Effects of Single Session Educational Training in Dengue Awareness among Female Community Health Volunteers of Pokhara Metropolitan Kaski, Nepal

Effects of Single Session Educational Training in Dengue Awareness among Female Community Health Volunteers of Pokhara Metropolitan Kaski, Nepal | 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 Effects of Single Session Educational Training in Dengue Awareness among Female Community Health Volunteers of Pokhara Metropolitan Kaski, Nepal Gyanu Poudel, Nawaraj Chapagain, Tulsiram Bhandari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6833774/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 Introduction: Dengue fever remains a critical public health concern in Nepal, particularly in urban and semi-urban areas such as Pokhara Metropolitan, where incidence rates have increased significantly in recent years. Female Community Health Volunteers (FCHVs) play a vital role in health education and community-based disease prevention; however, structured training programs focused on dengue prevention are lacking. This study assessed the effectiveness of an educational intervention based on the Health Belief Model (HBM) in improving dengue-related knowledge, attitudes, and beliefs among FCHVs. Methodology: An intervention with a compare group design was employed, involving 154 FCHVs from six wards of Pokhara Metropolitan. Three wards were randomly assigned to the intervention group and three to the control group. The intervention consisted of a single three-hour training session incorporating a mini-lecture, group discussion, and distribution of educational booklets. Knowledge, attitudes, and HBM constructs perceived susceptibility, severity, benefits, barriers, and self-efficacy were measured at baseline and six weeks post-intervention using structured questionnaires. Data were analyzed using (Statistical Package for Social Sciences) SPSS version 22, with statistical significance set at p < 0.05. Results: The intervention group demonstrated significant improvements in knowledge (median increased from 22 to 30; p < 0.001, effect size = 0.793), attitudes (median increased from 24 to 26.5; p < 0.001), and key HBM constructs, including perceived susceptibility, perceived benefits, and self-efficacy. Although between-group differences in perceived barriers were significant at the end line (p < 0.001), within-group changes were modest. No significant improvement was observed in perceived severity, likely due to high baseline awareness levels among participants. Conclusion: The findings indicate that a brief, theory-driven educational intervention can significantly enhance FCHVs’ knowledge, attitudes, and health beliefs related to dengue prevention. This supports the potential for scalable, low-cost training programs within Nepal’s existing FCHV framework to strengthen community-based dengue control efforts. Dengue Awareness Community Health Educational Intervention Health Belief Model Effectiveness Figures Figure 1 BACKGROUND Dengue fever is a viral illness primarily caused by four serotypes of dengue virus: DENV-1, DENV-2, DENV-3, and DENV-4. It is transmitted to humans through the bite of an infected Aedes mosquito. 1 The disease is most prevalent in warm, humid regions, particularly in urban and semi-urban areas worldwide. Increasing temperatures significantly contribute to the virus's growth and spread. 2 In the past three decades, urbanization, global warming, and increased human mobility have significantly contributed to the global dengue burden. 3 It is estimated that 390 million dengue virus infections occur each year, of which 96 million are symptomatic and approximately 40,000 deaths annually. The Southeast Asia region carries more than half of the global dengue burden although it can be deadly, it can be stopped or avoided. 4 – 6 In Nepal the first case of dengue was seen in 2004 7 , the trend of dengue occurrence has been increasing over the past two decades. 8 The Kaski district, particularly Pokhara Metropolitan, has been identified as a hotspot, with 8,858 cases reported in 2024 9 . Climate change has expanded the disease to higher-altitude areas previously considered non-endemic. 10 , 11 Community health volunteers (CHVs) are integral to public health efforts, especially in rural and semi-urban areas, where they support disease prevention, health education, and community engagement. 12 , 13 Training CHVs is crucial for enhancing their knowledge and skills in dengue prevention and control. This training enables them to educate communities, identify mosquito breeding sites, and promote early detection and timely medical care. 14 Vector control efforts include eliminating mosquito breeding sites, while awareness campaigns educate communities about transmission and prevention. 4 Despite these efforts, challenges remain in implementing these strategies effectively. Limited resources, low levels of community awareness, and environmental factors such as urbanization and poor waste management hinder progress, highlighting the need for more sustainable and innovative approaches. 4 , 15 Training and awareness are pivotal in addressing gaps in dengue prevention and control. Many communities lack sufficient knowledge about the disease and the measures needed to prevent it. 16 , 17 By training CHVs, they can be empowered to lead education campaigns and mobilize communities to adopt preventive practices, such as removing stagnant water, using mosquito nets, and recognizing symptoms early. 12 Effective training not only strengthens the capacity of CHVs but also fosters community participation, which is critical for reducing the burden of dengue. 18 , 19 Previous studies have highlighted the importance of community engagement and education in controlling dengue. Research shows that social capital, strong leadership, and community-driven initiatives, such as forming social groups and conducting voluntary cleaning efforts, are highly effective in reducing mosquito breeding and lowering dengue incidence. 18 , 19 However, limited research has focused on training programs for FCHVs in dengue prevention within the Pokhara Metropolitan context. Expanding training programs and engaging communities in education and capacity building are essential steps for more effective dengue prevention and control. 5 Dengue fever remains a major challenge to public health in the Pokhara metropolitan. Hence preventive measures should be effective. Training provides great opportunities to improving awareness and mobilizing communities to adopt preventive measures. Resources limitation and community engagement are very critical barriers to overcome in order to achieve sustainable disease control. The scientific knowledge on dengue among many of community level people are very limited 1 . This lack of awareness hampers the effectiveness of prevention and control measures, necessitating targeted educational interventions. A cross-sectional survey by 20 shows that only 12% of the population had good knowledge of dengue, emphasizing a significant gap in understanding the disease, its symptoms, prevention, and control measures. Despite ongoing efforts, dengue remains a major public health challenge, demanding urgent and effective preventive strategies. 8 , 21 Studies show that role of community interventions play a pivotal role in raising awareness, achieving sustainable vector control, and reducing transmission rates. 16 Currently government of Nepal doesn’t have any developed orientation module to provide training to FCHVs for raising awareness of dengue. Many cross-sectional studies have been done however there is scarce interventional research to improve dengue-related knowledge among female community health volunteers in Nepal. Thus, this study aims to discover more about dengue-related Knowledge among FCHVs of Pokhara Metropolitan assuming a significant improvement through educational intervention and also could be a basis for future research. The findings obtained from the study will be useful for concerned authorities on the prevention and management of dengue in the study area. METHODS Design of the Study This study used an intervention with a compare group design that included a pre-test and post-test control group. It was conducted from April to May 2025 in selected wards of Pokhara Metropolitan City, Nepal. The purpose was to assess the efficacy of an educational intervention in dengue prevention among Female Community Health Volunteers (FCHVs). Participants The participants were FCHVs working in six wards of Pokhara Metropolitan City. The inclusion criteria included FCHVs affiliated with government health institutions who provided informed consent. FCHVs who did not reside in their assigned areas were excluded. A total of 140 participants were included 74 in the intervention group and 66 in the control group. Sampling Methods A purposive sampling technique was used to select six wards (from 33) based on dengue risk and accessibility. Three wards were randomly assigned to the intervention group and three to the control group. All FCHVs from the selected wards were included using a census approach. The sample size was calculated using the formula for comparing two proportions, with a power of 90% and a significance level of 5%. Based on a previous study, the proportion of correct knowledge responses was expected to improve from 37–61%. After accounting for a 20% attrition rate, the final sample size was 77 participants per group. Data Collection Data were collected using a structured, validated self-administered questionnaire. The tool assessed socio-demographic characteristics, knowledge, attitudes, and constructs of the Health Belief Model (HBM) related to dengue prevention. The questionnaire was developed based on previous literature, translated into Nepali, and pre-tested among 10% of the sample in a similar setting. Adjustments were made based on pre-test feedback to improve clarity and reliability. The internal consistency of the scales was assessed using Cronbach’s alpha, with values above 0.7 being acceptable. Study Variables The Health Belief Model (HBM) served as the study's guideline. The dependent variable was dengue prevention and control practices, which were classified as acceptable or inadequate according to a cut-off score. Independent factors included age, education, occupation, marital status, ethnicity, place of residence, religion, and monthly income. Knowledge was assessed using 44 positive statements, with one point awarded for each right response; scores were classified as good or poor. HBM constructs (attitudes, perceived vulnerability, severity, benefits, barriers, and self-efficacy) were evaluated using a five-point Likert scale. Composite scores were classified as high or low depending on their median. Procedures Permission was obtained from relevant local authorities. A pre-test was administered to both groups using the structured questionnaire. The intervention group then received a 3-hour educational session, while the control group received no training at that time. After six weeks, a post-test was conducted in both groups using the same questionnaire. Following the post-test, the control group was also provided with educational materials to ensure ethical fairness. Educational Intervention