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Transcript
University Students’ Lyme Disease Knowledge and Protective Behaviors Pre- Versus Post-Intervention Karen Gilbert, BA, MLS, MPH Candidate Laurie J. Larkin, PhD; Joe Beck, DDAAS, Professor, Environmental Health Science; & Kevin L. Jones, PhD Eastern Kentucky University Richmond, KY. 40475 Introduction Lyme disease, a bacterial disease caused by the tick-borne organism Borrelia burgdorferi, is the most common (over 90%) vector-borne disease in North America (Radolf, Caimano, Stevenson, & Hu, 2012). B. burdgorferi is carried by the Black-Legged Tick, Ixodes scapularis (also known as the “deer tick”). Although Lyme disease is generally considered rare in the Southeast, the Centers for Disease Control and Prevention recently upgraded its estimate of the number of Americans diagnosed with Lyme disease from 30,000 to 300,000 cases yearly (CDC, 2013). This radical increase suggests that many cases of Lyme disease have either been unrecognized or incorrectly diagnosed. Possible reasons for uncertainty surrounding the prevalence of Lyme disease include both the difficulty of accurate diagnosis (Aucott et al., 2009; Aucott, Seifter, & Rebman, 2012), and that animal reservoirs include deer, rodents and, notably, migrating birds, resulting in a wide distribution (Hamer, Lehrer, & Magle, 2012). Given the general lack of awareness of Lyme disease in areas where it hasn’t previously been considered endemic, including the Southeast United States, and the benefits of increased awareness concerning the related risks and protective behaviors, more current regional research and prevention education is advisable. Purpose The purpose of this study is to determine the effectiveness of a brief instruction session on knowledge in university students of Lyme disease health risks, preventative measures, and proper tick removal. Instrument A twelve-question survey: The Lyme Disease Survey included five demographic questions testing knowledge of Lyme disease health risks and prevention, and proper tick removal. Methods Questions Missed/Pre- & