# Situation: Before the rainy season, the municipal health office asks the public health nurse to lead a dengue prevention campaign in several barangays using information, education, and communication (IEC) materials. The nurse pretests a draft leaflet with 12 intended readers. After reading it, each explains every message in his or her own words. The office accepts a message when at least 70% of readers explain it correctly. The number who explained each message correctly: Dengue spreads through the bite of an infected mosquito: 11 of 12 The mosquito breeds in clean, standing water: 3 of 12 The mosquito bites mostly in the daytime: 8 of 12 Bring a family member with fever to the health center early: 12 of 12 Most who erred on breeding sites said the mosquito breeds in dirty water. What should the nurse do NEXT?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627198  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: Before the rainy season, the municipal health office asks the public health nurse to lead a dengue prevention campaign in several barangays using information, education, and communication (IEC) materials.

The nurse pretests a draft leaflet with 12 intended readers. After reading it, each explains every message in his or her own words. The office accepts a message when at least 70% of readers explain it correctly. The number who explained each message correctly:
Dengue spreads through the bite of an infected mosquito: 11 of 12
The mosquito breeds in clean, standing water: 3 of 12
The mosquito bites mostly in the daytime: 8 of 12
Bring a family member with fever to the health center early: 12 of 12
Most who erred on breeding sites said the mosquito breeds in dirty water. What should the nurse do NEXT?

## 보기

1. Revise only the breeding-site message, then pretest the draft again
2. Print the leaflet, since overall comprehension is above the 70% standard
3. Revise the breeding-site and biting-time messages, then pretest again **✔ 정답**
4. Pretest the same draft with a larger group of readers before revising

**정답: 3**

## 해설

The 70% standard applies to each message, not to the leaflet as a whole. Mosquito bite (11 of 12, 91.7%) and early consultation (12 of 12, 100%) pass, but breeding site (3 of 12, 25.0%) and daytime biting (8 of 12, 66.7%) fall below 70%, so both must be revised and the draft pretested again before printing. The overall figure, 34 of 48 (70.8%), is just above the standard but hides two failed messages. A pretest is a formative evaluation meant to find and fix such problems before mass production.

## 심화 해설

The 70% comprehension standard is applied to each individual message, not to the leaflet as a whole. In this pretest, two messages failed to meet the threshold: the breeding-site message (3 of 12, 25.0%) and the daytime-biting message (8 of 12, 66.7%). Both fall below 70%, so they must be revised before the leaflet can be printed.

A pretest is a formative evaluation designed to identify and correct comprehension problems before mass production. The overall figure of 34 of 48 (70.8%) appears acceptable, but it masks the fact that two specific messages failed. Relying on the overall average would allow a leaflet to be distributed even though readers misunderstand critical prevention information.

| Message | Correct responses | Percentage | Decision |
| --- | --- | --- | --- |
| Dengue spreads through the bite of an infected mosquito | 11 of 12 | 91.7% | Pass |
| The mosquito breeds in clean, standing water | 3 of 12 | 25.0% | Fail — revise |
| The mosquito bites mostly in the daytime | 8 of 12 | 66.7% | Fail — revise |
| Bring a family member with fever to the health center early | 12 of 12 | 100% | Pass |

The breeding-site message is the most serious problem. Most readers who answered incorrectly said the mosquito breeds in dirty water. This is a common misconception that directly undermines prevention, because community members who look only in dirty, polluted water will miss the actual breeding sites. Aedes aegypti and Aedes albopictus prefer clean, stagnant water in containers such as flower pots, tires, roof gutters, and water storage jars. If the message is not corrected, households may unknowingly maintain the very containers where mosquitoes multiply.

The daytime-biting message also needs revision. At 66.7%, it is close to the threshold but still below it. This message matters because dengue prevention behaviors, such as wearing protective clothing or using repellent during the day, depend on knowing when the vector is active. A message that one-third of readers misunderstand cannot be considered ready for distribution.

Key point! In pretesting IEC materials, the unit of evaluation is the individual message, not the average score. A single failed message can lead to a dangerous behavior gap.

Watch out! Do not print the leaflet based on the overall 70.8% figure. That average hides two failed messages and would allow incorrect information to reach the community.

After revising the breeding-site and daytime-biting messages, the nurse should pretest the draft again with a new group of intended readers. This second pretest confirms whether the revisions actually improved comprehension before printing. The process reflects the iterative nature of formative evaluation: pretest, revise, pretest again, then produce.

Health communication research supports this approach. Tailoring messages to the audience’s existing beliefs and correcting specific misconceptions is more effective than repeating generic slogans. When readers hold a strong prior belief, such as “mosquitoes breed in dirty water,” simply stating the correct fact once is often insufficient. The message must directly address and replace the misconception. In this case, the revised leaflet should explicitly state that dengue mosquitoes breed in clean, standing water, and may add a contrast phrase such as “not in dirty or polluted water” to target the specific error identified during pretesting.

## 임상 시나리오

Dengue IEC Pretesting GuideApplying the 70% per-message comprehension standard
In pretesting IEC materials, the 70% comprehension standard applies to each individual message, not the leaflet as a whole. A message passes only when at least 70% of readers explain it correctly.

In this scenario, the breeding-site message (25.0%) and the daytime-biting message (66.7%) both failed. Both must be revised and the draft pretested again before printing.

CautionDo not rely on the overall average (70.8%), which masks failed messages. The misconception that mosquitoes breed in dirty water is especially dangerous because it directs community search efforts away from actual clean, stagnant water breeding sites.

## 핵심 개념

- **Pretest** — A formative evaluation method where draft materials are tested with a sample of the intended audience to identify and correct comprehension problems before mass production.
- **Formative evaluation** — Evaluation conducted during the development of a program or material to improve it before final implementation or distribution.
- **IEC materials** — Information, Education, and Communication materials used in public health campaigns to promote awareness and behavior change.
- **Comprehension threshold** — A predetermined minimum percentage of the target audience that must correctly understand a message for it to be considered acceptable.
- **Aedes aegypti** — The primary mosquito vector for dengue that prefers to breed in clean, stagnant water found in containers around homes.

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