Community Engagement in Dengue Interventions in Conflict-affected Aden, Yemen: An Implementation Research Using CFIR Framework 2.0.

Dengue fever is described by the World Health Organization (WHO) as “the most important mosquito-borne viral disease in the world.” In Yemen, dengue cases have consistently increased, with Aden Governorate reporting 12% of total cases and over 45% of dengue-related deaths, making it a leading public health challenge. Conflict has exacerbated health system weaknesses, limiting resources and energy for prevention efforts. Community engagement (CE) emerges as a critical approach to address these challenges.

This study aimed to identify barriers and facilitators to CE in dengue interventions within conflict-affected contexts and recommend evidence-based strategies for improved implementation. A cross-sectional qualitative study was conducted between February and July 2024 in Aden Governorate, involving 15 in-depth interviews (IDIs) and four focus group discussions (FGDs) with key stakeholders.

Findings revealed that while stakeholders perceived CE interventions positively, challenges included systemic issues such as lack of community trust, resource shortages, and health system politicization. Conflict intensified these barriers, reflected in security concerns, inadequate training, and fragmented institutional work. Financial constraints also limited implementers’ capacities. Facilitators included moral incentives, personal recognition, and community support from business owners. However, the dominance of policymakers and influencers due to systemic weaknesses negatively impacted the implementation process, particularly in participant selection and coordination strategies.

In conclusion, addressing systemic fragmentation, enhancing political support, and defining clear coordination plans are critical to adapting CE interventions effectively in conflict

Author Summary

Dengue fever is considered a major health problem for many low-and middle-income countries, leading to high numbers of mortality and morbidity rates with a significant economic burden. Our study highlights the intersection of public health challenges and conflict dynamics, providing unique insights into how community engagement strategies for vector-borne diseases can be adapted to conflict settings. Using the implementation research tool CFIR Framework 2.0, we identified critical barriers, including systemic fragmentation, lack of trust, resource shortages, and weak coordination mechanisms. Conversely, facilitators such as moral incentives, personal recognition, and community-driven support offer actionable strategies for improving implementation outcomes.