed five dimensions of self-reported health: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. The KAP tool included both closed and multiple-choice questions that generated a total score reflecting overall awareness and behaviours. A higher score indicated greater knowledge and better preventive practice. Similarly, the EQ-5D-5L tool was self-administered and scored using Indian value sets, with higher scores indicating better quality of life. All questionnaires were administered in-person, with support provided in English and Kannada, depending on participant preference. The data were collected anonymously and confidentiality was maintained throughout. To ensure the credibility of the finding’s, validated tools were used. The KAP questionnaire had previously demonstrated strong reliability, with Cronbach’s alpha values ranging from 0.72 to 0.80 in similar Indian urban populations (Kumar et al., 2018b). The EQ-5D-5L instrument also demonstrated high reliability and construct validity in the Indian context, with Cronbach’s alpha values between 0.82 and 0.85 (Jyani et al., 2022 ). . 2.5 | Intervention The intervention followed three distinct phases: baseline assessment, intervention delivery, and post-intervention evaluation. During the first week, all eligible participants completed a pretest assessment using the KAP and EQ-5D-5L instruments. Participants in the intervention group were then invited to attend two structured educational sessions held over the following two weeks. Each session lasted between 45 and 60 minutes and was delivered in classroom settings within the school premises during the morning hours. The educational intervention was facilitated by the principal investigator, ensuring consistency and standardization across both sessions. The content of the intervention was meticulously developed to align with the principles of public health education and covered a range of topics. In the first session, participants were introduced to the causes, symptoms, and transmission of dengue and malaria, with specific emphasis on the differences between Aedes aegypti and Anopheles mosquitoes. The second session reinforced this content and expanded on prevention strategies, including use of mosquito nets, repellents, wearing full-body clothing, and eliminating stagnant water sources. A key component of the sessions was the interactive Q&A segment, where participants could ask questions and clarify misconceptions. Printed educational materials were distributed, and discussions were encouraged to foster engagement. Visual aids and contextual examples were used to ensure better retention of information. Participants were grouped by school and attended the sessions together, allowing for interaction and support. After the second session, a post-test evaluation was conducted using the same KAP and QoL tools that were administered at baseline. 2.5.1 | Educational Intervention The educational intervention focused on structured delivery of content covering key aspects of arboviral disease prevention. It was designed to be culturally appropriate and practically applicable in the participants’ daily lives. The first session began with a brief overview of dengue and malaria, followed by an explanation of their transmission cycles, the session then transitioned into a discussion on early symptoms, causes and the importance of timely medical attention. The second session was more behaviourally focused, encouraging participants to implement protective actions within their homes and communities (Table I). Special attention was given to low-cost and time-efficient methods, such as covering water storage containers, using indoor fans, and disposing of unused vessels where water might collect. To enhance the impact of the intervention, multiple facilitation strategies were used. These included, printed materials, open discussions, and QandA where feasible. The principal investigator, delivered all sessions to ensure consistency in tone, content, and delivery quality. This consistency minimized facilitator bias and helped standardize the educational impact across all participants in the intervention arm. Table I Educational intervention sessions Session week Duration Content covered Delivery method Week 1 45–60 minutes Introduction to arboviral diseases, especially dengue and malaria. Explanation of causes, modes of transmission, and recognition of symptoms. Differentiation between Aedes aegypti (dengue) and Anopheles (malaria) mosquitoes. In-person verbal explanations, printed materials, and interactive Q&A sessions conducted in classrooms Week 2 45–60 minutes Focus on preventive strategies: use of mosquito repellents, bed nets, long-sleeved clothing, and environmental sanitation (e.g., removal of stagnant water). Interactive discussion on safe practices and methods of prevention. Printed handouts, verbal teaching, discussions, and Q&A 2.6 | Data Management and Analysis Statistical analysis for this quasi-experimental study was conducted using R software (version 4.5.0). Given the relatively small sample size and the non-normal distribution of the data, non-parametric statistical tests were employed to assess the effectiveness of the structured health education intervention. The two primary outcomes assessed were changes in (1) Knowledge, Attitudes, and Practices (KAP) related to arboviral diseases, and (2) Quality of Life (QoL), as measured using the EQ-5D-5L instrument. These outcomes were analysed both within each group (pre- vs. post-intervention) and between the two groups (intervention vs. comparator). To assess within-group changes, the Wilcoxon Signed-Rank Test was used for both the intervention and comparator groups. This test, appropriate for paired and non-normally distributed data, was used to evaluate whether there were statistically significant improvements in participants’ KAP and QoL scores after the intervention. For between-group comparisons, the Mann-Whitney U Test was applied to post-intervention scores. This test was chosen to determine whether there were significant differences in outcomes between those who received the educational sessions and those who did not. The use of these non-parametric tests ensured the robustness of the analysis in the context of small, independent samples without assumptions of normality. As the study design focused on a direct comparison between the two pre-defined groups. Participants who did not complete either the pre- or post-intervention questionnaire were excluded from the final analysis, and no imputation was performed for missing data. A p-value of less than 0.05 was considered statistically significant for all tests. This threshold was used to determine whether the observed changes in KAP and QoL were likely due to the intervention rather than chance. The results of these analyses provide evidence regarding the effectiveness of the structured health education program in enhancing awareness and reported preventive practices among parents in an urban Indian setting. Throughout the process, strict protocols for data privacy and integrity were followed. Data were stored in encrypted digital files, accessible only to the principal investigator and supervising academic staff. No identifying information was linked to any data used in the analysis, thereby preserving participant anonymity. 2.7 | Ethical Considerations This study received formal approval from the Human Ethics Committee of M.S. Ramaiah University of Applied Sciences, Bengaluru (IEC Registration No. : EC/NEW/INST/2023/KA/0347), and was conducted in full compliance with the ethical principles. The study was prospectively registered with the Clinical Trial Registry of India (CTRI Registration No: CTRI/2025/06/088495), All procedures involving human participants were performed by institutional, national, and international guidelines for ethical research. Before the commencement of data collection, the purpose, process, risks, and benefits of the study were thoroughly explained to all participants, both orally and in writing. Participants provided informed written consent, confirming their voluntary agreement to participate. Confidentiality was assured at every stage of the study. All identifying information was removed or coded, and data were stored in secure, password-protected files. Participants were also informed that their responses would be used solely for academic research purposes and that they had the right to withdraw from the study at any time without any negative consequences. Following the completion of the study, the comparator group was provided with the same educational material to ensure ethical fairness and equal access to health information. The study methods and results are presented as per TREND checklist(Haynes et al., 2021). Results A total of 60 parents (30 in the intervention group and 30 in the comparator group) participated in this quasi-experimental study conducted in urban Bengaluru. All participants completed both pre- and post-intervention assessments, with no attrition observed throughout the study. The demographic characteristics of the two groups are presented in Table II. Variables such as age, sex, education level, occupation, and household size were comparable between the intervention and comparator groups, and no statistically significant difference was found in any of the demographic variables between the two groups at baseline (p > 0.05), confirming that the groups were well-matched before the intervention. Table II: Sociodemographic characteristics of the groups Characteristic Category Intervention group (n%) Comparator group(n%) P Value Age group 30–39 17(56.7%) 17(56.7%) 1.000 40–49 13(43.3%) 13(43.3%) Gender Female 19(63.3%) 18(60.0%) 0.666 Male 11(36.7%) 12(40.0%) Education School 8(26.7%) 8(26.7%) 0.953 Intermediate 13(43.3%) 14(46.7%) Graduate 9(30.0%) 8(26.7%) At baseline, the mean Knowledge, Attitude, and Practice (KAP) score for the intervention group was 20.9 ± 2.23, while the comparator group had a similar mean of 20.83 ± 2.08, showing no significant difference prior to the educational intervention. However, following the two in-person structured health education sessions, the intervention group demonstrated a substantial improvement in their post-intervention KAP score, which increased to 26.6 ± 2.08. The within-group comparison using the Wilcoxon Signed-Rank Test (Table III) yielded a Z-value of 4.70, which was statistically significant (p < 0.001), with a strong effect size of r = 0.873. Table III: Within group comparisons using Wilcoxon signed rank test Group Outcome Pre-mean ± SD Post-Mean ± SD Z value P value Effect size (r) Intervention KAP Score 20.9 ± 2.23 26.6 ± 2.08 4.70 < 0.001 0.873 EQ-5D-5L score 0.9864 ± 0.0325 0.9881 ± 0.0318 0.000 1.000 0.000 Comparator KAP Score 21.03 ± 1.81 20.83 ± 1.68 0.899 0.368 0.116 EQ-5D-5L score 0.9903 ± 0.0234 0.9886 ± 0.0245 0.000 1.000 0.000 In contrast, the comparator group, which did not receive any health education during the study period, showed no statistically significant difference between their pretest and post-test scores (Z = 1.34, p = 0.18; r = 0.173). Furthermore, the between-group comparison using the Mann-Whitney U Test( Table IV ) indicated a statistically significant difference in post-intervention scores between the intervention and comparator groups (U = 18, p < 0.001), with a large effect size of r = 0.828. These findings confirm the effectiveness of the structured educational intervention in improving knowledge, attitudes, and practices related to arboviral disease prevention. In addition to changes in KAP scores, the study also evaluated quality of life (QoL) outcomes using the EQ-5D-5L instrument. However, there were no significant changes in QoL scores within or between groups over the course of the study. In both the intervention and comparator groups, the Wilcoxon Signed-Rank Test produced Z-values of 0, with a p-value of 1.000, indicating that the short duration of the intervention and the brief follow-up period did not yield measurable changes in perceived quality of life. No participants reported difficulty in understanding the educational content, and the printed materials, presentations, and group discussions were well received. While cues to action and barriers were not measured quantitatively through separate subscales in this study, participants did report feeling more confident in recognizing risk and initiating preventive steps, indicating improved self-efficacy and internal motivation. Table IV: Between group comparison using Mann Mann-Whitney U test Outcome Time Point Group Comparison U-value p-value Effect Size (r) KAP Score Pre-test Intervention vs Comparator 450.0 0.994 0.001 Post-test Intervention vs Comparator 18.0 < 0.001 0.828 EQ-5D-5L score Pre-test Intervention vs Comparator 438.0 0.771 0.038 Post-test Intervention vs Comparator 430.0 0.775 0.037 The comparator group, having received no structured intervention, did not demonstrate improvements in any domains and continued to exhibit pre-existing gaps in knowledge and preventive practices. After completion of the study, this group was also provided access to the educational material to ensure ethical equity. Discussion The present study demonstrated that a structured, school-based health education intervention significantly improved the knowledge, attitudes, and practices (KAP) of parents regarding arboviral diseases, specifically dengue and malaria. Participants in the intervention group, who initially had low KAP scores, showed statistically significant improvement following two in-person educational sessions. These findings underscore the potential of targeted educational interventions in bridging gaps in awareness and promoting informed preventive actions in urban communities. At baseline, both the intervention and comparator groups exhibited similar KAP scores, indicating that they began the study with a comparable level of understanding and awareness. However, after the educational sessions were delivered to the intervention group, their posttest KAP scores rose substantially, with an average increase of nearly 6 points. The within-group analysis confirmed that this improvement was statistically significant, while the comparator group, which did not receive any structured input during the study period, showed no notable change. This clear divergence between groups strongly supports the conclusion that the educational sessions were effective. These findings are consistent with previous studies that have examined the impact of educational programs on awareness and preventive knowledge related to mosquito-borne diseases. For instance, a study conducted by Kumar et al. (2018a) in Delhi schools found that training teachers as health educators led to a significant increase in students' knowledge about dengue and malaria. Similarly, Kosasih et al. ( 2021 ) observed that structured classroom education in Indonesia reduced the proportion of children with poor knowledge about dengue from 90–50%. In the current study, the parental population targeted also benefited from similarly structured content, suggesting that school-linked outreach can serve as a valuable platform for broader community education. The significant increase in knowledge scores among participants in this study reflects the effectiveness of delivering clear, practical, and locally relevant information. The intervention emphasized topics such as symptom recognition, mosquito breeding habits, transmission differences between Aedes and Anopheles mosquitoes, and practical household-level prevention strategies. These focused, straightforward messages likely contributed to improved retention and recall, which was evident in the post-intervention assessments. In addition to knowledge, participant attitudes toward arboviral disease prevention also improved significantly. Many participants reported greater concern about their families’ risk of exposure and expressed more positive views on simple preventive actions such as covering water containers, using mosquito repellents, and maintaining clean surroundings. where community-based education contributed to changes in how participants perceived and prioritized vector control efforts. Practice-related improvements were also observed. Participants in the intervention group reported adopting or planning to adopt more consistent preventive actions, such as removing standing water, using mosquito nets, and monitoring household surroundings for breeding sites. These practices represent simple but vital steps in controlling the spread of dengue and malaria, especially in densely populated urban settings like Bengaluru. While the study relied on self-reported practices rather than direct observation, the consistency in reported changes across participants suggests genuine shifts in behaviour intent and awareness. Notably, the study did not find a significant change in Quality of Life (QoL) scores, as measured by the EQ-5D-5L instrument. This outcome was expected, as the intervention primarily focused on improving awareness and reported practices over a short duration. Quality of life, particularly in terms of mobility, self-care, anxiety, and pain, may require longer-term interventions or follow-up periods to detect measurable changes. Similar findings have been reported in other short-term intervention studies, such as those cited by Jyani et al. ( 2022 ), where changes in knowledge did not immediately translate into shifts in perceived health-related well-being. The strength of this study lies in its focused, low-resource, and replicable approach. By delivering structured education in a school setting to parents—who play a central role in household decision-making—the intervention effectively reached a population capable of influencing both individual and family-level practices. The two-session structure allowed for a manageable dissemination of content without overwhelming participants. Moreover, the use of simple language, printed materials, and direct engagement allowed for better comprehension, even among participants with modest educational backgrounds. Nonetheless, some limitations must be acknowledged. The relatively small sample size and short follow-up period limited the ability to assess long-term retention of knowledge or sustained changes in practice. Additionally, the study relied on self-reported data, which is subject to response bias. Participants may have overestimated their knowledge or practices, especially in the post-intervention phase. Moreover, while the EQ-5D-5L instrument is well-validated, its generic nature may not be sensitive enough to detect subtle health-related quality-of-life changes specific to vector-borne disease prevention. Despite these limitations, the results offer compelling evidence for the role of structured educational interventions in improving community-level awareness and response to arboviral threats. In the context of ongoing challenges posed by dengue and malaria outbreaks in Indian cities, such interventions can be effectively integrated into existing school health programs, public health outreach, and municipal vector control initiatives. In conclusion, this study adds to the growing body of evidence showing that short, focused health education interventions can significantly improve public knowledge and awareness of mosquito-borne diseases. While changes in quality of life were not observed in the short term, the marked improvement in knowledge, attitudes, and practices suggests that such educational efforts could play a pivotal role in broader public health strategies aimed at reducing the burden of arboviral infections in urban India. 