Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico.

Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.

Bronfenbrenner's Bioecological Theory Revision: Moving Culture From the Macro Into the Micro.

Bronfenbrenner's bioecological theory of human development is one of the most widely known theoretical frameworks in human development. In spite of its popularity, the notion of culture within the macrosystem, as a separate entity of everyday practices and therefore microsystems, is problematic. Using the theoretical and empirical work of Rogoff and Weisner, and influenced as they are by Vygotsky's sociocultural perspective, we reconceptualize Bronfenbrenner's model by placing culture as an intricate part of proximal development processes. In our model, culture has the role of defining and organizing microsystems and therefore becomes part of the central processes of human development. Culture is an ever changing system composed of the daily practices of social communities (families, schools, neighborhoods, etc.) and the interpretation of those practices through language and communication. It also comprises tools and signs that are part of the historical legacy of those communities, and thus diversity is an integral part of the child's microsystems, leading to culturally defined acceptable developmental processes and outcomes.