The importance of values in a community-based response to malaria in Santo Domingo, Dominican Republic: results from a longitudinal, mixed-methods study

Trust and other values are essential for community engagement but their role in intervention outcomes is less understood. The objective of this study was to explore values in a community-based intervention for malaria control in Santo Domingo, Dominican Republic. The study used an exploratory, mixed-methods design that began in 2020 with a cross-sectional survey of 489 households. The survey measured trust for neighbors, neighborhood associations, health system actors, and the national government. Ordinal alpha, exploratory factor analysis, and ordinal logistic regression tested scale reliability, dimensionality, and significant associations. Then, a two-year, qualitative phase collected 66 interviews from 39 key informants recruited through theoretical, snowball, and referral sampling based on their insight as malaria patients, neighborhood residents, and community health workers. An iterative approach and grounded theory guided thematic analysis. Reliability of the trust module was acceptable (ordinal α = 0.70). Household survey participants rated public and private institutions as "very trustworthy," while neighbors and neighborhood associations were most frequently considered "somewhat trustworthy." In qualitative analysis, companionship, reciprocity, and "showing face" fostered a virtuous circle linking participation, morale, and timely diagnosis and treatment. Quantitative and qualitative results suggest two domains of values: one in which trust links people and institutions, and the other in which values of solidarity and reciprocity connect people to each other. Both domains contributed to the intervention. The study provides a nuanced picture of trust and values in interventions and encourages thinking of community initiatives as "projects of mutual creation" with values at the center.