4.1 | Limitations of the Study This study was conducted in a specific urban setting—Bengaluru—and focused on a limited sample of 60 parents from selected schools, which may affect the generalizability of the findings. Although purposive sampling helped target participants with lower baseline knowledge, it may also have introduced selection bias. Moreover, the small sample size, while sufficient for detecting statistically significant differences in KAP scores, limits the ability to make broader population-level inferences. The short duration of the intervention and follow-up period restricted the assessment to immediate post-intervention changes. Consequently, the study was unable to determine the sustainability of knowledge, attitude, or practice improvements over time. Additionally, the use of self-reported questionnaires to assess KAP introduced the possibility of social desirability bias, where participants may have over-reported positive practices or attitudes, particularly in the intervention group. Another limitation was the inability to detect any measurable change in health-related quality of life (QoL) during the short study period. While the EQ-5D-5L tool is standardized and validated, it may not have been sensitive enough to capture small or short-term improvements in perceived well-being associated with increased awareness. Finally, logistical constraints limited the intervention to two sessions, which may not be sufficient for instilling long-term behavioural change or deeper engagement with complex public health information. Despite these limitations, the study offers valuable insights into the impact of structured health education on parental knowledge and practices in urban Indian settings and sets the stage for future interventions with larger samples and longer-term assessments. Conclusion The present study demonstrated that a structured health education program delivered to parents of adolescents in urban Bengaluru led to a significant improvement in knowledge, attitudes, and reported practices related to arboviral diseases such as dengue and malaria. The intervention successfully addressed key gaps in awareness regarding mosquito vectors, disease symptoms, and household-level prevention strategies. Post-intervention assessments showed substantial gains in KAP scores among participants who attended the sessions, compared to those in the comparator group. These findings reinforce the value of short, focused, and contextually relevant educational programs as effective tools in the prevention and control of mosquito-borne diseases. However, no statistically significant changes were observed in quality of life over the short follow-up period, suggesting the need for longer-term studies to evaluate broader health impacts. Given the rising burden of arboviral diseases in urban India, the findings of this study support the integration of parent-focused health education into school-linked community outreach programs. Expanding such interventions with larger samples and longer follow-up could contribute significantly to reducing the transmission of dengue and malaria through improved public awareness and practical prevention at the household level. Declarations Acknowledgements The authors would like to express their sincere gratitude to the participants of this study—the parents who volunteered their time to support the research—as well as the administrative staff and faculty of New Manjula Public School, Bengaluru, for their cooperation and support during data collection. We are also grateful to the faculty and research staff of M.S. Ramaiah University of Applied Sciences for their guidance throughout the study. The authors thank the Institutional Ethics Committee for timely review and approval. Ethics Statement This study received ethical approval from the Human Ethics Committee of M.S. Ramaiah University of Applied Sciences, Bengaluru (IEC Registration No.: EC/NEW/INST/2023/KA/0347). All procedures were conducted in accordance with institutional guidelines and ICMR ethical standards. Written informed consent was obtained from all participants before enrolment. Funding No funding was received for conducting this study. Conflicts of Interest The authors declare that there are no conflicts of interest related to this study. Data Availability Statement The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request. Transparency Statement The lead author, Sneha Singh, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported. No important aspects of the study have been omitted, and any deviations from the study protocol have been clearly explained. Author Contributions 1 Sneha Singh: Conceptualization, data collection, analysis, interpretation, and manuscript writing. 2 Dr. Denny John: Conceptual guidance, supervision, and critical review. References Abamecha, F., Sudhakar, M., Abebe, L., Kebede, Y., Alemayehu, G., & Birhanu, Z. (2021). Effectiveness of the school-based social and behaviour change communication interventions on insecticide-treated nets utilization among primary school children in rural Ethiopia: A controlled quasi-experimental design. Malaria Journal , 20 (1), 41. https://doi.org/10.1186/s12936-020-03578-x Arnold, S. M. (2020). School Based Dengue Control Programme; Impact of awareness and training on control measures. Scientific Research Journal , 8 (10), 12–17. https://doi.org/10.31364/SCIRJ/v8.i10.2020.P1020814 Bhatt, S., Gething, P. W., Brady, O. J., Messina, J. P., Farlow, A. W., Moyes, C. L., Drake, J. M., Brownstein, J. S., Hoen, A. G., Sankoh, O., Myers, M. F., George, D. B., Jaenisch, T., Wint, G. R. W., Simmons, C. P., Scott, T. W., Farrar, J. J., & Hay, S. I. (2013). The global distribution and burden of dengue. Nature , 496 (7446), 504–507. https://doi.org/10.1038/nature12060 Carreto, C., Gutiérrez-Romero, R., & Rodríguez, T. (2022). Climate-driven mosquito-borne viral suitability index: Measuring risk transmission of dengue, chikungunya and Zika in Mexico. International Journal of Health Geographics , 21 (1), 15. https://doi.org/10.1186/s12942-022-00317-0 Dapari, R., Muniandy, K., Fattah Azman, A. Z., Abu Bakar, S., Mohd Desa, M. N., Hwa, L. C., Singh Sandhu, S., Mustapha, N. F., Mohd Rosli, N., Ahmad Zamzuri, M. ‘Ammar I., Hassan, M. R., Che Dom, N., Syed Abdul Rahim, S. S., Singh Gill, B., & Ab Hamid, N. (2024). Effectiveness of the Integrated Dengue Education and Learning (iDEAL) module in improving the knowledge, attitude, practice, environmental cleanliness index, and dengue index among schoolchildren: A randomised controlled trial protocol. PLOS ONE , 19 (4), e0302736. https://doi.org/10.1371/journal.pone.0302736 Dash, A. P., Valecha, N., Anvikar, A. R., & Kumar, A. (2008). Malaria in India: Challenges and opportunities. Journal of Biosciences , 33 (4), 583–592. https://doi.org/10.1007/s12038-008-0076-x Dayanand, K. K., Punnath, K., Chandrashekar, V., Achur, R. N., Kakkilaya, S. B., Ghosh, S. K., Kumari, S., & Gowda, D. C. (2017). Malaria prevalence in Mangaluru city area in the southwestern coastal region of India. Malaria Journal , 16 (1), 492. https://doi.org/10.1186/s12936-017-2141-0 Garcia, L. S. (2010). Malaria. Clinics in Laboratory Medicine , 30 (1), 93–129. https://doi.org/10.1016/j.cll.2009.10.001 Ghimire, S., & Pangeni, S. (2024). A mixed method evaluation of knowledge, attitude and practice on dengue fever among Lalitpur Metropolitan City residents: A cross-sectional investigation. BMC Infectious Diseases , 24 (1), 1124. https://doi.org/10.1186/s12879-024-10025-8 Halstead, S. (2019). Recent advances in understanding dengue. F1000Research , 8 , F1000 Faculty Rev-1279. https://doi.org/10.12688/f1000research.19197.1 Hasan, S., Jamdar, S. F., Alalowi, M., & Al Ageel Al Beaiji, S. M. (2016). Dengue virus: A global human threat: Review of literature. Journal of International Society of Preventive & Community Dentistry , 6 (1), 1–6. https://doi.org/10.4103/2231-0762.175416 Jyani, G., Sharma, A., Prinja, S., Kar, S. S., Trivedi, M., Patro, B. K., Goyal, A., Purba, F. D., Finch, A. P., Rajsekar, K., Raman, S., Stolk, E., & Kaur, M. (2022). Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value in Health , 25 (7), 1218–1226. https://doi.org/10.1016/j.jval.2021.11.1370 Kosasih, C. E., Lukman, M., Solehati, T., & Mediani, H. S. (2021). Effect of dengue hemorrhagic fever health education on knowledge and attitudes, in elementary school children in West Java, Indonesia. Linguistics and Culture Review , 5 (S1), 191–200. https://doi.org/10.21744/lingcure.v5nS1.1349 Mobin, M., Khan, M., Anjum, H., Rahman, H., Marzan, M., & Islam, M. A. (2022). Knowledge, Attitudes, and Practices in Relation to Mosquito-Borne Diseases in Bangladesh. International Journal of Environmental Research and Public Health , 19 (14), 8258. https://doi.org/10.3390/ijerph19148258 Mohapatra, M., Patra, P., & Agrawala, R. (2012). Manifestation and outcome of concurrent malaria and dengue infection. Journal of Vector Borne Diseases , 49 (4), 262. https://doi.org/10.4103/0972-9062.213508 Sabbatani, S., Fiorino, S., & Manfredi, R. (n.d.). The emerging of the fifth malaria parasite (Plasmodium knowlesi). A public health concern? Braz J Infect Dis . Savi, M. K. (2022). An Overview of Malaria Transmission Mechanisms, Control, and Modeling. Medical Sciences , 11 (1), 3. https://doi.org/10.3390/medsci11010003 Shafique, S., Bhattacharyya, D. S., Nowrin, I., Sultana, F., Islam, M. R., Dutta, G. K., Del Barrio, M. O., & Reidpath, D. D. (2024). Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: A systematic review. Systematic Reviews , 13 (1), 253. https://doi.org/10.1186/s13643-024-02651-9 Soni, S., Gill, V. J. S., . A., Singh, J., Chhabra, J., Gill, G. J. S., & Bakshi, R. (2023). Dengue, Chikungunya, and Zika: The Causes and Threats of Emerging and Re-emerging Arboviral Diseases. Cureus . https://doi.org/10.7759/cureus.41717 Zdrodowska, A., Zajkowska, J., Golian, J., Grygorczuk, S., Krupa, W., & Kondrusik, M. (2006). [Tropical malaria—Danger for persons visiting endemic areas]. Przeglad Lekarski , 63 (3), 162–165. