Is participation contagious? evidence from a household vector control campaign in urban Peru

Objectives: High rates of household participation are critical to the success of door-to-door vector control campaigns. We used the Health Belief Model to assess determinants of participation, including neighbor participation as a cue to action, in a Chagas disease vector control campaign in Peru. Methods: We evaluated clustering of participation among neighbors; estimated participation as a function of household infestation status, neighborhood type, and number of participating neighbors; and described reported reasons for refusal to participate in a district of 2911 households. Results: We observed significant clustering of participation along city blocks (p< .0001). Participation was significantly higher for households in new vs. established neighborhoods, for infested households, and for households with more participating neighbors. The effect of neighbor participation was greater in new neighborhoods. Conclusions: Results support a “contagion” model of participation, highlighting the possibility that one or two participating households can tip a block towards full participation. Future campaigns can leverage these findings by making participation more visible, by addressing stigma associated with spraying, and by employing group incentives to spray.