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Border Health Surveillance Mobile App Enhancements

Engaging the community and sustaining its investment in control programs is recommended as a critical component of assessing response during dengue outbreaks [1]. Evidence of the effectiveness of community engagement to impact entomological and to a lesser extent epidemiological endpoints is growing [2-5]. Both effectiveness and sustainability need to be explored as even effective programs may be unsustainable if community members lose motivation [6]. Evidence suggests that the use of theoretical frameworks such as the health belief model improves the effectiveness of public health interventions [7]. The health belief model would suggest that action is most likely taken when individuals have knowledge about Aedes mosquitoes and the viruses they carry; perceive Aedes mosquitoes to be a risk to them and their household members and that the risk is severe; perceive that the benefits of interventions outweigh the barriers to implementation; and are further motivated by self-efficacy and external cues to action such as media campaigns [8].

Indeed the best practices for communicating vector control strategies to the public have not been well defined particularly for industrialized countries where evaluation mosquito-borne disease messaging is particularly sparse. Vulnerable populations, including individuals residing in public housing, were less likely to receive information about dengue during an outbreak in Key West, FL [9]. During the West Nile outbreak in 2003 a study indicated people were most commonly getting their information from communications through newspapers, radio and TV broadcasts [10]however those that reported taking action were more likely to have gotten their information from the newspaper, word of mouth, or searching on the internet as compared to information they received from radio, TV, brochures, or health professionals perhaps due to the more active engagement associated with these sources. Some studies have indicated that mass media reports during outbreaks may not provide accurate risk information that could help individuals determine if they should take precautions [11, 12].

Leveraging mobile apps and social media as public health communication tools has become more broadly implemented for improving healthy behaviors; with most regular implementation addressing physical activity and smoking cessation [13, 14]. While mobile apps have shown variable effectiveness at increasing positive health behaviors, the potential is recognized [13]. 

Kidenga is a community-based surveillance and education app developed to address the increasing risk of Aedes-borne diseases in the southern United States. The Kidenga app was launched in late September 2016 and was developed through a collaborative partnership between the University of Arizona (lead institution) and CDC personnel based at the Division of Global Migration and Quarantine in San Diego, CA ( The intention of Kidenga is to both collect data on syndromes that may be consistent with Aedes-borne diseases and to provide timely and accurate risk information back to the user.

As part of this work the Kidenga team will build upon existing Kidenga mobile application development to provide a “Spanish-version” for use along the Arizona and Texas borders to enhance surveillance and education for Zika, dengue and Chikungunya disease and their mosquito vector, Aedes aegypti (yellow fever mosquito). In addition, a preliminary assessment of the acceptability of Kidenga mobile application with end-user groups and a prioritization of modifications or enhancements to increase the usability and acceptability of Kidenga.  

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