Harnessing community knowledge and actions to strengthen rabies control programs in East Nusa Tenggara, Indonesia

Background and Aim: Rabies remains a critical public health concern in Indonesia, particularly in high-risk provinces, such as East Nusa Tenggara. Despite governmental efforts under the One Health framework, gaps persist in vaccination coverage, public awareness, and intersectoral coordination. This study aims to assess community knowledge, attitudes, and practices (KAP) regarding rabies and evaluate rabies control strategies in Belu and Malaka regencies, incorporating both community and policymaker perspectives. Materials and Methods: A mixed-methods approach was adopted, integrating quantitative surveys and qualitative interviews. Structured questionnaires assessed KAP levels among 225 respondents across two regencies, while logistic regression identified sociodemographic predictors of adequate rabies knowledge. Qualitative data, obtained through in-depth interviews and focus group discussions, were thematically analyzed using the context, input, process, and product evaluation model to explore stakeholder coordination, community engagement, and systemic challenges. Results: Female respondents and those aged >50 years exhibited significantly higher knowledge of rabies (adjusted odds ratios [AOR] for males = 0.321, p = 0.003; AOR for ≤30 years = 0.390, p = 0.032). Vaccination coverage among domestic animals remained suboptimal (~50%), below the national target of ≥75%. Weak but significant positive correlations were observed between knowledge and both attitude (r = 0.144, p = 0.03) and practice (r = 0.211, p = 0.001). Qualitative findings revealed the fragmented implementation of One Health, insufficient vaccine supply, limited veterinary personnel, and poor integration of traditional knowledge into health communication strategies. Conclusion: This study underscores the importance of tailored health education, particularly for younger and male populations, and highlights the potential of community-driven interventions to improve rabies control. Integrating traditional cultural expressions with modern outreach, strengthening intersectoral collaboration, and improving logistical support are essential for sustainable control. The use of technology (e.g., WhatsApp-based reporting) and community task forces demonstrated promise in enhancing responsiveness. Future programs should prioritize culturally adaptive strategies and expand the operational scope of One Health to mitigate rabies in endemic regions. Keywords: community knowledge, East Nusa Tenggara, Indonesia, knowledge, attitudes, and practices, mixed-methods, One Health, rabies control, vaccination.