Newspaper Coverage of Dengue Prevention Messages in Four Newspapers in Puerto Rico during Epidemic and Non-Epidemic Years

Theoretical Background and research questions/hypothesis:  Dengue is the most common arboviral disease globally, with about 40% of the population at risk.  Dengue prevention has relied on Aedes aegypti mosquito control and personal protection from mosquito bites since no vaccines are available. Previous studies from Puerto Rico  showed that participants had misconceptions about dengue prevention and obtained most of their information from local newspapers. We conducted a content analysis of four daily newspapers to determine if the quality of dengue prevention messages had changed over time.    

Methods:  The content analysis was conducted on publications during epidemic (1994, 1998, and 2010) and non-epidemic (2002, 2004) years.  Articles were selected by identifying title keywords, including dengue, dengue hemorrhagic fever, Aedes aegypti, mosquito, and spraying. Article content was assigned to the following, non-mutually exclusive, categories: importance attributed to dengue based on number of articles per year, page location, and type of article; information source or spokesperson interviewed by journalists; accuracy of dengue messages; visual aids used to complement messages; and policies regarding dengue prevention conveyed in the article.

Results:  We selected 377 articles; 350 (93%) were published during epidemic years, 174 (46%) were on page >16, and 222 (59%) were about dengue incidence and outbreaks. Quoted spokespersons were primarily high level health department officials (94/167; 56%) but in later years, the health department’s Dengue Weekly Reports were used to describe epidemics (67/548; 12%). Epidemiological data (888/3,239; 27%) was sometimes incorrectly reported and epidemiologic terms were used incorrectly or with no appropriate explanation. Messages about prevention practices (818/3,239; 25%) and educational campaigns (279; 36%) raised awareness about disease symptoms, the elimination of water-holding containers and the use of repellents. In 2010, published educational flyers combined influenza and dengue prevention messages due to concomitant epidemics. Images of adult Aedes aegypti were the most common visual aids (139/401; 35%). Photos showed incorrect mosquito breeding sites (e.g., bodies of water without garbage), mosquito control practices (e.g., trucks conducting outdoor spraying), and commercial products to avoid mosquito bites (27/401; 7%). In 1998 and 2010, messages about spraying campaigns (267/775; 35%) were complemented by messages stating it was partially effective. However, outdoor spraying schedules were published in all study years.

Conclusions:  While dengue prevention messages should occur before the annual dengue season, newspapers gave more importance to dengue during epidemics. Although dengue messages improved over time, spokespersons often delivered unclear messages and journalists seemed to misunderstand the epidemiological terminology in the dengue surveillance report and transmitted the epidemiological data incorrectly. Combined flyers about influenza and dengue gave incorrect prevention messages.  Although outdoor spraying has been shown to be ineffective against dengue mosquitoes, this was not conveyed by the newspapers.  In an attempt to improve media information about dengue, a course for journalists was conducted on November 2013 and a web portal for the media came online in December, 2013.

Implications for research and/or practice:  When the public health community depends on the media to inform about health issues, clear messages and talking points should be provided consistently throughout the years.