The educational intervention was developed based on a review of relevant literature and in consultation with experts from the National Health Education, Information and Communication Canter (NHEICC). The content was designed to be culturally appropriate, easily understandable, and visually engaging. It included a mini-lecture, group discussion, and distribution of an illustrated booklet. The intervention aimed to improve participants' knowledge and preventive practices regarding dengue. Data Management and Analysis Data were entered using EpiData and exported to SPSS version 22 for analysis. Descriptive statistics (frequencies, percentages, medians, and interquartile ranges) were used to summarize the data. Inferential tests including Pearson’s chi-squared test, Wilcoxon signed-rank test, and Mann–Whitney U test were used as appropriate. A p-value less than 0.05 was considered statistically significant. Data quality was ensured through daily review and double-checking of entries. Ethical Considerations Ethical approval was obtained from the Institutional Review Committee (IRC) of Pokhara University (Ref no. 171/2081/82). Written informed consent was obtained from all participants. Data collection was conducted in Nepali to ensure understanding. Participants were assured of the voluntary nature of the study and the confidentiality of their responses. Unique code numbers were used to maintain anonymity. The study posed a minimal risk, and participants in the intervention group benefited from health education. The control group received the same educational content after data collection. RESULTS Out of 154 total 140 (98.71%) Female Community Health Volunteers (FCHVs) participated in the baseline study, with 78 each assigned to the intervention and control groups. At the time of the post-test, the response rate was 96.9% (74) in the intervention group and 85.7% (66) in the control group. Table 1 shows the distribution of demographic characteristics (age, ethnicity, marital status, religion, educational level, occupational group, residence, and family income). The finding shows the family income, occupational group, and educational level were statistically significant differences between the two groups in terms of demographic variables and the results of the chi-square test(p < 0.05) (Table 3 ) Table 1 Baseline characteristics of the participants Variables Intervention group (n = 74) Control group (n = 66) p-value n % n % Age 24–37 19 25.7 17 25.8 0.951 c 38–43 23 31.1 19 28.8 ≥ 44 32 43.2 30 45.5 Median (IQR) 42.5(37) 43(31) Ethnicity Dalit 6 8.1 5 7.6 0.627 c Janajati 17 23 11 16.7 Brahmin/Chhetri 51 68.9 50 75.8 Marital Status Single 4 5.4 3 4.5 0.816 c Married 70 94.6 63 95.5 Religion Hindu 74 100 63 95.5 0.102 f Buddha 0 0 3 4.5 Educational Level Informal 12 16.2 15 22.7 0.017 c Basic 10 13.5 21 31.8 Secondary 46 62.2 28 42.4 Bachelor and above 6 8.1 2 3.0 Occupational Group Housewife 33 44.6 31 47 0.024 c Agriculture 37 50 24 36.4 Business 4 5.4 4 6.1 Unemployment 0 0 7 10.6 Residence Urban 41 55.4 28 42.4 0.125 c Semi-Urban 33 44.6 38 57.6 Family Income ≤ 37500 NPR 49 66.2 21 31.8 37500 NPR 25 33.8 45 68.2 c = Chi-square test; IQR = Interquartile Range Statistical significance set at p < 0.0, NPR = Nepalese Currency (1 USD = 140.13 NPR) Baseline characteristics of the participants Table 1 illustrates the information about baseline characteristics of participants from the intervention and control groups. in the intervention (n = 74) and control groups (n = 66). Age, ethnicity, marital status, religion, and residency were distributed similarly between the groups (all p > 0.05), confirming baseline comparability. The majority of individuals in both groups were at least 44 years old, married, Hindu, and of Brahmin/Chhetri origin. The study found significant differences in educational level (p = 0.017), occupational group (p = 0.024), and monthly family income (p < 0.001). The control group had a higher number of people with basic education (31.8%) and informal education (22.7%), whereas intervention group participants had a higher percentage of secondary education (62.2%). In terms of occupation, agricultural labour was more common in the intervention group (50%) than in the control group (36.4%), while unemployment was only documented in the control group (10.6%). The intervention group had a higher number of participants with a monthly household income of less than 37,500 Nepalese Rupees (66.2%) compared to the control group (31.8%). These disparities in socioeconomic indices should be addressed when analyzing the intervention's results. Knowledge of dengue within and between groups over time Table 2 shows the median knowledge scores on dengue for the intervention (n = 74) and control groups (n = 66) at baseline and endpoint. At baseline, there was no significant difference between groups (p = 0.146, d = 0.123). At the endpoint, the intervention group had significantly higher knowledge scores (median = 30, IQR = 22.75-34) than the control group (median = 19, IQR = 16.25–24.5; p < 0.001, d = 0.539). Within-group comparisons showed a substantial improvement in the intervention group (p < 0.001, d = 0.793), but no significant change in the control group (p = 0.789, d = 0.033). The Wilcoxon signed-rank and Mann-Whitney U tests were employed to compare within and between groups, respectively. Table 2 Knowledge of dengue within and between groups over time Group Variable Intervention group Control group p-value Effect Size(r) n Median (IQR) n Median (IQR) Knowledge Baseline 74 22 (19–22) 66 18(16–26) 0.146 m 0.123 Endline 74 30(22.75-34) 64 19(16.25–24.5) < 0.001 m 0.539 p-value < 0.001 w 0.789 w Effect Size(r) 0.793 0.033 W =Wilcoxon matched-pairs signed-rank test; m =Mann-Whitney U test; IQR = Interquartile Range; Statistical significance set at p < 0.05 Attitude of dengue within and between groups over time Table 3 displays the median attitude scores regarding dengue for the intervention (n = 74) and control (n = 66) groups at baseline and endpoints. At baseline, there was no significant difference between groups (p = 0.133, d = 0.127). By the end, the intervention group had significantly higher attitude scores (median = 26.5, IQR = 24–29) than the control group (median = 25, IQR = 23–26; p = 0.011, d = 0.215). Within-group analysis showed a substantial improvement in the intervention group (p < 0.001, d = 0.465), but no significant change in the control group (p = 0.284, d = 0.132). The Wilcoxon signed-rank test and the Mann-Whitney U test were employed to compare within and between groups, respectively. Table 3 Attitude of dengue within and between groups over time Group Variable Intervention group Control group p-value Effect Size(r) n Median (IQR) n Median (IQR) Attitude Baseline 74 24 (24-25.25) 66 25 (22–28) 0.133 m 0.127 Endline 74 26.5 (24–29) 64 25 (23–26) < 0.011 m 0.215 p-value < 0.001 W 0.284 W Effect Size(r) 0.465 0.132 W =Wilcoxon matched-pairs signed-rank test; m =Mann-Whitney U test; IQR = Interquartile Range; Statistical significance set at p < 0.05 HBM construct of dengue within and between groups over time Table 4 shows how the intervention affected Health Belief Model (HBM) variables among participants in the intervention and control groups at baseline and endpoint. At both time points, there were no significant variations in perceived susceptibility. However, the intervention group showed a significant within-group improvement (p < 0.001, d = 0.533), indicating enhanced personal risk awareness. Perceived severity did not alter significantly across or within groups, showing that perceptions of dengue's significance remained consistent. Although there were no significant differences between groups, the intervention group showed a significant increase within the group (p < 0.001, d = 0.441), indicating increased awareness of the benefits of preventative practices. At The endline of the study, the intervention group had considerably decreased perceived barriers (p < 0.001, d = 0.324), but no significant differences were seen between groups. Self-efficacy significantly improved in the intervention group, both between groups (p < 0.001, d = 0.652) and within the group over time (p < 0.001, d = 0.769), showing a stronger belief in personal competence to adopt dengue-preventive activities. These findings demonstrate the intervention's effectiveness in positively changing important health beliefs associated with behavior change. Table 4 HBM Construct of dengue within and between groups over time Group Variable Intervention group (n = 74) Control group (n = 66) p-value Effect Size(r) Median IQR Median IQR Perceived Susceptibility Baseline 21 (21,22) 21 (20,24) 0.309 m 0.086 Endline 23 (20,25) 22 (20,24) < 0.121 m 0.131 p-value < 0.001 W 0.843 W Effect Size(r) 0.533 0.024 Perceived severity Baseline 22 (21,25) 21 (18.75-25) 0.108 m 0.136 Endline 21 (20,25) 21 (19,24) < 0.208 m 0.106 p-value < 0.284 W 0.838 W Effect Size(r) 0.124 0.025 Perceived Benefits Baseline 20 (20,21) 21 (19.75,22.25) 0.443 m 0.065 Endline 20 (20,25) 21 (19,23.75) 0.136 m 0.126 p-value < 0.001 W 0.490 W Effect Size(r) 0.441 0.085 Perceived Barriers Baseline 13 (11,14) 13 (9,14.25) 0.368 m 0.076 Endline 13.5 (9–14) 12 (10,14) < 0.001 m 0.324 p-value < 0.390 W 0.730 W Effect Size(r) 0.100 0.042 Self-Efficacy Baseline 20 (20,20) 20 (18,21) 0.649 m 0.038 Endline 23 (20.75,24.25) 19 (18,21) < 0.001 m 0.652 p-value < 0.001 W 0.136 W Effect Size(r) 0.769 0.184 W =Wilcoxon matched-pairs signed-rank test; m =Mann-Whitney U test; IQR = Interquartile Range; Statistical significance set at p < 0.05 DISCUSSION The community-based study evaluated the effectiveness of community health workers and on dengue knowledge, attitude, and constructs of HBM among female community health volunteers of Pokhara Metropolitan, Kaski, Nepal. This study shows that its primary goal of significantly enhancing dengue-related knowledge among female community health volunteers (FCHVs), is evidenced by a large increase in median scores aligning with international studies. Attitudes improved significantly but moderately, consistent with the known slower shift in beliefs compared to factual knowledge. The intervention effectively heightened perceived susceptibility and perceived benefits of prevention, also this intervention significantly boosted self-efficacy, supported by studies in different similar interventional studies. This study demonstrated a significant improvement in knowledge scores among the intervention group, with the median increasing from 22 to 30 (p < 0.001) and a large within-group effect size of 0.793. This finding aligns with similar studies conducted in South Asia and other comparable settings. A study among village health sanitation and nutrition committee members in rural India reported an increase in median perception (knowledge) scores from 17 to 24 following training (p < 0.001) 22 . Similarly, in Iran, observed a significant rise in mean knowledge scores ( 10.77 ± 0.98, p < 0.05) after an HBM-based educational intervention. 17 An urban community trial in India also found that the intervention group had a mean end-line knowledge score of 25.55, nearly double that of the control group (12.81, p < 0.001) 23 . Furthermore, a Nepalese study using SMS and leaflet-based education reported a mean knowledge gain of 32.7 points (SD = 13.7) in the SMS + leaflet group compared to 13.3 points (SD = 8.8 ) in the leaflet-only group. 