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6919266","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472872322,"identity":"ea5bbfa1-f3bb-44ed-9cc9-86909a9d8f8b","order_by":0,"name":"Sneha Singh","email":"","orcid":"","institution":"M S Ramaiah University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sneha","middleName":"","lastName":"Singh","suffix":""},{"id":472872323,"identity":"2cfc0bba-c02e-4c2f-81d3-fbd85b951e63","order_by":1,"name":"Dr Denny John","email":"data:image/png;base64,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","orcid":"","institution":"M S Ramaiah University of Applied sciences","correspondingAuthor":true,"prefix":"Dr","firstName":"Denny","middleName":"","lastName":"John","suffix":""}],"badges":[],"createdAt":"2025-06-18 05:20:35","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6919266/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6919266/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84947051,"identity":"748325e3-7463-44aa-8aef-fb1701fcc7d8","added_by":"auto","created_at":"2025-06-19 06:35:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":780596,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6919266/v1/2a6bae70-26ea-4342-b8c4-447d59ef1ce2.pdf"},{"id":84946161,"identity":"cc8ff34c-1e54-4a43-a3b9-13c6e3ff6572","added_by":"auto","created_at":"2025-06-19 06:19:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26957,"visible":true,"origin":"","legend":"","description":"","filename":"TRENDchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-6919266/v1/6bbdfa23b0e4b329540e31e9.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEffectiveness of health education on arboviral diseases in urban Bengaluru: A quasi-experimental study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eArboviral diseases, particularly dengue and malaria, continue to pose a critical public health threat globally, especially in low- and middle-income countries (LMICs) like India. These diseases are primarily transmitted by mosquitoes: dengue by the \u003cem\u003eAedes aegypti\u003c/em\u003e mosquito and malaria by \u003cem\u003eAnopheles\u003c/em\u003e species(Dash et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Garcia, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The \u003cem\u003eAedes aegypti\u003c/em\u003e mosquito is highly adaptive, thriving in urban environments where stagnant water accumulates in artificial containers such as discarded tires, uncovered water tanks, and plastic bins (Mobin et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This urban-friendly vector has significantly expanded its range due to climate change, increasing urbanization, and poor waste and water management systems(Arnold, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; (Carreto et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDengue is caused by the dengue virus (DENV), which has four distinct serotypes (DENV-1 to DENV-4), and infection with one serotype does not confer immunity to the others. As a result, reinfections are common and often lead to more severe forms such as dengue haemorrhagic fever or dengue shock syndrome(Halstead, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Hasan et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Globally, an estimated 390\u0026nbsp;million dengue infections occur annually, with nearly 96\u0026nbsp;million showing clinical symptom (Bhatt et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). The World Health Organization (WHO) reported a steep rise in dengue cases\u0026mdash;from fewer than 500,000 in 2000 to over 3.34\u0026nbsp;million in 2016\u0026mdash;highlighting a global trend toward increasing outbreaks, particularly in tropical and subtropical urban areas(Bhatt et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Soni et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Asia bears the brunt of this burden, accounting for approximately 70% of all dengue cases worldwide.\u003c/p\u003e \u003cp\u003eClinical manifestations of dengue include high-grade fever (39\u0026ndash;40\u0026deg;C), intense headache, muscle and joint pain, pain behind the eyes, anorexia, nausea, and severe fatigue. In more critical cases, patients may experience bleeding, circulatory failure, or multi-organ dysfunction, which can be fatal if not treated promptly (Hasan et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMalaria, in contrast, is caused by \u003cem\u003ePlasmodium\u003c/em\u003e parasites, primarily \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e. These are transmitted to humans through the bites of infected female \u003cem\u003eAnopheles\u003c/em\u003e mosquitoes. Malaria remains endemic in many Indian cities such as Mangaluru, where poor sanitation, standing water, and high humidity create ideal conditions for mosquito breeding(Dayanand et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e;Savi, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Recently, \u003cem\u003ePlasmodium knowlesi\u003c/em\u003e, a zoonotic malaria species, has emerged as a fifth human malaria parasite, adding a new layer of complexity to disease surveillance and diagnosis(Sabbatani, Fiorino and Manfredi, no date; (Savi, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe situation is further complicated by co-infection scenarios. In some patients, malaria and dengue infections occur simultaneously, making differential diagnosis difficult and increasing the risk of clinical mismanagement(Mohapatra et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2012\u003c/span\u003e); (Zdrodowska et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2006\u003c/span\u003e); Zhao et al., 2024).\u003c/p\u003e \u003cp\u003eDespite governmental and non-governmental efforts in India to reduce the burden of mosquito-borne diseases, persistent gaps in community knowledge, attitudes, and practices (KAP) hinder effective disease prevention. While awareness of arboviral diseases may be present, it does not necessarily translate into consistent behaviour such as using mosquito repellents, emptying stagnant water, or maintaining environmental cleanliness(Ghimire \u0026amp; Pangeni, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e); (Mobin et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This disconnect underscores the need for structured health education that goes beyond information dissemination and actively promotes behavioural change.\u003c/p\u003e \u003cp\u003eHealth education interventions, especially those rooted in behavioural science theories, have proven to be impactful in driving community-level change. Structured education programs in schools and community settings have led to marked improvements in dengue awareness and prevention. For instance, school-based sensitization workshops for teachers in New Delhi resulted in enhanced knowledge and transmission of health messages to students and families (Kumar, Rathi, Lal and S. K. Goel, 2018. In West Java, Indonesia, a targeted dengue education program decreased the proportion of children with poor knowledge from 90\u0026ndash;50%(Kosasih et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Likewise, the Integrated Dengue Education and Learning (iDEAL) module implemented in Malaysian schools led to improvements in students' knowledge, attitudes, and environmental cleanliness, along with a measurable reduction in dengue incidence (Dapari et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)..\u003c/p\u003e \u003cp\u003eAmong the various theoretical frameworks used in designing health interventions, the Health Belief Model (HBM) is one of the most widely applied. HBM posits that health behaviour is determined by individual beliefs about a disease\u0026rsquo;s risk and severity, the perceived benefits and barriers to preventive action, cues to act, and one\u0026rsquo;s confidence in their ability to take action (self-efficacy) (Shafique et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Hasan et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). It has been particularly effective in explaining preventive behaviours related to mosquito-borne diseases like dengue. For instance, if an individual perceives a high risk of contracting dengue (susceptibility), believes it is a serious illness (severity), sees the benefit of using repellents (benefits), faces few obstacles in doing so (barriers), and feels confident in maintaining such practices (self-efficacy), they are more likely to adopt and sustain preventive behaviours.\u003c/p\u003e \u003cp\u003eIn India, however, most studies examining arboviral diseases are either cross-sectional or observational, with little emphasis on theory-based intervention or longitudinal outcomes. Furthermore, while KAP assessments are commonly used, there is limited exploration of broader impacts such as health-related quality of life (QoL). Tools like EQ-5D-5L, which assess mobility, self-care, pain/discomfort, and anxiety/depression, offer valuable insights into how diseases and preventive efforts affect overall well-being (Jyani et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the high burden of arboviral diseases in urban Bengaluru, characterized by socio-economic heterogeneity, poor sanitation, and limited access to health services, context-specific and evidence-based interventions are urgently needed. Schools serve as effective platforms to reach parents and families through educational campaigns, given their established trust and accessibility within communities.