Rapid Behavioral Assessment of Knowledge, Attitudes, and Practices on Dengue Fever to Inform Risk Communication and Community Engagement Efforts in the Kingdom of Tonga

In February 2025, Tonga's Minister of Health declared a national dengue fever epidemic, emphasizing the urgent need to raise public awareness and implement preventative measures. In response to this declaration, a study was conducted from March to May 2025 to investigate the sociodemographic determinants affecting dengue fever awareness and preventative behaviors across Tonga's primary islands: Tongatapu, Ha'apai, and Vava'u. Researchers conducted a survey of 140 randomly selected households, achieving a 93% response rate. The results revealed that although 90% of respondents were aware of dengue fever, 67% had limited knowledge of its transmission and prevention. A multivariable analysis revealed that awareness levels were significantly higher among individuals with at least a secondary education, those who regularly listened to radio broadcasts, and those who classified dengue fever as "very serious." Focus group discussions further illuminated community misconceptions about dengue fever symptoms, which were often mistaken for those of respiratory conditions. Participants also expressed concerns about a noticeable decrease in the frequency of health officials' home visits since the onset of the coronavirus disease 2019 pandemic. Community members advocated bolstering local engagement strategies, including the utilization of community radio, village committees, and targeted networks for mothers and youth. These findings underscore the necessity for effective communication strategies, including Tongan-language radio dramas, to enhance community health resilience and encourage sustained preventative practices.