24 These studies consistently show that targeted dengue-prevention interventions can lead to substantial knowledge gains 17 , 22 – 24 , finally, the results of this study align with this pattern, confirming the effectiveness of a single-session training approach in significantly enhancing dengue-related knowledge among female community health volunteers in a Nepal. The intervention group demonstrated a statistically significant improvement in attitude scores from baseline to end-line (median: 24 to 26.5: p < 0.001), with a moderate effect size of 0.465. In contrast, the control group showed no significant change ( p = 0.284), and a significant between-group difference at the end-line ( p = 0.011) supports the intervention's effectiveness. This pattern matches the study conducted in Delhi community intervention, the intervention group’s mean attitude score rose to 21.06 (SD 2.48) versus 18.24 (SD 5.61) in controls at follow-up (p < 0.001). 23 Likewise study from Iran on HBM-based educational intervention shows a mean attitude reached 24.30 (± 1.59) post-intervention (p < 0.05) 17 . In this study, we observed a similar trend FCHVs reported more favorable attitudes after the single session (p < 0.05). However, the magnitude was smaller than knowledge gains, reflecting the common finding that beliefs/attitudes improve more slowly 17 , 23 . Altogether the data shows a meaningful positive shift in attitude, in line with other observed interventions. In this study within the intervention group, perceived susceptibility significantly increased from baseline to end-line (p < 0.001, effect size = 0.533), indicating that the training had an impact in raising participant's awareness of their risk also reflects the effectiveness of the intervention in enhancing perceived vulnerability to dengue. Findings from multiple countries demonstrate that dengue-related education interventions significantly increase an individual’s perception of susceptibility. A study conducted in Iran reported a significant rise in mean susceptibility scores following the intervention, from 18.82 ± 2.04 pre-intervention to 20.05 ± 1.42 post-intervention (p < 0.001). 17 Similarly study from Indonesia on a community health education campaign raised the proportion of people with a good susceptibility perception from 76.1–90.1% after training (p = 0.021). 25 In contrast to our setting research conducted in a student setting from India shows comprehensive training workshops dramatically increased reported risk. Those believing they were likely to get dengue climbed from 16.7% before training to 55% after. 26 Findings from different research matches this study, here FCHVs showed higher susceptibility scores post-training. In all cases, training raised people’s sense of personal risk. Other studies in endemic settings likewise report that education increases perceived risk. Cross-sectional surveys show that higher perceived susceptibility predicts preventive behavior. 27 , 28 This study did not find a statistically significant change in this perceived severity construct among FCHVs in Pokhara (intervention group: p = 0.284, effect size = 0.124; control group: p = 0.838, effect size = 0.025). While a substantial body of evidence from diverse settings including Iran observed a significant increase in mean perceived severity scores post-intervention in Iran 17 , a study in Malaysia reported a rise from 77.0–90.0% in participants rating dengue as highly serious following an HBM-based intervention among Indigenous villagers. 29 These studies suggest that while structured, theory-informed educational interventions can effectively enhance perceptions of disease severity in the general population, their impact may be attenuated among health volunteers due to pre-existing high levels of awareness. This phenomenon is supported by 30 , who found that 98% of FCHVs in Sainamina Municipality, Nepal, had a general knowledge of dengue. The intervention group exhibited a statistically significant increase in perceived benefits from baseline to endline (p < 0.001), with a moderate effect size (r = 0.441). In contrast, the control group showed no significant change (p = 0.490, r = 0.085). A study from Indonesia depicts that Good-benefit perception increased from 76.1–95.8% after education (p = 0.001) Nearly all participants came to see dengue control measures as effective. 25 Similarly Training raised perceived benefits of prevention. The mean benefits score went from 25.98 ± 2.05 to 28.00 ± 2.16 in the intervention group (p < 0.001) indicating the stronger belief in preventive actions. 17 These studies align with this study which shows that the training effectively enhanced participant’s recognition of dengue prevention advantages. Despite minimal within-group changes in perceived barriers, the end-line comparison between the intervention and control groups revealed a statistically significant difference (p < 0.001). Interventional studies show mixed effects on perceived barriers after dengue education. An intervention study report from Iran shows dramatic barrier reduction after HBM-based training, the intervention group’s barrier score fell in the end-line from the baseline. 17 In contrast to this a Thai quasi‐experiment found very little change baseline barrier scores were nearly equal (Intervention 14.09 ± 0.93 vs Control 13.97 ± 0.93; p = 0.593) and post‐training scores were 14.41 ± 0.84 vs 14.13 ± 0.83 intervention group did not show a significant within‐group gain. 31 . This study studies suggest that community training can lower perceived barriers often showing stronger between‐group than within‐group changes showing our finding that trained volunteers differed significantly from controls on barriers (p 0.05). Several interventional studies support the finding that educational training significantly improves self-efficacy related to dengue prevention. In this study, self-efficacy increased from a median of 20 (IQR: 20–20) to 23 (IQR: 20.75–24.25) in the intervention group (p < 0.001), while the control group remained nearly unchanged (p < 0.001). Similarly, a study in Malaysia reported a significant post-intervention increase in self-efficacy scores among participants who received community-based dengue education (p < 0.001). 29 In Iran, Self-efficacy increased significantly, Mean self-efficacy went from 12.89 ± 1.64 to 14.77 ± 0.51 post-intervention (p < 0.001) reflecting greater confidence in one’s ability to carry out preventive behaviors. 17 Likewise, a study from Thailand reported that after a participatory village-level dengue program, community members’ perceived self‐efficacy scores rose significantly (post-intervention self‐efficacy higher in the intervention versus comparison villages, (p < 0.001). 32 align to this study multiple interventions in low-resource community settings have found that targeted dengue education significantly boosts self‐efficacy for dengue prevention (often with p < 0.001), supporting results of this study. There were a few limitations in our study. First, blinding of participants was not possible due to the nature of the intervention, which may have introduced response bias in self-reported outcomes. Second, while the study measured changes in knowledge, attitudes, and HBM constructs, it did not assess actual behavioral outcomes, limiting the ability to determine real-world impact. Third, the study did not include any follow-up assessment or reinforcement training, making it difficult to evaluate the sustainability of the intervention effects over time. CONCLUSIONS This study demonstrated that even a single-session, structured educational intervention significantly improved dengue-related knowledge, attitudes, and key health beliefs including perceived susceptibility, perceived benefits, and self-efficacy among Female Community Health Volunteers (FCHVs) in Pokhara Metropolitan, Nepal. Although perceived barriers showed only modest improvement and perceived severity remained unchanged, the latter likely reflected high baseline awareness. The findings support the potential for low-cost, theory-driven training to enhance FCHV capacity for effective community-based dengue prevention. Abbreviations DENV Dengue Virus EDCD Epidemiology and Disease Control Division HBM Health Belief Model IEC Information, Education and Communication IRC Institutional Review Committee NHEICC National Health Education, Information and Communication Center PMC Pokhara Metropolitan City SMS Short Message Services SPSS Statistical Package for Social Sciences WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval was obtained from the Institutional Review Committee (IRC) of Pokhara University (Ref no.171/2081/82). All study participants were informed of the study's goal, their freedom to refuse or withdraw from participation at any time, and the promise of anonymity and confidentiality of their data. Study subjects provided written informed consent. The study followed the ethical criteria mentioned in the Declaration of Helsinki. The study posed a minimal risk, and participants in the intervention group benefited from health education. The control group received the same educational content after data collection. Consent for publication Not applicable Availability of Data and Materials The data of this study will be available from the corresponding author upon reasonable request. Competing of Interests The authors declare that they have no competing interests. Funding No funding was received for this study. Authors Contribution GP contributed to wrote the theme introduction, conceptualizing the study, developing the methodology, and gathering data. TRB oversaw the research process and overall guidance. NRC contributed to the data analysis and drafting of the paper. All writers reviewed the final manuscript. Acknowledgments The authors would like to thank each one of the study participants from the bottom of our hearts. We would especially like to thank Mr. Amar Dawadi and Mr Ramesh Shrestha for their assistance with the data collection support. Authors' information (optional) 1,3 School of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Kaski, Nepal 2 Nutrition Research Project of Kansai Medical University Japan in Annapurna Rural Municipality, Kaski, Nepal References Phuyal P, Kramer IM, Kuch U, Magdeburg A, Groneberg DA, Lamichhane Dhimal M, et al. The knowledge, attitude, and practice of community people on dengue fever in Central Nepal: a cross-sectional study. BMC Infect Dis. 2022;22:454. Messina JP, Brady OJ, Golding N, Kraemer MU, Wint GW, Ray SE, et al. The current and future global distribution and population at risk of dengue. Nat Microbiol. 2019;4:1508–15. Yang X, Quam MB, Zhang T, Sang S. Global burden for dengue and the evolving pattern in the past 30 years. J Travel Med. 2021;28:taab146. Chaudhary MN, Lim VC, Faller EM, Regmi P, Aryal N, Mohd Zain SN, et al. Assessing the basic knowledge and awareness of dengue fever prevention among migrant workers in Klang Valley, Malaysia. PLoS ONE. 2024;19:e0297527. Gwee XWS, Chua PEY, Pang J. Global dengue importation: a systematic review. BMC Infect Dis. 2021;21:1–10. World Health Organization. Vector Borne Disease [Internet]. Geneva, Switzerland; [cited 2024 Dec 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases Pandey BD, Rai SK, Morita K, Kurane I. First case of Dengue virus infection in Nepal. Nepal Med Coll J NMCJ. 2004;6:157–9. Rimal S, Shrestha S, Pandey K, Nguyen TV, Bhandari P, Shah Y, et al. 