Evaluating the implementation, the process of empowerment, and the influence of context on a community mobilization intervention to reduce dengue infections in Brazil

The proposed study is a series of implementation science evaluations that will be embedded within a funded cluster randomized trial (CRT) to allow us to understand how the intervention brings about sustainable change, the influence of context on the intervention, and the potential for transferability and scaling up. The CRT is measuring the effectiveness of a community mobilization intervention on dengue incidence in children in Fortaleza, Brazil. Studying if community mobilization results in sustainable change and for whom, will improve our understanding of the intervention processes and the potential success of the intervention in other contexts and thus enhancing the transferability of results and approach. Our proposed study is a series of implementation science evaluations in eight of the intervention communities assessing the implementation process, fidelity, and social acceptability of the intervention (Objective 1). We will also examine if and how the intervention empowers communities and if this can be sustained over time (Objective 2). Finally, we will identify the interactions between the context, the mechanism, and the effect of the intervention through conducting a realist evaluation. The data collection for all three objectives will be a mix of documents, field observations, and interviews with key community stakeholders. For Objectives 1 & 2, a deductive-inductive approach will be used for the analysis of each of the domains of interest. For the realist evaluation, the qualitative data will be analyzed using a realist evaluation process. Knowledge translation activities are integrated throughout the study with community stakeholders as well as municipal and state partners. The insight gained from the implementation science evaluations will be crucial for the interpretation of the findings from the CRT and for advancing our knowledge and practice of community mobilization for dengue control.