\u003c/p\u003e \u003cp\u003e This quasi-experimental study, grounded in the Health Belief Model, was conducted to evaluate the effectiveness of a structured health education intervention in improving knowledge, attitudes, and practices (KAP) among parents of adolescents aged 12\u0026ndash;15 years in urban Bengaluru. The study also assessed changes in quality of life as a secondary outcome using the EQ-5D-5L instrument. By targeting parents\u0026mdash;who are decision-makers within the household\u0026mdash;this intervention aimed to promote lasting behavioural change and contribute to community-level prevention of dengue and malaria. The findings are expected to provide actionable insights for policymakers, educators, and public health planners striving to curb the spread of mosquito-borne diseases in India\u0026rsquo;s growing urban centres.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 | Design of Study\u003c/h2\u003e \u003cp\u003eThis study employed a quasi-experimental, pretest-post-test design with a comparator group to assess the impact of a structured health education intervention on the prevention of arboviral diseases in an urban Indian setting. The intervention was evaluated among parents of school-going adolescents in Bengaluru, India, during March to May 2025. The design involved two parallel arms: an intervention group, which received structured in-person health education sessions, and a comparator group, which did not receive any form of educational input during the intervention period. Both groups completed identical assessments before and after the intervention to allow comparison of outcomes. The primary outcome assessed was change in Knowledge, Attitudes, and Practices (KAP) regarding arboviral diseases such as dengue and malaria, and the secondary outcome was change in quality of life, measured using a standardized instrument. The quasi-experimental nature of the study, though lacking randomisation, allowed for pragmatic implementation within a real-world school setting, with careful steps taken to ensure equivalence of groups at baseline.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 | Participants\u003c/h3\u003e\n\u003cp\u003eThe study population included parents of adolescents aged 12 to 15 years, residing in urban areas of Bengaluru. Participants were recruited from schools purposively selected based on criteria such as the number of eligible students, geographical accessibility for the research team, and administrative willingness to support the study. All participants were required to provide informed consent and to demonstrate a basic understanding of English or Kannada to ensure effective communication during the sessions and questionnaire administration. Only those participants who scored less than 75 percent on the baseline KAP questionnaire were included in the study, thus targeting those with comparatively low initial awareness and knowledge levels. Parents who had previously participated in any form of arboviral disease awareness or health education programs were excluded from the study in order to avoid potential bias due to prior exposure.\u003c/p\u003e \u003cp\u003eSample size was calculated using statistical parameters relevant to quasi-experimental designs. An expected effect size of 0.67 was assumed, reflecting a moderate-to-large effect. The estimated standard deviation was set at 15, with a minimum detectable difference of 10. Based on these values, and using a standard normal deviate (Z) for a power of 80% and significance level of 5%, the calculated sample size was 27 participants per group. To account for potential attrition, a 10% increase was applied, resulting in a final sample size of 30 per group, or 60 participants in total. This calculation aligned with similar studies assessing behavioural interventions for mosquito-borne diseases (Abamecha et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)..\u003c/p\u003e\n\u003ch3\u003e2.3 | Sampling Method\u003c/h3\u003e\n\u003cp\u003eThe sampling method combined purposive and random selection strategies. Initially, schools were purposively selected within Bengaluru city based on their demographic composition, accessibility, and administrative cooperation. Within these schools, participants were randomly approached, and those meeting the eligibility criteria and providing consent were enrolled. After baseline assessment, 60 participants were selected, with 30 assigned to the intervention group and 30 to the comparator group. The grouping was based on logistic feasibility rather than random allocation; however, care was taken to ensure that both groups were similar in sociodemographic characteristics and baseline KAP scores. Importantly, there were no participant dropouts in either group throughout the duration of the study, ensuring the integrity of the data.\u003c/p\u003e\n\u003ch3\u003e2.4 | Data Collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted in two phases: prior to the intervention (pretest) and after the intervention (post-test). Two primary tools were used for measurement. The first was a structured Knowledge, Attitudes, and Practices (KAP) questionnaire adapted from validated instruments used in prior Indian studies, including those by (Kumar et al., 2018b) This questionnaire assessed participants\u0026rsquo; knowledge about arboviral diseases, their perceived risk and severity, their attitudes toward preventive actions, and their reported practices such as use of mosquito repellents or eliminating stagnant water. The second instrument used was the EQ-5D-5L tool, developed by the EuroQol Group and validated in the Indian context by (Jyani et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This tool assessed five dimensions of self-reported health: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression.\u003c/p\u003e \u003cp\u003eThe KAP tool included both closed and multiple-choice questions that generated a total score reflecting overall awareness and behaviours. A higher score indicated greater knowledge and better preventive practice. Similarly, the EQ-5D-5L tool was self-administered and scored using Indian value sets, with higher scores indicating better quality of life. All questionnaires were administered in-person, with support provided in English and Kannada, depending on participant preference. The data were collected anonymously and confidentiality was maintained throughout.\u003c/p\u003e \u003cp\u003eTo ensure the credibility of the finding\u0026rsquo;s, validated tools were used. The KAP questionnaire had previously demonstrated strong reliability, with Cronbach\u0026rsquo;s alpha values ranging from 0.72 to 0.80 in similar Indian urban populations (Kumar et al., 2018b). The EQ-5D-5L instrument also demonstrated high reliability and construct validity in the Indian context, with Cronbach\u0026rsquo;s alpha values between 0.82 and 0.85 (Jyani et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). .\u003c/p\u003e\n\u003ch3\u003e2.5 | Intervention\u003c/h3\u003e\n\u003cp\u003eThe intervention followed three distinct phases: baseline assessment, intervention delivery, and post-intervention evaluation. During the first week, all eligible participants completed a pretest assessment using the KAP and EQ-5D-5L instruments. Participants in the intervention group were then invited to attend two structured educational sessions held over the following two weeks. Each session lasted between 45 and 60 minutes and was delivered in classroom settings within the school premises during the morning hours. The educational intervention was facilitated by the principal investigator, ensuring consistency and standardization across both sessions.\u003c/p\u003e \u003cp\u003eThe content of the intervention was meticulously developed to align with the principles of public health education and covered a range of topics. In the first session, participants were introduced to the causes, symptoms, and transmission of dengue and malaria, with specific emphasis on the differences between \u003cem\u003eAedes aegypti\u003c/em\u003e and \u003cem\u003eAnopheles\u003c/em\u003e mosquitoes. The second session reinforced this content and expanded on prevention strategies, including use of mosquito nets, repellents, wearing full-body clothing, and eliminating stagnant water sources. A key component of the sessions was the interactive Q\u0026amp;A segment, where participants could ask questions and clarify misconceptions.\u003c/p\u003e \u003cp\u003ePrinted educational materials were distributed, and discussions were encouraged to foster engagement. Visual aids and contextual examples were used to ensure better retention of information. Participants were grouped by school and attended the sessions together, allowing for interaction and support. After the second session, a post-test evaluation was conducted using the same KAP and QoL tools that were administered at baseline.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5.1 | Educational Intervention\u003c/h2\u003e \u003cp\u003eThe educational intervention focused on structured delivery of content covering key aspects of arboviral disease prevention. It was designed to be culturally appropriate and practically applicable in the participants\u0026rsquo; daily lives. The first session began with a brief overview of dengue and malaria, followed by an explanation of their transmission cycles, the session then transitioned into a discussion on early symptoms, causes and the importance of timely medical attention. The second session was more behaviourally focused, encouraging participants to implement protective actions within their homes and communities (Table I). Special attention was given to low-cost and time-efficient methods, such as covering water storage containers, using indoor fans, and disposing of unused vessels where water might collect.\u003c/p\u003e \u003cp\u003eTo enhance the impact of the intervention, multiple facilitation strategies were used. These included, printed materials, open discussions, and QandA where feasible. The principal investigator, delivered all sessions to ensure consistency in tone, content, and delivery quality. This consistency minimized facilitator bias and helped standardize the educational impact across all participants in the intervention arm.