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J Nobel Med Coll. 2020;9:28–33. Udayanga L, Gunathilaka N, Iqbal M, Pahalagedara K, Amarasinghe US, Abeyewickreme W. Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka. BMC Infect Dis. 2018;18:1–14. World Health Organization. Special Programme for Research, Training in Tropical Diseases. Department of Control of Neglected Tropical Diseases, World Health Organization. Epidemic, Pandemic Alert. Dengue: guidelines for diagnosis, treatment, prevention and control. World Health Organization; 2009. Sreedevi A, Burru RV, Rao GV, Yalamanchili P, Subhaprada C, Kumari V, et al. Study on awareness about vector borne diseases and education about preventive measures in rural field practice areas of Kurnool medical college, Kurnool. Int J Med Sci Public Health. 2016;5:1803–7. Lachyan AS, Khan AM, Zaki RA, Banerjee B. Effect of community-based intervention on awareness of dengue and its prevention among urban poor community in India: A systematic review approach. Int J Community Med Public Health. 2020;7:5182–9. Yari A, Mohseni S, Ezati Rad R, Hosseini Z, Shahabi N, Aghamolaei T. The Effectiveness of Educational Intervention in Promoting Preventive Behaviors of Dengue Fever in Southern Iran: Applying Health Belief Model (HBM). Health Sci Rep. 2024;7:e70198. Chung MHL, Hazmi H, Cheah WL. Role performance of community health volunteers and its associated factors in Kuching district, Sarawak. J Environ Public Health. 2017;2017:9610928. Sulistyawati S, Dwi Astuti F, Rahmah Umniyati S, Tunggul Satoto TB, Lazuardi L, Nilsson M, et al. Dengue vector control through community empowerment: lessons learned from a community-based study in Yogyakarta, Indonesia. Int J Environ Res Public Health. 2019;16:1013. Dhimal M, Aryal KK, Dhimal ML, Gautam I, Singh SP, Bhusal CL, et al. Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in central Nepal. PLoS ONE. 2014;9:e102028. World Health Organization. Comprehensive guideline for prevention and control of dengue and dengue haemorrhagic fever. 2011. Kulkarni P, Kumar S, Hugara S, Manjunatha R, Murthy N. Empowering Village Health Sanitation and Nutrition Committee members on dengue prevention and control: An educational interventional study in rural areas of Mysuru, Karnataka. Indian J Med Sci. 2020;73:1–5. Lachyan A, Zaki RA, Banerjee B, Aghamohammadi N. The effect of community-based intervention on Dengue awareness and prevention among poor urban communities in Delhi, India. J Res Health Sci. 2023;23:e00596. Bhattarai AH, Sanjaya GY, Khadka A, Kumar R, Ahmad RA. The addition of mobile SMS effectively improves dengue prevention practices in the community: an implementation study in Nepal. BMC Health Serv Res. 2019;19:1–11. Paluseri AMA, Ishak H, Manyullei S. Analysis of the Influence of Environmental Health Interventions Based on The Health Belief Model (HBM) on the Risk Factors of Dengue Hemorrhagic Fever (DHF) Benteng Village, Indonesia. Natl J Community Med. 2023;14:568–74. Rahul A, Dhanalakshmi R, Srirama S, Nagarajan SA, Dhakshinamoorthy AD, Nelson A et al. Capacity Building for Dengue Prevention: A Comprehensive Training Approach in Two Medical Colleges in Puducherry, India. Cureus. 2025;17. Chandren JR, Wong LP, AbuBakar S. Practices of Dengue Fever Prevention and the Associated Factors among the Orang Asli in Peninsular Malaysia. PLoS Negl Trop Dis. 2015;9:e0003954. Siddiqui TR, Ghazal S, Bibi S, Ahmed W, Sajjad SF. Use of the health belief model for the assessment of public knowledge and household preventive practices in Karachi, Pakistan, a dengue-endemic city. PLoS Negl Trop Dis. 2016;10:e0005129. Wong LP, Rajandra A, Abd Jamil J, AbuBakar S, Lin Y, Lee HY. Effectiveness of dengue awareness calendar on indigenous population: Impact on knowledge, belief and practice. In MDPI; 2023. p. 637. Lamsal S. Awareness of Dengue Disease among Female Community Health Volunteers of Sainamina Municipality, Nepal. SNPRC J. 2023;4:70–81. Hanklang S, Ratanasiripong P, Sivasan S. Effectiveness of the intervention program for dengue hemorrhagic fever prevention among rural communities in Thailand: A quasi-experimental study. J Health Res. 2018;32:352–63. Therawiwat M, Fungladda W, Kaewkungwal J, Imamee N, Steckler A. Community-based approach for prevention and control of dengue hemorrhagic fever in Kanchanaburi Province, Thailand. 2005. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-6833774","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470376774,"identity":"10190d5b-20db-4471-9594-ff1f2ebd9ccd","order_by":0,"name":"Gyanu Poudel","email":"","orcid":"","institution":"Pokhara University","correspondingAuthor":false,"prefix":"","firstName":"Gyanu","middleName":"","lastName":"Poudel","suffix":""},{"id":470376776,"identity":"1740f833-9dd3-4177-bf56-2aaa79fea05a","order_by":1,"name":"Nawaraj Chapagain","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYLCCDwwMzGzszQcfABkMbOxE6GCcAdTCx3Ms2XAGSAszEVqYeYCEnESOmTAPmEtAuTn7GcMPvHvs2NmAWphtfm2T52NmYPzwMQe3FsueHGMJiWfJzGw8z8oe5/bdNmxjZmCWnLkNtxaDA7kbJAwOMAO9n7zdOLfnNiNQCxszLz4t599u/pFwoJ6ZjSHBTNqy57Y9YS03crdJHDhwmJmNI8VMmuHH7UQitLz/Ztlw4DjQL8BA7m24ndzGzNiM3y/n05Jv/zlQnSzfDozKH39u284HMj58xKMFBpLBJGMbmGwgrB4I7CDUH6IUj4JRMApGwQgDACMcURsiF2yTAAAAAElFTkSuQmCC","orcid":"","institution":"Nutrition Research Project of Kansai Medical University Japan in Annapurna Rural Municipality","correspondingAuthor":true,"prefix":"","firstName":"Nawaraj","middleName":"","lastName":"Chapagain","suffix":""},{"id":470376778,"identity":"91e89d8f-b7ad-4f3e-b6e3-9c0d8d37e31a","order_by":2,"name":"Tulsiram Bhandari","email":"","orcid":"","institution":"Pokhara University","correspondingAuthor":false,"prefix":"","firstName":"Tulsiram","middleName":"","lastName":"Bhandari","suffix":""}],"badges":[],"createdAt":"2025-06-06 05:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6833774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6833774/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84678248,"identity":"8ba451e1-b8e4-4044-8b94-b52e41e7e337","added_by":"auto","created_at":"2025-06-16 07:54:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":96499,"visible":true,"origin":"","legend":"\u003cp\u003eStudy process (flow diagram)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6833774/v1/7fdde1155972f08ecb32a422.png"},{"id":84678926,"identity":"48579b7f-ff63-4059-850d-736de278821f","added_by":"auto","created_at":"2025-06-16 08:03:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1359791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6833774/v1/9a323c4b-5d82-4e67-ba63-b9160e31afe3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Single Session Educational Training in Dengue Awareness among Female Community Health Volunteers of Pokhara Metropolitan Kaski, Nepal","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDengue fever is a viral illness primarily caused by four serotypes of dengue virus: DENV-1, DENV-2, DENV-3, and DENV-4. It is transmitted to humans through the bite of an infected Aedes mosquito.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The disease is most prevalent in warm, humid regions, particularly in urban and semi-urban areas worldwide. Increasing temperatures significantly contribute to the virus's growth and spread.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the past three decades, urbanization, global warming, and increased human mobility have significantly contributed to the global dengue burden.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e It is estimated that 390\u0026nbsp;million dengue virus infections occur each year, of which 96\u0026nbsp;million are symptomatic and approximately 40,000 deaths annually. The Southeast Asia region carries more than half of the global dengue burden although it can be deadly, it can be stopped or avoided. \u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In Nepal the first case of dengue was seen in 2004\u003csup\u003e7\u003c/sup\u003e, the trend of dengue occurrence has been increasing over the past two decades.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e The Kaski district, particularly Pokhara Metropolitan, has been identified as a hotspot, with 8,858 cases reported in 2024\u003csup\u003e9\u003c/sup\u003e. Climate change has expanded the disease to higher-altitude areas previously considered non-endemic. \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCommunity health volunteers (CHVs) are integral to public health efforts, especially in rural and semi-urban areas, where they support disease prevention, health education, and community engagement.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Training CHVs is crucial for enhancing their knowledge and skills in dengue prevention and control. This training enables them to educate communities, identify mosquito breeding sites, and promote early detection and timely medical care.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVector control efforts include eliminating mosquito breeding sites, while awareness campaigns educate communities about transmission and prevention.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Despite these efforts, challenges remain in implementing these strategies effectively. Limited resources, low levels of community awareness, and environmental factors such as urbanization and poor waste management hinder progress, highlighting the need for more sustainable and innovative approaches.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTraining and awareness are pivotal in addressing gaps in dengue prevention and control. Many communities lack sufficient knowledge about the disease and the measures needed to prevent it.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e By training CHVs, they can be empowered to lead education campaigns and mobilize communities to adopt preventive practices, such as removing stagnant water, using mosquito nets, and recognizing symptoms early.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Effective training not only strengthens the capacity of CHVs but also fosters community participation, which is critical for reducing the burden of dengue.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePrevious studies have highlighted the importance of community engagement and education in controlling dengue. Research shows that social capital, strong leadership, and community-driven initiatives, such as forming social groups and conducting voluntary cleaning efforts, are highly effective in reducing mosquito breeding and lowering dengue incidence.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e However, limited research has focused on training programs for FCHVs in dengue prevention within the Pokhara Metropolitan context. Expanding training programs and engaging communities in education and capacity building are essential steps for more effective dengue prevention and control.