Development and validation of a behavioral index for adaptation to lyme disease
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RESEARCH ARTICLE
Open Access
Development and validation of a behavioral index for adaptation to lyme disease Pierre Valois1* , David Bouchard1, Cécile Aenishaenslin2, Denis Talbot3, Catherine Bouchard2,4, Sandie Briand5 and Maxime Tessier1
Abstract Background: Recent evidence suggests that climate change and other factors are leading to the emergence of Lyme disease in the province of Quebec, where it previously did not exist. As risk areas expand further north, the population can adopt specific preventive behaviors to limit chances of infection. The objectives of this study were to (1) create an index of Lyme disease prevention behaviors (LDPB), and (2) use the theory of planned behavior (TPB) to explain the decision-making process of people who choose to adopt LDPB. Methods: A sample of 1959 adults living in a Lyme disease risk area completed a questionnaire by phone (n = 1003) or on the Web (n = 956). The questionnaire measured whether they did or did not adopt the LDPB proposed by public health officials. It also measured some TPB variables, including their attitude or perceived social norms regarding LDPB. Results: Our findings led to the creation of a Lyme disease prevention index consisting of 10 behaviors, down from the 19 behaviors initially considered for inclusion in the index. Rates of adoption of each behavior varied tremendously, from 4.30 to 83.80%. All variables of the TPB model (attitude, social norms, and perceived control) were significantly associated with intention to adopt preventive behaviors. Intention itself was significantly associated with adoption of LDPB. Likewise, risk perception was positively correlated with the adoption of LDPB. Conclusions: This study led to the creation of a Lyme disease prevention index that can be used by public health agencies, researchers, and professionals to monitor the evolution over time of individuals’ LDPB adoption rates. It also showed the usefulness of the TPB in understanding the adoption of LDPB and how intention to adopt such behaviors is formed. Keywords: Adaptation, Lyme disease, Theory of planned behavior, Index, Validation
Background Floods and heat waves are some of the most common issues linked to climate change, with current predictions showing an increase in their frequency and intensity in the near future [1–4]. However, the impacts of our changing climate on human health include not only these * Correspondence: [email protected] 1 Faculty of Education, Université Laval, 2320, rue des Bibliothèques, Quebec City, QC G1V 0A6, Canada Full list of author information is available at the end of the article
dangerous climatic events, but also an increase in zoonotic diseases, such as Lyme disease. Linked to a specific species of ticks in eastern and Midwestern North America, Ixodes scapularis, Lyme disease is slowly gaining ground further north, being found in areas where it used to be completely absent [5–12]. These areas include the province of Quebec, Canada, where the number of confirmed cases of Lyme disease rose from 32 in 201
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