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable I Educational intervention sessions\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContent covered\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDelivery method\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntroduction to arboviral diseases, especially dengue and malaria. Explanation of causes, modes of transmission, and recognition of symptoms. Differentiation between Aedes aegypti (dengue) and Anopheles (malaria) mosquitoes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIn-person verbal explanations, printed materials, and interactive Q\u0026amp;A sessions conducted in classrooms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFocus on preventive strategies: use of mosquito repellents, bed nets, long-sleeved clothing, and environmental sanitation (e.g., removal of stagnant water). Interactive discussion on safe practices and methods of prevention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrinted handouts, verbal teaching, discussions, and Q\u0026amp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.6 | Data Management and Analysis\u003c/h3\u003e\n\u003cp\u003eStatistical analysis for this quasi-experimental study was conducted using R software (version 4.5.0). Given the relatively small sample size and the non-normal distribution of the data, non-parametric statistical tests were employed to assess the effectiveness of the structured health education intervention.\u003c/p\u003e \u003cp\u003eThe two primary outcomes assessed were changes in (1) Knowledge, Attitudes, and Practices (KAP) related to arboviral diseases, and (2) Quality of Life (QoL), as measured using the EQ-5D-5L instrument. These outcomes were analysed both within each group (pre- vs. post-intervention) and between the two groups (intervention vs. comparator).\u003c/p\u003e \u003cp\u003eTo assess within-group changes, the Wilcoxon Signed-Rank Test was used for both the intervention and comparator groups. This test, appropriate for paired and non-normally distributed data, was used to evaluate whether there were statistically significant improvements in participants\u0026rsquo; KAP and QoL scores after the intervention. For between-group comparisons, the Mann-Whitney U Test was applied to post-intervention scores. This test was chosen to determine whether there were significant differences in outcomes between those who received the educational sessions and those who did not. The use of these non-parametric tests ensured the robustness of the analysis in the context of small, independent samples without assumptions of normality.\u003c/p\u003e \u003cp\u003eAs the study design focused on a direct comparison between the two pre-defined groups. Participants who did not complete either the pre- or post-intervention questionnaire were excluded from the final analysis, and no imputation was performed for missing data. A p-value of less than 0.05 was considered statistically significant for all tests. This threshold was used to determine whether the observed changes in KAP and QoL were likely due to the intervention rather than chance. The results of these analyses provide evidence regarding the effectiveness of the structured health education program in enhancing awareness and reported preventive practices among parents in an urban Indian setting.\u003c/p\u003e \u003cp\u003eThroughout the process, strict protocols for data privacy and integrity were followed. Data were stored in encrypted digital files, accessible only to the principal investigator and supervising academic staff. No identifying information was linked to any data used in the analysis, thereby preserving participant anonymity.\u003c/p\u003e\n\u003ch3\u003e2.7 | Ethical Considerations\u003c/h3\u003e\n\u003cp\u003eThis study received formal approval from the Human Ethics Committee of M.S. Ramaiah University of Applied Sciences, Bengaluru (IEC Registration No. : EC/NEW/INST/2023/KA/0347), and was conducted in full compliance with the ethical principles. The study was prospectively registered with the Clinical Trial Registry of India (CTRI Registration No: CTRI/2025/06/088495), All procedures involving human participants were performed by institutional, national, and international guidelines for ethical research.\u003c/p\u003e \u003cp\u003eBefore the commencement of data collection, the purpose, process, risks, and benefits of the study were thoroughly explained to all participants, both orally and in writing. Participants provided informed written consent, confirming their voluntary agreement to participate.\u003c/p\u003e \u003cp\u003eConfidentiality was assured at every stage of the study. All identifying information was removed or coded, and data were stored in secure, password-protected files. Participants were also informed that their responses would be used solely for academic research purposes and that they had the right to withdraw from the study at any time without any negative consequences. Following the completion of the study, the comparator group was provided with the same educational material to ensure ethical fairness and equal access to health information.\u003c/p\u003e \u003cp\u003eThe study methods and results are presented as per TREND checklist(Haynes et al., 2021).\u003c/p\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003cp\u003eA total of 60 parents (30 in the intervention group and 30 in the comparator group) participated in this quasi-experimental study conducted in urban Bengaluru. All participants completed both pre- and post-intervention assessments, with no attrition observed throughout the study. The demographic characteristics of the two groups are presented in Table II. Variables such as age, sex, education level, occupation, and household size were comparable between the intervention and comparator groups, and no statistically significant difference was found in any of the demographic variables between the two groups at baseline (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), confirming that the groups were well-matched before the intervention.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable II: Sociodemographic characteristics of the groups\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention group (n%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComparator group(n%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(43.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12(40.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(46.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(26.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt baseline, the mean Knowledge, Attitude, and Practice (KAP) score for the intervention group was 20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23, while the comparator group had a similar mean of 20.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08, showing no significant difference prior to the educational intervention. However, following the two in-person structured health education sessions, the intervention group demonstrated a substantial improvement in their post-intervention KAP score, which increased to 26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08. The within-group comparison using the Wilcoxon Signed-Rank Test (Table III) yielded a Z-value of 4.70, which was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a strong effect size of r\u0026thinsp;=\u0026thinsp;0.873.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable III: Within group comparisons using Wilcoxon signed rank test\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect size\u003c/p\u003e \u003cp\u003e(r)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKAP Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-5D-5L score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9864\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9881\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e KAP Score\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-5D-5L score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9903\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9886\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn contrast, the comparator group, which did not receive any health education during the study period, showed no statistically significant difference between their pretest and post-test scores (Z\u0026thinsp;=\u0026thinsp;1.34, p\u0026thinsp;=\u0026thinsp;0.18; r\u0026thinsp;=\u0026thinsp;0.173). Furthermore, the between-group comparison using the Mann-Whitney U Test(\u003cem\u003eTable IV\u003c/em\u003e) indicated a statistically significant difference in post-intervention scores between the intervention and comparator groups (U\u0026thinsp;=\u0026thinsp;18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a large effect size of r\u0026thinsp;=\u0026thinsp;0.828. These findings confirm the effectiveness of the structured educational intervention in improving knowledge, attitudes, and practices related to arboviral disease prevention.\u003c/p\u003e \u003cp\u003eIn addition to changes in KAP scores, the study also evaluated quality of life (QoL) outcomes using the EQ-5D-5L instrument. However, there were no significant changes in QoL scores within or between groups over the course of the study. In both the intervention and comparator groups, the Wilcoxon Signed-Rank Test produced Z-values of 0, with a p-value of 1.000, indicating that the short duration of the intervention and the brief follow-up period did not yield measurable changes in perceived quality of life.