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Dengue fever remains a major challenge to public health in the Pokhara metropolitan. Hence preventive measures should be effective. Training provides great opportunities to improving awareness and mobilizing communities to adopt preventive measures. Resources limitation and community engagement are very critical barriers to overcome in order to achieve sustainable disease control.\u003c/p\u003e \u003cp\u003eThe scientific knowledge on dengue among many of community level people are very limited\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. This lack of awareness hampers the effectiveness of prevention and control measures, necessitating targeted educational interventions. A cross-sectional survey by \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e shows that only 12% of the population had good knowledge of dengue, emphasizing a significant gap in understanding the disease, its symptoms, prevention, and control measures. Despite ongoing efforts, dengue remains a major public health challenge, demanding urgent and effective preventive strategies.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies show that role of community interventions play a pivotal role in raising awareness, achieving sustainable vector control, and reducing transmission rates.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Currently government of Nepal doesn\u0026rsquo;t have any developed orientation module to provide training to FCHVs for raising awareness of dengue. Many cross-sectional studies have been done however there is scarce interventional research to improve dengue-related knowledge among female community health volunteers in Nepal. Thus, this study aims to discover more about dengue-related Knowledge among FCHVs of Pokhara Metropolitan assuming a significant improvement through educational intervention and also could be a basis for future research. The findings obtained from the study will be useful for concerned authorities on the prevention and management of dengue in the study area.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eDesign of the Study\u003c/h2\u003e\n \u003cp\u003eThis study used an intervention with a compare group design that included a pre-test and post-test control group. It was conducted from April to May 2025 in selected wards of Pokhara Metropolitan City, Nepal. The purpose was to assess the efficacy of an educational intervention in dengue prevention among Female Community Health Volunteers (FCHVs).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe participants were FCHVs working in six wards of Pokhara Metropolitan City. The inclusion criteria included FCHVs affiliated with government health institutions who provided informed consent. FCHVs who did not reside in their assigned areas were excluded. A total of 140 participants were included 74 in the intervention group and 66 in the control group.\u003c/p\u003e\n\u003ch3\u003eSampling Methods\u003c/h3\u003e\n\u003cp\u003eA purposive sampling technique was used to select six wards (from 33) based on dengue risk and accessibility. Three wards were randomly assigned to the intervention group and three to the control group. All FCHVs from the selected wards were included using a census approach. The sample size was calculated using the formula for comparing two proportions, with a power of 90% and a significance level of 5%. Based on a previous study, the proportion of correct knowledge responses was expected to improve from 37\u0026ndash;61%. After accounting for a 20% attrition rate, the final sample size was 77 participants per group.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured, validated self-administered questionnaire. The tool assessed socio-demographic characteristics, knowledge, attitudes, and constructs of the Health Belief Model (HBM) related to dengue prevention. The questionnaire was developed based on previous literature, translated into Nepali, and pre-tested among 10% of the sample in a similar setting. Adjustments were made based on pre-test feedback to improve clarity and reliability. The internal consistency of the scales was assessed using Cronbach\u0026rsquo;s alpha, with values above 0.7 being acceptable.\u003c/p\u003e\n\u003ch3\u003eStudy Variables\u003c/h3\u003e\n\u003cp\u003eThe Health Belief Model (HBM) served as the study\u0026apos;s guideline. The dependent variable was dengue prevention and control practices, which were classified as acceptable or inadequate according to a cut-off score. Independent factors included age, education, occupation, marital status, ethnicity, place of residence, religion, and monthly income. Knowledge was assessed using 44 positive statements, with one point awarded for each right response; scores were classified as good or poor. HBM constructs (attitudes, perceived vulnerability, severity, benefits, barriers, and self-efficacy) were evaluated using a five-point Likert scale. Composite scores were classified as high or low depending on their median.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedures\u003c/h2\u003e\n \u003cp\u003ePermission was obtained from relevant local authorities. A pre-test was administered to both groups using the structured questionnaire. The intervention group then received a 3-hour educational session, while the control group received no training at that time. After six weeks, a post-test was conducted in both groups using the same questionnaire. Following the post-test, the control group was also provided with educational materials to ensure ethical fairness.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEducational Intervention\u003c/h3\u003e\n\u003cp\u003eThe educational intervention was developed based on a review of relevant literature and in consultation with experts from the National Health Education, Information and Communication Canter (NHEICC). The content was designed to be culturally appropriate, easily understandable, and visually engaging. It included a mini-lecture, group discussion, and distribution of an illustrated booklet. The intervention aimed to improve participants\u0026apos; knowledge and preventive practices regarding dengue.\u003c/p\u003e\n\u003ch3\u003eData Management and Analysis\u003c/h3\u003e\n\u003cp\u003eData were entered using EpiData and exported to SPSS version 22 for analysis. Descriptive statistics (frequencies, percentages, medians, and interquartile ranges) were used to summarize the data. Inferential tests including Pearson\u0026rsquo;s chi-squared test, Wilcoxon signed-rank test, and Mann\u0026ndash;Whitney U test were used as appropriate. A p-value less than 0.05 was considered statistically significant. Data quality was ensured through daily review and double-checking of entries.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical Considerations\u003c/h2\u003e\n \u003cp\u003eEthical approval was obtained from the Institutional Review Committee (IRC) of Pokhara University (Ref no. 171/2081/82). Written informed consent was obtained from all participants. Data collection was conducted in Nepali to ensure understanding. Participants were assured of the voluntary nature of the study and the confidentiality of their responses. Unique code numbers were used to maintain anonymity. The study posed a minimal risk, and participants in the intervention group benefited from health education. The control group received the same educational content after data collection.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOut of 154 total 140 (98.71%) Female Community Health Volunteers (FCHVs) participated in the baseline study, with 78 each assigned to the intervention and control groups. At the time of the post-test, the response rate was 96.9% (74) in the intervention group and 85.7% (66) in the control group. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of demographic characteristics (age, ethnicity, marital status, religion, educational level, occupational group, residence, and family income). The finding shows the family income, occupational group, and educational level were statistically significant differences between the two groups in terms of demographic variables and the results of the chi-square test(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics of the participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u0026ndash;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.951\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u0026ndash;43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e42.5(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e43(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDalit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.627 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJanajati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrahmin/Chhetri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.816 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.102\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBuddha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInformal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.017 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.024 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgriculture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.125 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSemi-Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;37500 NPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;37500 NPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e \u003cem\u003e= Chi-square test; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eStatistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.0, NPR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;Nepalese Currency (1 USD\u0026thinsp;=\u0026thinsp;140.13 NPR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eBaseline characteristics of the participants\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the information about baseline characteristics of participants from the intervention and control groups. in the intervention (n\u0026thinsp;=\u0026thinsp;74) and control groups (n\u0026thinsp;=\u0026thinsp;66). Age, ethnicity, marital status, religion, and residency were distributed similarly between the groups (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), confirming baseline comparability. The majority of individuals in both groups were at least 44 years old, married, Hindu, and of Brahmin/Chhetri origin. The study found significant differences in educational level (p\u0026thinsp;=\u0026thinsp;0.017), occupational group (p\u0026thinsp;=\u0026thinsp;0.024), and monthly family income (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The control group had a higher number of people with basic education (31.8%) and informal education (22.7%), whereas intervention group participants had a higher percentage of secondary education (62.2%). In terms of occupation, agricultural labour was more common in the intervention group (50%) than in the control group (36.4%), while unemployment was only documented in the control group (10.6%). The intervention group had a higher number of participants with a monthly household income of less than 37,500 Nepalese Rupees (66.2%) compared to the control group (31.8%). These disparities in socioeconomic indices should be addressed when analyzing the intervention\u0026apos;s results.