Motivators and barriers concerning Chagas disease indoor residual spraying campaigns in Arequipa, Peru

Simple household hygiene coupled with periodic indoor residual spray campaigns (IRS) can decrease transmission and prevalence of Chagas disease in endemic areas. In recent years, a government-run Chagas disease vector control campaign in Arequipa, Peru has been threatened by declining rates of IRS participation among urban and peri-urban communities. In order to develop strategies to increase participation, a qualitative study was conducted to identify factors related to decreased participation in IRS campaigns. Two focus group discussions (FGD) and 71 semi-structured interviews (SSI) were conducted with individuals who had participated in a first round of IRS, but had declined to participate in a second IRS round. Both FGD and SSI results reveal that most individuals feel that IRS is effective (80.3% in SSI). The most common reported barriers were logistical, such as limited hours of spraying (those who work are not available during spray times), difficulty in moving furniture to allow for effective spraying, campaign staff who arrive later than scheduled, or not being able to open all rooms of the house for the spray if renters have locked their doors. Other barriers included the perception that IRS was not necessary because the house was “clean” or not infested; concerns about health impacts of insecticide on young or elderly households members or those with respiratory conditions; and lack of trust of the campaign personnel. Interventions to improve participation based on these behavioral and attitudinal diagnoses have been designed and are currently being trialed in a pragmatic community-based cluster randomized trial.