Using Risk Group Profiles as a Lightweight Qualitative Approach for Intervention Development: An Example of Prevention of Tick Bites and Lyme Disease

Abstract

BackgroundMany public health campaigns use a one-size-fits-all strategy to achieve their desired effect. Public health campaigns for tick bites and Lyme disease (LD) in many countries convey all relevant preventive measures to all members of the public. Although preventing tick bites (eg, by wearing protective clothing or using repellants) and checking for tick bites after visiting a risk area are effective and cost-efficient methods to prevent an individual from contracting a tick-borne disease, public compliance to these methods is low.ObjectiveWe aimed to identify the group of individuals within the general Dutch population that are at high risk of being bitten by a tick or developing LD and to describe their characteristics, knowledge, and perceptions. The incidence of patients visiting their general practitioner for tick bites and erythema migrans (the first sign of LD) has increased tremendously in the last decades in the Netherlands and other European countries; therefore, our efforts can be used to counter this troubling trend.MethodsWe conducted in-depth semi-structured interviews to identify individuals belonging to the average risk group. Participants were recruited in two ways. Patients who visited two municipal health services travel health clinics (one in a high-endemic area and one in a low-endemic area) were asked to participate. This resulted in 18 interviews. Further, parents were recruited using the convenience sampling method, which resulted in 7 interviews. We discontinued interviewing when the point of data saturation was reached. We analyzed the results immediately after each interview to identify the point of data saturation. Data saturation is when the new interviews provided no new information compared to the previous interviews. The interviews were transcribed and analyzed using inductive thematic analysis.ResultsWe identified four groups at risk of being bitten by ticks and developing LD among the general Dutch population. The groups were as follows: (1) outdoor people that check for tick bites, (2) outdoor people that do not check for tick bites, (3) parents that check their children for tick bites, and (4) parents that do not check their children for tick bites. Previous experience with ticks or LD was the main denominator between the groups. Checking for tick bites is a more easily adopted measure than preventing tick bites. Therefore, for all groups, public health efforts in the future should primarily emphasize on the importance of checking for tick bites.ConclusionsThe lightweight qualitative approach presented in this paper is highly relevant in tailoring public health efforts toward specific groups. The profiles of members in each risk group and the motivations underlying the behaviors of the members in each risk group can be used to determine the features and content of a targeted communication strategy about ticks and LD.

Attention for Lyme prevention

“…We have previously studied how to design an electronic health intervention for prevention of tick bites and LB by using end-user profiling and a value-based design [15,177]. This previous study resulted in a set of requirements that not only specify what the technology should do (functionalities), but also how it should be implemented.…”

“…Questionnaire 2 contained some of the questions that were also asked during questionnaire 1 (11,13,14,15,16,21,22,41,42,43,44,45,47,46,48,49,50). Questions concerning behavior in the past year in questionnaire 1 were replaced by questions concerning behavior in the past three months in questionnaire 2.…”

“…These are not readily accessible in times of need, for example if a person is hiking in a tick-rich environment. mHealth can make this information more accessible, by making it available on a smartphone, something people have with them most of the time [113,15]. This study aimed to evaluate a dedicated tick-related smartphone application.…”

Telephone versus web panel National Survey for monitoring adoption of preventive behaviors to climate change in populations: a case study of Lyme disease in Québec, Canada

“…The self-reported adopted preventive behaviors were selected based on a literature review [50][51][52][53][54][55] and recommendations from public health agencies [43,56]. Using these behavioral indicators, we created and validated an index of LDPB [57].…”

A qualitative study to explore farmworkers’ knowledge, beliefs and preventive practices toward ticks and tick-borne diseases

“…The changes in health beliefs have been considered an important method to decrease the burden of infectious diseases in humans [14,15]. The Health Belief Model (HBM) is a frequently used psychological model to explore a health behavior, and it assesses the perception of severity, susceptibility, benefits, barriers and self-efficacy [16].…”