{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:56:47Z","timestamp":1791961007524,"version":"4.3.4"},"reference-count":96,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:00:00Z","timestamp":1760832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dengue is a mosquito\u2010borne disease prevalent in Latin America and the Caribbean. Transmission is determined by ecological, biological and social (eco\u2010bio\u2010social) factors. Understanding the knowledge, attitudes, practices and perceptions of dengue's eco\u2010bio\u2010social factors among at\u2010risk populations is essential for dengue prevention. We used the Ecohealth approach to investigate the socioeconomic and demographic factors associated with dengue knowledge, attitudes, practices and perceptions among residents of S\u00e3o Paulo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a concurrent nested mixed\u2010methods study between May and November 2024 using an online knowledge, attitudes, practices and perceptions survey, focus group discussions and Photovoice activity. Quantitative data were analysed using descriptive statistics and multivariable logistic regressions. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Qualitative data were analysed thematically. Integration from both method strands used a weaving, narrative approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Overall, 388 participants completed the knowledge, attitudes, practices and perceptions survey. Having some or a lot of vegetation around the home (aOR 2.63, 95% CI: 1.05\u20136.60; aOR 3.90, 95% CI: 1.57\u20139.69, respectively) and never having dengue (self\u2010reported; aOR 1.80, 95% CI: 1.10\u20132.94) were associated with high knowledge scores. Higher education was associated with positive vaccine attitudes (aOR 2.04, 95% CI: 1.14\u20133.64). Women (aOR 1.57, 95% CI: 1.01\u20132.45) and individuals with three and more than three household members (aOR 2.04, 95% CI: 1.07\u20133.87; aOR 3.10, 95% CI: 1.62\u20135.94, respectively) had higher odds of using mosquito repellents at home. Those who earned more than R$6000 monthly had higher odds of having a high perception of self\u2010efficacy to prevent dengue compared to those who earned less than R$2000 monthly (aOR 2.03, 95% CI: 1.08\u20133.82). Focus group discussions and Photovoice participants perceived climate change as a risk factor of dengue transmission. The high cost of mosquito repellents was a perceived challenge to prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Several individual\u2010 and household\u2010level factors were associated with dengue knowledge, attitudes, practices and perceptions in S\u00e3o Paulo. There is a need to increase public awareness about dengue and its vaccine. Future research should assess the effectiveness of community\u2010tailored interventions to reduce dengue risk in this urban, climate\u2010vulnerable setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70050","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T05:31:34Z","timestamp":1760938294000},"page":"58-79","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Knowledge, Attitudes, Practices and Perceptions of the Eco\u2010Bio\u2010Social Determinants of Dengue Transmission in S\u00e3o Paulo, Brazil: A Mixed\u2010Methods Study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9212-7313","authenticated-orcid":false,"given":"Aisha","family":"Barkhad","sequence":"first","affiliation":[{"name":"Mary Heersink School of Global Health and Social Medicine McMaster University  Hamilton 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