\u003c/p\u003e \u003cp\u003eNo participants reported difficulty in understanding the educational content, and the printed materials, presentations, and group discussions were well received. While cues to action and barriers were not measured quantitatively through separate subscales in this study, participants did report feeling more confident in recognizing risk and initiating preventive steps, indicating improved self-efficacy and internal motivation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IV: Between group comparison using Mann Mann-Whitney U test\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime Point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup Comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eU-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect Size (r)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKAP Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention vs Comparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e450.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention vs Comparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-5D-5L score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention vs Comparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e438.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention vs Comparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e430.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparator group, having received no structured intervention, did not demonstrate improvements in any domains and continued to exhibit pre-existing gaps in knowledge and preventive practices. After completion of the study, this group was also provided access to the educational material to ensure ethical equity.\u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cp\u003eThe present study demonstrated that a structured, school-based health education intervention significantly improved the knowledge, attitudes, and practices (KAP) of parents regarding arboviral diseases, specifically dengue and malaria. Participants in the intervention group, who initially had low KAP scores, showed statistically significant improvement following two in-person educational sessions. These findings underscore the potential of targeted educational interventions in bridging gaps in awareness and promoting informed preventive actions in urban communities.\u003c/p\u003e \u003cp\u003eAt baseline, both the intervention and comparator groups exhibited similar KAP scores, indicating that they began the study with a comparable level of understanding and awareness. However, after the educational sessions were delivered to the intervention group, their posttest KAP scores rose substantially, with an average increase of nearly 6 points. The within-group analysis confirmed that this improvement was statistically significant, while the comparator group, which did not receive any structured input during the study period, showed no notable change. This clear divergence between groups strongly supports the conclusion that the educational sessions were effective.\u003c/p\u003e \u003cp\u003eThese findings are consistent with previous studies that have examined the impact of educational programs on awareness and preventive knowledge related to mosquito-borne diseases. For instance, a study conducted by Kumar et al. (2018a) in Delhi schools found that training teachers as health educators led to a significant increase in students' knowledge about dengue and malaria. Similarly, Kosasih et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) observed that structured classroom education in Indonesia reduced the proportion of children with poor knowledge about dengue from 90\u0026ndash;50%. In the current study, the parental population targeted also benefited from similarly structured content, suggesting that school-linked outreach can serve as a valuable platform for broader community education.\u003c/p\u003e \u003cp\u003eThe significant increase in knowledge scores among participants in this study reflects the effectiveness of delivering clear, practical, and locally relevant information. The intervention emphasized topics such as symptom recognition, mosquito breeding habits, transmission differences between \u003cem\u003eAedes\u003c/em\u003e and \u003cem\u003eAnopheles\u003c/em\u003e mosquitoes, and practical household-level prevention strategies. These focused, straightforward messages likely contributed to improved retention and recall, which was evident in the post-intervention assessments.\u003c/p\u003e \u003cp\u003eIn addition to knowledge, participant attitudes toward arboviral disease prevention also improved significantly. Many participants reported greater concern about their families\u0026rsquo; risk of exposure and expressed more positive views on simple preventive actions such as covering water containers, using mosquito repellents, and maintaining clean surroundings. where community-based education contributed to changes in how participants perceived and prioritized vector control efforts. Practice-related improvements were also observed. Participants in the intervention group reported adopting or planning to adopt more consistent preventive actions, such as removing standing water, using mosquito nets, and monitoring household surroundings for breeding sites. These practices represent simple but vital steps in controlling the spread of dengue and malaria, especially in densely populated urban settings like Bengaluru. While the study relied on self-reported practices rather than direct observation, the consistency in reported changes across participants suggests genuine shifts in behaviour intent and awareness.\u003c/p\u003e \u003cp\u003eNotably, the study did not find a significant change in Quality of Life (QoL) scores, as measured by the EQ-5D-5L instrument. This outcome was expected, as the intervention primarily focused on improving awareness and reported practices over a short duration. Quality of life, particularly in terms of mobility, self-care, anxiety, and pain, may require longer-term interventions or follow-up periods to detect measurable changes. Similar findings have been reported in other short-term intervention studies, such as those cited by Jyani et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), where changes in knowledge did not immediately translate into shifts in perceived health-related well-being.\u003c/p\u003e \u003cp\u003eThe strength of this study lies in its focused, low-resource, and replicable approach. By delivering structured education in a school setting to parents\u0026mdash;who play a central role in household decision-making\u0026mdash;the intervention effectively reached a population capable of influencing both individual and family-level practices. The two-session structure allowed for a manageable dissemination of content without overwhelming participants. Moreover, the use of simple language, printed materials, and direct engagement allowed for better comprehension, even among participants with modest educational backgrounds.\u003c/p\u003e \u003cp\u003eNonetheless, some limitations must be acknowledged. The relatively small sample size and short follow-up period limited the ability to assess long-term retention of knowledge or sustained changes in practice. Additionally, the study relied on self-reported data, which is subject to response bias. Participants may have overestimated their knowledge or practices, especially in the post-intervention phase. Moreover, while the EQ-5D-5L instrument is well-validated, its generic nature may not be sensitive enough to detect subtle health-related quality-of-life changes specific to vector-borne disease prevention. Despite these limitations, the results offer compelling evidence for the role of structured educational interventions in improving community-level awareness and response to arboviral threats. In the context of ongoing challenges posed by dengue and malaria outbreaks in Indian cities, such interventions can be effectively integrated into existing school health programs, public health outreach, and municipal vector control initiatives.\u003c/p\u003e \u003cp\u003eIn conclusion, this study adds to the growing body of evidence showing that short, focused health education interventions can significantly improve public knowledge and awareness of mosquito-borne diseases. While changes in quality of life were not observed in the short term, the marked improvement in knowledge, attitudes, and practices suggests that such educational efforts could play a pivotal role in broader public health strategies aimed at reducing the burden of arboviral infections in urban India.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 | Limitations of the Study\u003c/h2\u003e \u003cp\u003e This study was conducted in a specific urban setting\u0026mdash;Bengaluru\u0026mdash;and focused on a limited sample of 60 parents from selected schools, which may affect the generalizability of the findings. Although purposive sampling helped target participants with lower baseline knowledge, it may also have introduced selection bias. Moreover, the small sample size, while sufficient for detecting statistically significant differences in KAP scores, limits the ability to make broader population-level inferences.\u003c/p\u003e \u003cp\u003eThe short duration of the intervention and follow-up period restricted the assessment to immediate post-intervention changes. Consequently, the study was unable to determine the sustainability of knowledge, attitude, or practice improvements over time. Additionally, the use of self-reported questionnaires to assess KAP introduced the possibility of social desirability bias, where participants may have over-reported positive practices or attitudes, particularly in the intervention group.\u003c/p\u003e \u003cp\u003eAnother limitation was the inability to detect any measurable change in health-related quality of life (QoL) during the short study period. While the EQ-5D-5L tool is standardized and validated, it may not have been sensitive enough to capture small or short-term improvements in perceived well-being associated with increased awareness. Finally, logistical constraints limited the intervention to two sessions, which may not be sufficient for instilling long-term behavioural change or deeper engagement with complex public health information.