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eKnowledge of dengue within and between groups over time\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the median knowledge scores on dengue for the intervention (n\u0026thinsp;=\u0026thinsp;74) and control groups (n\u0026thinsp;=\u0026thinsp;66) at baseline and endpoint. At baseline, there was no significant difference between groups (p\u0026thinsp;=\u0026thinsp;0.146, d\u0026thinsp;=\u0026thinsp;0.123). At the endpoint, the intervention group had significantly higher knowledge scores (median\u0026thinsp;=\u0026thinsp;30, IQR\u0026thinsp;=\u0026thinsp;22.75-34) than the control group (median\u0026thinsp;=\u0026thinsp;19, IQR\u0026thinsp;=\u0026thinsp;16.25\u0026ndash;24.5; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.539). Within-group comparisons showed a substantial improvement in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.793), but no significant change in the control group (p\u0026thinsp;=\u0026thinsp;0.789, d\u0026thinsp;=\u0026thinsp;0.033). The Wilcoxon signed-rank and Mann-Whitney U tests were employed to compare within and between groups, respectively.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKnowledge of dengue within and between groups over time\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGroup Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEffect Size(r)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (19\u0026ndash;22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(16\u0026ndash;26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.146 \u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30(22.75-34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(16.25\u0026ndash;24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e \u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ew\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.789\u003csup\u003ew\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cem\u003eW\u003c/em\u003e\u003c/sup\u003e \u003cem\u003e=Wilcoxon matched-pairs signed-rank test;\u003c/em\u003e \u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e=Mann-Whitney U test; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range; Statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eAttitude of dengue within and between groups over time\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e displays the median attitude scores regarding dengue for the intervention (n\u0026thinsp;=\u0026thinsp;74) and control (n\u0026thinsp;=\u0026thinsp;66) groups at baseline and endpoints. At baseline, there was no significant difference between groups (p\u0026thinsp;=\u0026thinsp;0.133, d\u0026thinsp;=\u0026thinsp;0.127). By the end, the intervention group had significantly higher attitude scores (median\u0026thinsp;=\u0026thinsp;26.5, IQR\u0026thinsp;=\u0026thinsp;24\u0026ndash;29) than the control group (median\u0026thinsp;=\u0026thinsp;25, IQR\u0026thinsp;=\u0026thinsp;23\u0026ndash;26; p\u0026thinsp;=\u0026thinsp;0.011, d\u0026thinsp;=\u0026thinsp;0.215). Within-group analysis showed a substantial improvement in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.465), but no significant change in the control group (p\u0026thinsp;=\u0026thinsp;0.284, d\u0026thinsp;=\u0026thinsp;0.132). The Wilcoxon signed-rank test and the Mann-Whitney U test were employed to compare within and between groups, respectively.\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAttitude of dengue within and between groups over time\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGroup Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEffect Size(r)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(IQR)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (24-25.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (22\u0026ndash;28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.133\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5 (24\u0026ndash;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (23\u0026ndash;26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.011\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003em\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eW\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.284\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cem\u003eW\u003c/em\u003e\u003c/sup\u003e \u003cem\u003e=Wilcoxon matched-pairs signed-rank test;\u003c/em\u003e \u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e=Mann-Whitney U test; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range; Statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eHBM construct of dengue within and between groups over time\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows how the intervention affected Health Belief Model (HBM) variables among participants in the intervention and control groups at baseline and endpoint. At both time points, there were no significant variations in perceived susceptibility. However, the intervention group showed a significant within-group improvement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.533), indicating enhanced personal risk awareness. Perceived severity did not alter significantly across or within groups, showing that perceptions of dengue\u0026apos;s significance remained consistent. Although there were no significant differences between groups, the intervention group showed a significant increase within the group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.441), indicating increased awareness of the benefits of preventative practices. At The endline of the study, the intervention group had considerably decreased perceived barriers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.324), but no significant differences were seen between groups. Self-efficacy significantly improved in the intervention group, both between groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.652) and within the group over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, d\u0026thinsp;=\u0026thinsp;0.769), showing a stronger belief in personal competence to adopt dengue-preventive activities. These findings demonstrate the intervention\u0026apos;s effectiveness in positively changing important health beliefs associated with behavior change.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHBM Construct of dengue within and between groups over time\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGroup Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEffect Size(r)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003ePerceived Susceptibility\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.309\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.121\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eW\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.843\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(18.75-25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.108\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(19,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.208\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.284\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.838\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Benefits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(19.75,22.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.443\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(19,23.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.136\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eW\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.490\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Barriers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(11,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9,14.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.368\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9\u0026ndash;14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(10,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003em\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.390\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.730\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-Efficacy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20,20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(18,21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.649\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(20.75,24.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(18,21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003em\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eW\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.136\u003csup\u003eW\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size(r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cem\u003eW\u003c/em\u003e\u003c/sup\u003e \u003cem\u003e=Wilcoxon matched-pairs signed-rank test;\u003c/em\u003e \u003csup\u003e\u003cem\u003em\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e=Mann-Whitney U test; IQR\u0026thinsp;=\u0026thinsp;Interquartile Range; Statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe community-based study evaluated the effectiveness of community health workers and on dengue knowledge, attitude, and constructs of HBM among female community health volunteers of Pokhara Metropolitan, Kaski, Nepal. This study shows that its primary goal of significantly enhancing dengue-related knowledge among female community health volunteers (FCHVs), is evidenced by a large increase in median scores aligning with international studies. Attitudes improved significantly but moderately, consistent with the known slower shift in beliefs compared to factual knowledge.\u003c/p\u003e \u003cp\u003eThe intervention effectively heightened perceived susceptibility and perceived benefits of prevention, also this intervention significantly boosted self-efficacy, supported by studies in different similar interventional studies. This study demonstrated a significant improvement in knowledge scores among the intervention group, with the median increasing from 22 to 30 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a large within-group effect size of 0.793. This finding aligns with similar studies conducted in South Asia and other comparable settings. A study among village health sanitation and nutrition committee members in rural India reported an increase in median perception (knowledge) scores from 17 to 24 following training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003csup\u003e22\u003c/sup\u003e. Similarly, in Iran, observed a significant rise in mean knowledge scores \u003cb\u003e(\u003c/b\u003e10.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) after an HBM-based educational intervention.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e An urban community trial in India also found that the intervention group had a mean end-line knowledge score of 25.55, nearly double that of the control group (12.81, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Furthermore, a Nepalese study using SMS and leaflet-based education reported a mean knowledge gain of 32.7 points (SD\u0026thinsp;=\u0026thinsp;13.7) in the SMS\u0026thinsp;+\u0026thinsp;leaflet group compared to 13.3 points (SD\u0026thinsp;=\u0026thinsp;8.8\u003cb\u003e)\u003c/b\u003e in the leaflet-only group.