Lyme disease prevention: A content analysis of Canadian patient group and government websites

Content Analysis: An Approach to Exploring the Depiction of Tick-Borne Diseases

Content analysis is a research technique used to gather and analyze content of a text to make replicable and valid inferences from the text. This type of analysis enables researchers to describe, categorize, and make inferences about communication messages qualitatively and quantitatively. This chapter provides a tutorial for conducting such an analysis on social media depiction of tick-borne diseases. Social media, such as Twitter is a critical platform for the development of the tick-borne disease political, social, and health narratives, and thus understanding this narrative's sentiments is crucial.

Identifying Trusted Sources of Lyme Disease Prevention Information Among Internet Users Connected to Academic Public Health Resources: Internet-Based Survey Study

BACKGROUND

Misinformation about Lyme disease and other tick-transmitted pathogens circulates frequently on the internet and can compete with, or even overshadow, science-based guidance on tick-borne disease (TBD) prevention.

OBJECTIVE

We surveyed internet users connected to academic tick-related resources to identify trusted sources of Lyme disease prevention information, explore confidence in tick bite prevention information, and examine associations of these responses with answers to commonly disputed issues.

METHODS

The survey was conducted through social media and website pages for Western Connecticut State University Tickborne Disease Prevention Laboratory and the University of Rhode Island TickEncounter Resource Center.

RESULTS

Respondents (N=1190) were predominantly female (903/1190, 76.3%), middle-aged (574/1182, 48.6%), and resided in New England states (663/1190, 55.7%). In total 984 of 1186 (83%) respondents identified conventional experts (eg, the Centers for Disease Control [CDC] or other government health agencies, physicians who follow Infectious Diseases Society of America guidelines for Lyme disease treatment guidelines, and academics) as trustworthy TBD prevention resources. However, nearly one-fourth of respondents would first consult personal contacts and web-based communities regarding prevention information before consulting conventional expert sources. The opinions of public health experts and physicians were rated among the top motivators underlying personal prevention decisions; yet, more than 50% of participants revealed distrustful attitudes toward, or were uncertain about, CDC-supported statements related to time to transmission of Lyme disease (708/1190, 59.5%), the safety of diethyltoluamide-based repellents for children (604/1183, 51.1%), and recommended use of antibiotic prophylaxis (773/1181, 65.4%). Multimodal regression models revealed that participants from high-Lyme-disease-incidence states were more likely to first seek TBD prevention information from personal networks and nontraditional sources before approaching conventional sources of TBD prevention information. We found that those reporting high rates of social media usage were more than twice as likely to first seek traditional expert sources of prevention information but were overall more likely to reject CDC-promoted Lyme disease information, in particular the established time to transmission of Lyme disease bacteria. Models also predicted that those participants who disagreed with the conventional scientific view on the antibiotic prophylaxis prevention statement were less likely to be confident in their ability to protect themselves from a tick bite. Overall, uncertainty in one's ability to protect oneself against tick bites was strongly associated with uncertainty about beliefs in CDC-promoted TBD prevention information. Self-reported trust in experts and frequency of social media use suggest that these platforms may provide opportunities to engage directly with the public about TBD prevention practices.

CONCLUSIONS

Using strategies to improve public trust and provide information where the public engages on social media may improve prevention communication and adoption of best practices.

Lyme Disease Training and Knowledge Translation Resources Available to Canadian Healthcare Professionals: A Gray Literature Review

Introduction:

Lyme Disease (LD) is the most common tick-borne disease in North America. With the number of cases increasing yearly, Canadian healthcare professionals (HCP) rely on up-to-date and evidence-informed guidelines, instruction, and resources to effectively prevent, diagnose, and treat Lyme disease (LD). This review is the first of its kind to examine gray literature and analyze the diversity of recommendations provided to Canadian HCP about the prevention, diagnosis, and treatment of Lyme disease.

Methods:

A gray literature review consisting of 4 search strategies was conducted to retrieve materials targeted to Canadian HCP. Searches within targeted websites, targeted Google searches, and gray literature databases, and consultation with content experts were done to look for continuing medical education (CME) events, clinical flow charts, webinars, videos, and reference documents that discussed the prevention, diagnosis, and treatment of Lyme disease.

Results:

A total of 115 resources were included in this study. Recommendations surrounding prevention strategies were less varied between materials, whereas diagnosis and treatment recommendations were more varied. Our findings suggest that Canadian HCP are met with varying and sometimes contradictory recommendations for diagnosing and treating LD.

Conclusions:

Due to the increasing incidence of LD in Canada, there is a greater need for resource consistency. Providing this consistency may help mitigate LD burden, standardize approaches to prevention, diagnosis and treatment, and improve patient outcomes.

Assessing Public Tick Identification Ability and Tick Bite Riskiness Using Passive Photograph-Based Crowdsourced Tick Surveillance

Tick identification is critical for assessing disease risk from a tick bite and for determining requisite treatment. Data from the University of Rhode Island's TickEncounter Resource Center's photo-based surveillance system, TickSpotters, indicate that users incorrectly identified their submitted specimen 83% of the time. Of the top four most commonly submitted tick species, western blacklegged ticks (Ixodes pacificus Cooley & Kohls [Ixodida: Ixodidae]) had the largest proportion of unidentified or misidentified submissions (87.7% incorrectly identified to species), followed by lone star ticks (Amblyomma americanum Linneaus [Ixodida: Ixodidae]; 86.8% incorrect), American dog ticks (Dermacentor variabilis Say [Ixodida: Ixodidae]; 80.7% incorrect), and blacklegged ticks (Ixodes scapularis Say [Ixodida: Ixodidae]; 77.1% incorrect). More than one quarter of participants (26.3%) submitted photographs of ticks that had been feeding for at least 2.5 d, suggesting heightened risk. Logistic regression generalized linear models suggested that participants were significantly more likely to misidentify nymph-stage ticks than adult ticks (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.23, 0.68, P < 0.001). Ticks reported on pets were more likely to be identified correctly than those found on humans (OR = 1.07, 95% CI: 1.01-2.04, P < 0.001), and ticks feeding for 2.5 d or longer were more likely to be misidentified than those having fed for one day or less (OR = 0.43, 95% CI: 0.29-0.65, P < 0.001). State and region of residence and season of submission did not contribute significantly to the optimal model. These findings provide targets for future educational efforts and underscore the value of photograph-based tick surveillance to elucidate these knowledge gaps.