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study offers valuable insights into the impact of structured health education on parental knowledge and practices in urban Indian settings and sets the stage for future interventions with larger samples and longer-term assessments.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003cp\u003e The present study demonstrated that a structured health education program delivered to parents of adolescents in urban Bengaluru led to a significant improvement in knowledge, attitudes, and reported practices related to arboviral diseases such as dengue and malaria. The intervention successfully addressed key gaps in awareness regarding mosquito vectors, disease symptoms, and household-level prevention strategies.\u003c/p\u003e \u003cp\u003ePost-intervention assessments showed substantial gains in KAP scores among participants who attended the sessions, compared to those in the comparator group. These findings reinforce the value of short, focused, and contextually relevant educational programs as effective tools in the prevention and control of mosquito-borne diseases. However, no statistically significant changes were observed in quality of life over the short follow-up period, suggesting the need for longer-term studies to evaluate broader health impacts.\u003c/p\u003e \u003cp\u003eGiven the rising burden of arboviral diseases in urban India, the findings of this study support the integration of parent-focused health education into school-linked community outreach programs. Expanding such interventions with larger samples and longer follow-up could contribute significantly to reducing the transmission of dengue and malaria through improved public awareness and practical prevention at the household level.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the participants of this study\u0026mdash;the parents who volunteered their time to support the research\u0026mdash;as well as the administrative staff and faculty of New Manjula Public School, Bengaluru, for their cooperation and support during data collection. We are also grateful to the faculty and research staff of M.S. Ramaiah University of Applied Sciences for their guidance throughout the study. The authors thank the Institutional Ethics Committee for timely review and approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Human Ethics Committee of M.S. Ramaiah University of Applied Sciences, Bengaluru (IEC Registration No.: EC/NEW/INST/2023/KA/0347). All procedures were conducted in accordance with institutional guidelines and ICMR ethical standards. Written informed consent was obtained from all participants before enrolment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransparency Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe lead author, Sneha Singh, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported. No important aspects of the study have been omitted, and any deviations from the study protocol have been clearly explained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSneha Singh: Conceptualization, data collection, analysis, interpretation, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDr. Denny John: Conceptual guidance, supervision, and critical review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbamecha, F., Sudhakar, M., Abebe, L., Kebede, Y., Alemayehu, G., \u0026amp; Birhanu, Z. (2021). Effectiveness of the school-based social and behaviour change communication interventions on insecticide-treated nets utilization among primary school children in rural Ethiopia: A controlled quasi-experimental design. \u003cem\u003eMalaria Journal\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(1), 41. https://doi.org/10.1186/s12936-020-03578-x\u003c/li\u003e\n\u003cli\u003eArnold, S. M. (2020). School Based Dengue Control Programme; Impact of awareness and training on control measures. \u003cem\u003eScientific Research Journal\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(10), 12\u0026ndash;17. https://doi.org/10.31364/SCIRJ/v8.i10.2020.P1020814\u003c/li\u003e\n\u003cli\u003eBhatt, S., Gething, P. W., Brady, O. J., Messina, J. P., Farlow, A. W., Moyes, C. L., Drake, J. M., Brownstein, J. S., Hoen, A. G., Sankoh, O., Myers, M. F., George, D. B., Jaenisch, T., Wint, G. R. W., Simmons, C. P., Scott, T. W., Farrar, J. J., \u0026amp; Hay, S. I. (2013). 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Effectiveness of the Integrated Dengue Education and Learning (iDEAL) module in improving the knowledge, attitude, practice, environmental cleanliness index, and dengue index among schoolchildren: A randomised controlled trial protocol. \u003cem\u003ePLOS ONE\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(4), e0302736. https://doi.org/10.1371/journal.pone.0302736\u003c/li\u003e\n\u003cli\u003eDash, A. P., Valecha, N., Anvikar, A. R., \u0026amp; Kumar, A. (2008). Malaria in India: Challenges and opportunities. \u003cem\u003eJournal of Biosciences\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(4), 583\u0026ndash;592. https://doi.org/10.1007/s12038-008-0076-x\u003c/li\u003e\n\u003cli\u003eDayanand, K. K., Punnath, K., Chandrashekar, V., Achur, R. N., Kakkilaya, S. B., Ghosh, S. K., Kumari, S., \u0026amp; Gowda, D. C. (2017). 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An Overview of Malaria Transmission Mechanisms, Control, and Modeling. \u003cem\u003eMedical Sciences\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 3. https://doi.org/10.3390/medsci11010003\u003c/li\u003e\n\u003cli\u003eShafique, S., Bhattacharyya, D. S., Nowrin, I., Sultana, F., Islam, M. R., Dutta, G. K., Del Barrio, M. O., \u0026amp; Reidpath, D. D. (2024). Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: A systematic review. \u003cem\u003eSystematic Reviews\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1), 253. https://doi.org/10.1186/s13643-024-02651-9\u003c/li\u003e\n\u003cli\u003eSoni, S., Gill, V. J. S., . A., Singh, J., Chhabra, J., Gill, G. J. S., \u0026amp; Bakshi, R. (2023). Dengue, Chikungunya, and Zika: The Causes and Threats of Emerging and Re-emerging Arboviral Diseases. \u003cem\u003eCureus\u003c/em\u003e. https://doi.org/10.7759/cureus.41717\u003c/li\u003e\n\u003cli\u003eZdrodowska, A., Zajkowska, J., Golian, J., Grygorczuk, S., Krupa, W., \u0026amp; Kondrusik, M. (2006). [Tropical malaria\u0026mdash;Danger for persons visiting endemic areas]. \u003cem\u003ePrzeglad Lekarski\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(3), 162\u0026ndash;165.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"M S Ramaiah University of Applied Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Arboviral diseases, LMIC, KAP, EQ-5D-5L, health education, quasi experimental study, dengue, malaria","lastPublishedDoi":"10.21203/rs.3.rs-6919266/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6919266/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aims\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eArboviral diseases such as dengue and malaria remain significant public health concerns in urban Bengaluru, primarily due to urbanization, poor vector control, and inadequate community awareness. Despite being preventable, gaps in knowledge, attitudes, and practices (KAP) hinder effective disease prevention. This study aimed to evaluate the effectiveness of a structured health education intervention in improving KAP related to arboviral diseases among parents of adolescents in urban Bengaluru.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quasi-experimental study design was employed in 2025, involving 60 participants (30 in the intervention group and 30 in the comparator group). Participants were selected based on scoring below 75% on a baseline KAP assessment. The intervention group received two structured in-person educational sessions over three weeks, covering causes, transmission, symptoms, and prevention strategies for dengue and malaria. Data were collected using validated KAP and EQ-5D-5L tools, administered pre- and post-intervention. Statistical analyses were conducted using Wilcoxon Signed-Rank and Mann-Whitney U tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-intervention, the intervention group showed a significant increase in KAP scores (pre: 20.9 ± 2.23; post: 26.6 ± 2.08; Z = 4.70, p \u0026lt; 0.001; r = 0.873), while no improvement was seen in the comparator group. Between-group analysis also indicated a significant difference (U = 18, p \u0026lt; 0.001; r = 0.828). However, no significant changes were observed in quality of life (QoL) scores in either group (p = 1.000).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe structured health education intervention effectively improved participants’ knowledge, attitudes, and practices related to arboviral disease prevention. However, short-term changes in QoL were not observed. These findings support integrating targeted health education into urban public health programs to reduce the burden of mosquito-borne diseases.\u003c/p\u003e","manuscriptTitle":"Effectiveness of health education on arboviral diseases in urban Bengaluru: A quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-19 06:19:35","doi":"10.21203/rs.3.rs-6919266/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4adb0ca7-04dc-4fe1-99e1-01771630d8c7","owner":[],"postedDate":"June 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50217558,"name":"Infectious Diseases"},{"id":50217559,"name":"Epidemiology"}],"tags":[],"updatedAt":"2025-06-19T06:19:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-19 06:19:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6919266","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6919266","identity":"rs-6919266","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}