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e These studies consistently show that targeted dengue-prevention interventions can lead to substantial knowledge gains\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, finally, the results of this study align with this pattern, confirming the effectiveness of a single-session training approach in significantly enhancing dengue-related knowledge among female community health volunteers in a Nepal.\u003c/p\u003e \u003cp\u003eThe intervention group demonstrated a statistically significant improvement in attitude scores from baseline to end-line (median: 24 to 26.5: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a moderate effect size of 0.465. In contrast, the control group showed no significant change (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.284), and a significant between-group difference at the end-line (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011) supports the intervention's effectiveness. This pattern matches the study conducted in Delhi community intervention, the intervention group\u0026rsquo;s mean attitude score rose to 21.06 (SD 2.48) versus 18.24 (SD 5.61) in controls at follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e23\u003c/sup\u003e Likewise study from Iran on HBM-based educational intervention shows a mean attitude reached 24.30 (\u0026plusmn;\u0026thinsp;1.59) post-intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003csup\u003e17\u003c/sup\u003e. In this study, we observed a similar trend FCHVs reported more favorable attitudes after the single session (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the magnitude was smaller than knowledge gains, reflecting the common finding that beliefs/attitudes improve more slowly\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Altogether the data shows a meaningful positive shift in attitude, in line with other observed interventions.\u003c/p\u003e \u003cp\u003eIn this study within the intervention group, perceived susceptibility significantly increased from baseline to end-line (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, effect size\u0026thinsp;=\u0026thinsp;0.533), indicating that the training had an impact in raising participant's awareness of their risk also reflects the effectiveness of the intervention in enhancing perceived vulnerability to dengue. Findings from multiple countries demonstrate that dengue-related education interventions significantly increase an individual\u0026rsquo;s perception of susceptibility. A study conducted in Iran reported a significant rise in mean susceptibility scores following the intervention, from 18.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04 pre-intervention to 20.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 post-intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e17\u003c/sup\u003e Similarly study from Indonesia on a community health education campaign raised the proportion of people with a good susceptibility perception from 76.1\u0026ndash;90.1% after training (p\u0026thinsp;=\u0026thinsp;0.021).\u003csup\u003e25\u003c/sup\u003e In contrast to our setting research conducted in a student setting from India shows comprehensive training workshops dramatically increased reported risk. Those believing they were likely to get dengue climbed from 16.7% before training to 55% after.\u003csup\u003e26\u003c/sup\u003e Findings from different research matches this study, here FCHVs showed higher susceptibility scores post-training. In all cases, training raised people\u0026rsquo;s sense of personal risk. Other studies in endemic settings likewise report that education increases perceived risk. Cross-sectional surveys show that higher perceived susceptibility predicts preventive behavior.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study did not find a statistically significant change in this perceived severity construct among FCHVs in Pokhara (intervention group: p\u0026thinsp;=\u0026thinsp;0.284, effect size\u0026thinsp;=\u0026thinsp;0.124; control group: p\u0026thinsp;=\u0026thinsp;0.838, effect size\u0026thinsp;=\u0026thinsp;0.025). While a substantial body of evidence from diverse settings including Iran observed a significant increase in mean perceived severity scores post-intervention in Iran \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, a study in Malaysia reported a rise from 77.0\u0026ndash;90.0% in participants rating dengue as highly serious following an HBM-based intervention among Indigenous villagers.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e These studies suggest that while structured, theory-informed educational interventions can effectively enhance perceptions of disease severity in the general population, their impact may be attenuated among health volunteers due to pre-existing high levels of awareness. This phenomenon is supported by \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, who found that 98% of FCHVs in Sainamina Municipality, Nepal, had a general knowledge of dengue.\u003c/p\u003e \u003cp\u003eThe intervention group exhibited a statistically significant increase in perceived benefits from baseline to endline (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a moderate effect size (r\u0026thinsp;=\u0026thinsp;0.441). In contrast, the control group showed no significant change (p\u0026thinsp;=\u0026thinsp;0.490, r\u0026thinsp;=\u0026thinsp;0.085). A study from Indonesia depicts that Good-benefit perception increased from 76.1\u0026ndash;95.8% after education (p\u0026thinsp;=\u0026thinsp;0.001) Nearly all participants came to see dengue control measures as effective.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Similarly Training raised perceived benefits of prevention. The mean benefits score went from 25.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05 to 28.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16 in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) indicating the stronger belief in preventive actions.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These studies align with this study which shows that the training effectively enhanced participant\u0026rsquo;s recognition of dengue prevention advantages.\u003c/p\u003e \u003cp\u003eDespite minimal within-group changes in perceived barriers, the end-line comparison between the intervention and control groups revealed a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Interventional studies show mixed effects on perceived barriers after dengue education. An intervention study report from Iran shows dramatic barrier reduction after HBM-based training, the intervention group\u0026rsquo;s barrier score fell in the end-line from the baseline.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e In contrast to this a Thai quasi‐experiment found very little change baseline barrier scores were nearly equal (Intervention 14.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93 vs Control 13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93; p\u0026thinsp;=\u0026thinsp;0.593) and post‐training scores were 14.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 vs 14.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83 intervention group did not show a significant within‐group gain.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. This study studies suggest that community training can lower perceived barriers often showing stronger between‐group than within‐group changes showing our finding that trained volunteers differed significantly from controls on barriers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) even though neither group\u0026rsquo;s pre/post change was significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eSeveral interventional studies support the finding that educational training significantly improves self-efficacy related to dengue prevention. In this study, self-efficacy increased from a median of 20 (IQR: 20\u0026ndash;20) to 23 (IQR: 20.75\u0026ndash;24.25) in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the control group remained nearly unchanged (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, a study in Malaysia reported a significant post-intervention increase in self-efficacy scores among participants who received community-based dengue education (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e29\u003c/sup\u003e In Iran, Self-efficacy increased significantly, Mean self-efficacy went from 12.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64 to 14.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 post-intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) reflecting greater confidence in one\u0026rsquo;s ability to carry out preventive behaviors.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Likewise, a study from Thailand reported that after a participatory village-level dengue program, community members\u0026rsquo; perceived self‐efficacy scores rose significantly (post-intervention self‐efficacy higher in the intervention versus comparison villages, (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e32\u003c/sup\u003e align to this study multiple interventions in low-resource community settings have found that targeted dengue education significantly boosts self‐efficacy for dengue prevention (often with p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), supporting results of this study.\u003c/p\u003e \u003cp\u003eThere were a few limitations in our study. First, blinding of participants was not possible due to the nature of the intervention, which may have introduced response bias in self-reported outcomes. Second, while the study measured changes in knowledge, attitudes, and HBM constructs, it did not assess actual behavioral outcomes, limiting the ability to determine real-world impact. Third, the study did not include any follow-up assessment or reinforcement training, making it difficult to evaluate the sustainability of the intervention effects over time.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study demonstrated that even a single-session, structured educational intervention significantly improved dengue-related knowledge, attitudes, and key health beliefs including perceived susceptibility, perceived benefits, and self-efficacy among Female Community Health Volunteers (FCHVs) in Pokhara Metropolitan, Nepal. Although perceived barriers showed only modest improvement and perceived severity remained unchanged, the latter likely reflected high baseline awareness. The findings support the potential for low-cost, theory-driven training to enhance FCHV capacity for effective community-based dengue prevention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDENV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDengue Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEDCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEpidemiology and Disease Control Division\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHBM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth Belief Model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInformation, Education and Communication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIRC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNHEICC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNational Health Education, Information and Communication Center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePokhara Metropolitan City\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSMS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eShort Message Services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Committee (IRC) of Pokhara University (Ref no.171/2081/82).