48 Background 49 Chagas disease (CD), typically confined to the Latin America (LA) region, is emerging 50 as a global health problem. In Japan, as in the rest of world, the under-diagnose rate of 51 CD is alarmingly high. Various studies have highlighted the importance of informed 52 knowledge in the seeking behavior. Educational integrative activities, with 53 consideration for socio-cultural factors, can help increase the knowledge of the 54 participants. There has been no studies that analyze the difference in knowledge, before 55 and after these educational activities. This study aimed to qualitatively and 56 quantitatively investigate the knowledge, behavior and attitude toward CD among LA 57 migrants in Japan and to evaluate the effectiveness of the community educational 58 activity in increasing knowledge of CD. Methodology60 This cross-sectional study involved two questionnaires to analyze the knowledge of the 61 LA migrant participants before and after the community activity (CA) in four cities in 62 Japan (Oizumi, Suzuka, Hadano, and Nagoya).63 Principal Findings 64 A total of 75 participants were enrolled, predominantly Bolivians from hyperendemic 65 areas. The baseline knowledge of CD was low. However, most of them were familiar 66 with the disease although less than 10% of them had been tested for CD before. Living 67 in Japan for more than 10 years and previously being tested for CD were the factors 68 associated with better knowledge. The conducted CA significantly improved the 69 knowledge of the participants. They associated the term "Chagas" mostly with fear and 4 70 concern. In contrast to other studies, the level of stigmatization was low. The barriers in 71 care seeking behavior were language, migration process and difficulties to access to the 72 healthcare system. Conclusion74 Educational activities with integrative approach are useful to increase knowledge of 75 CD. The activity brings the possibility to explore not only the level of knowledge, but 76 also to reveal the experience and to understand the needs of the people at risk. 77 Author Summary78 Though the incident rate of Chagas disease (CD) has fallen, more than 7 million people 79 are affected worldwide. The CD prevalence is under-estimated because just 1% of these 80 affected people can access to the diagnosis and treatment. This situation is maintaining 81 mainly for the lack of implication of socio-cultural factors in the interventions to 82 decrease the burden of the disease. Educational activities with integral approach are 83 useful to increase the knowledge of the people at risk. People that have being tested for 84 CD before or living in Japan for more than 10 years have better knowledge about the 85 disease, suggesting the importance of knowledge in the seeking behavior. The authors 86 recommend the implementation of educational activities with integral approach as a 87 strategy to improves the knowledge of Chagas disease among Latin America migrants 88 in Japan. 89Introduction 90 It has been more than 100 years since the ...