Tailoring dengue health communication: Survey-based strategies to reduce message fatigue across risk areas

Background Dengue remains a significant public health challenge in Taiwan, particularly in the southern region where Aedes aegypti and Aedes albopictus mosquitoes thrive. Despite nationwide dengue prevention campaigns, message fatigue—where individuals become disengaged due to repetitive messaging—may reduce the effectiveness of public health communication. This study analyses trends and associations between key predictors—such as age, sex, education, job, and perceived risks (optimistic bias, perceived prevalence, and perceived severity)—and message fatigue across different dengue-risk areas in Taiwan. Methodology/principal findings A cross-sectional online survey was conducted from October 25 to November 13, 2023, among 814 adults across Taiwan. Participants were classified into high-risk (southern Taiwan) and low-risk (other regions) groups. Message fatigue was assessed using the message environment (ME) and audience response (AR) dimensions. Perceived risks (perceived prevalence, severity, and optimistic bias) and demographic variables (sex, age, education, job experience, and residency) were analyzed using Poisson and Negative Binomial regression models. Findings The findings revealed that message fatigue varied by region and demographic factors. In high-risk areas, individuals with lower education levels exhibited higher AR fatigue (boredom and disengagement) (p = 0.04). In low-risk areas, males (p = 0.02), individuals with lower education (p = 0.01), and those with optimistic bias (p = 0.02) reported significantly higher ME fatigue (perceived overexposure). Despite uniform nationwide messaging, participants in high-risk regions exhibited greater message fatigue, possibly due to habituation. Conclusions/significance Message fatigue is associated with regional dengue risk, demographic factors, and perceived risk. A uniform health communication approach may not be effective across different populations. In high-risk regions, message fatigue is more pronounced. Repetitive warnings may contribute to disengagement, suggesting a need for communication strategies that reduce redundancy and emphasize localized, actionable information. In low-risk areas, messages should focus on engagement, particularly for men, who exhibited higher fatigue in this study. Simplified messaging can reduce cognitive overload for lower-educated populations. Addressing message fatigue can enhance the effectiveness of dengue prevention campaigns and sustain public engagement in long-term health communication efforts.