\u0026nbsp;All study participants were informed of the study's goal, their freedom to refuse or withdraw from participation at any time, and the promise of anonymity and confidentiality of their data. Study subjects provided written informed consent. The study followed the ethical criteria mentioned in the Declaration of Helsinki.\u0026nbsp;The study posed a minimal risk, and participants in the intervention group benefited from health education. The control group received the same educational content after data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of this study will be available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGP contributed to wrote the theme introduction, conceptualizing the study, developing the methodology, and gathering data. \u0026nbsp; TRB oversaw the research process and overall guidance. NRC contributed to the data analysis and drafting of the paper. All writers reviewed the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank each one of the study participants from the bottom of our hearts. We would especially like to thank Mr. Amar Dawadi and Mr Ramesh Shrestha for their assistance with the data collection support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1,3\u0026nbsp;\u003c/sup\u003eSchool of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Kaski, Nepal\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eNutrition Research Project of Kansai Medical University Japan in Annapurna Rural Municipality, Kaski, Nepal\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePhuyal P, Kramer IM, Kuch U, Magdeburg A, Groneberg DA, Lamichhane Dhimal M, et al. The knowledge, attitude, and practice of community people on dengue fever in Central Nepal: a cross-sectional study. 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Am J Trop Med Hyg. 2013;88:677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDumre SP, Bhandari R, Shakya G, Shrestha SK, Cherif MS, Ghimire P, et al. Dengue virus serotypes 1 and 2 responsible for major dengue outbreaks in Nepal: clinical, laboratory, and epidemiological features. Am J Trop Med Hyg. 2017;97:1062.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaral D, Ghimire A, Uprety S, Pokharel SM, Baral S. Participation of Community in Prevention and Control of Dengue Fever in Dharan Sub Metropolitan City of Province 1, Nepal. J Nobel Med Coll. 2020;9:28\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUdayanga L, Gunathilaka N, Iqbal M, Pahalagedara K, Amarasinghe US, Abeyewickreme W. Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka. BMC Infect Dis. 2018;18:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Special Programme for Research, Training in Tropical Diseases. Department of Control of Neglected Tropical Diseases, World Health Organization. Epidemic, Pandemic Alert. Dengue: guidelines for diagnosis, treatment, prevention and control. World Health Organization; 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSreedevi A, Burru RV, Rao GV, Yalamanchili P, Subhaprada C, Kumari V, et al. Study on awareness about vector borne diseases and education about preventive measures in rural field practice areas of Kurnool medical college, Kurnool. Int J Med Sci Public Health. 2016;5:1803\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLachyan AS, Khan AM, Zaki RA, Banerjee B. Effect of community-based intervention on awareness of dengue and its prevention among urban poor community in India: A systematic review approach. Int J Community Med Public Health. 2020;7:5182\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYari A, Mohseni S, Ezati Rad R, Hosseini Z, Shahabi N, Aghamolaei T. The Effectiveness of Educational Intervention in Promoting Preventive Behaviors of Dengue Fever in Southern Iran: Applying Health Belief Model (HBM). Health Sci Rep. 2024;7:e70198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung MHL, Hazmi H, Cheah WL. Role performance of community health volunteers and its associated factors in Kuching district, Sarawak. J Environ Public Health. 2017;2017:9610928.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSulistyawati S, Dwi Astuti F, Rahmah Umniyati S, Tunggul Satoto TB, Lazuardi L, Nilsson M, et al. Dengue vector control through community empowerment: lessons learned from a community-based study in Yogyakarta, Indonesia. Int J Environ Res Public Health. 2019;16:1013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhimal M, Aryal KK, Dhimal ML, Gautam I, Singh SP, Bhusal CL, et al. Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in central Nepal. PLoS ONE. 2014;9:e102028.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Comprehensive guideline for prevention and control of dengue and dengue haemorrhagic fever. 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulkarni P, Kumar S, Hugara S, Manjunatha R, Murthy N. Empowering Village Health Sanitation and Nutrition Committee members on dengue prevention and control: An educational interventional study in rural areas of Mysuru, Karnataka. Indian J Med Sci. 2020;73:1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLachyan A, Zaki RA, Banerjee B, Aghamohammadi N. The effect of community-based intervention on Dengue awareness and prevention among poor urban communities in Delhi, India. J Res Health Sci. 2023;23:e00596.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhattarai AH, Sanjaya GY, Khadka A, Kumar R, Ahmad RA. The addition of mobile SMS effectively improves dengue prevention practices in the community: an implementation study in Nepal. BMC Health Serv Res. 2019;19:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaluseri AMA, Ishak H, Manyullei S. Analysis of the Influence of Environmental Health Interventions Based on The Health Belief Model (HBM) on the Risk Factors of Dengue Hemorrhagic Fever (DHF) Benteng Village, Indonesia. Natl J Community Med. 2023;14:568\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahul A, Dhanalakshmi R, Srirama S, Nagarajan SA, Dhakshinamoorthy AD, Nelson A et al. Capacity Building for Dengue Prevention: A Comprehensive Training Approach in Two Medical Colleges in Puducherry, India. Cureus. 2025;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandren JR, Wong LP, AbuBakar S. Practices of Dengue Fever Prevention and the Associated Factors among the Orang Asli in Peninsular Malaysia. PLoS Negl Trop Dis. 2015;9:e0003954.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqui TR, Ghazal S, Bibi S, Ahmed W, Sajjad SF. Use of the health belief model for the assessment of public knowledge and household preventive practices in Karachi, Pakistan, a dengue-endemic city. PLoS Negl Trop Dis. 2016;10:e0005129.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong LP, Rajandra A, Abd Jamil J, AbuBakar S, Lin Y, Lee HY. Effectiveness of dengue awareness calendar on indigenous population: Impact on knowledge, belief and practice. In MDPI; 2023. p. 637.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLamsal S. Awareness of Dengue Disease among Female Community Health Volunteers of Sainamina Municipality, Nepal. SNPRC J. 2023;4:70\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanklang S, Ratanasiripong P, Sivasan S. Effectiveness of the intervention program for dengue hemorrhagic fever prevention among rural communities in Thailand: A quasi-experimental study. J Health Res. 2018;32:352\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTherawiwat M, Fungladda W, Kaewkungwal J, Imamee N, Steckler A. Community-based approach for prevention and control of dengue hemorrhagic fever in Kanchanaburi Province, Thailand. 2005.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","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":"Dengue, Awareness, Community Health, Educational Intervention, Health Belief Model, Effectiveness","lastPublishedDoi":"10.21203/rs.3.rs-6833774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6833774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eDengue fever remains a critical public health concern in Nepal, particularly in urban and semi-urban areas such as Pokhara Metropolitan, where incidence rates have increased significantly in recent years. Female Community Health Volunteers (FCHVs) play a vital role in health education and community-based disease prevention; however, structured training programs focused on dengue prevention are lacking. This study assessed the effectiveness of an educational intervention based on the Health Belief Model (HBM) in improving dengue-related knowledge, attitudes, and beliefs among FCHVs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eAn intervention with a compare group design was employed, involving 154 FCHVs from six wards of Pokhara Metropolitan. Three wards were randomly assigned to the intervention group and three to the control group. The intervention consisted of a single three-hour training session incorporating a mini-lecture, group discussion, and distribution of educational booklets. Knowledge, attitudes, and HBM constructs perceived susceptibility, severity, benefits, barriers, and self-efficacy were measured at baseline and six weeks post-intervention using structured questionnaires. Data were analyzed using (Statistical Package for Social Sciences) SPSS version 22, with statistical significance set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe intervention group demonstrated significant improvements in knowledge (median increased from 22 to 30; p \u0026lt; 0.001, effect size = 0.793), attitudes (median increased from 24 to 26.5; p \u0026lt; 0.001), and key HBM constructs, including perceived susceptibility, perceived benefits, and self-efficacy. Although between-group differences in perceived barriers were significant at the end line (p \u0026lt; 0.001), within-group changes were modest. No significant improvement was observed in perceived severity, likely due to high baseline awareness levels among participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings indicate that a brief, theory-driven educational intervention can significantly enhance FCHVs’ knowledge, attitudes, and health beliefs related to dengue prevention. This supports the potential for scalable, low-cost training programs within Nepal’s existing FCHV framework to strengthen community-based dengue control efforts.\u003c/p\u003e","manuscriptTitle":"Effects of Single Session Educational Training in Dengue Awareness among Female Community Health Volunteers of Pokhara Metropolitan Kaski, Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 07:53:30","doi":"10.21203/rs.3.rs-6833774/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":"f35d95ee-6e07-4bd2-b9f3-19573dd5522a","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-16T07:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 07:53:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6833774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6833774","identity":"rs-6833774","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}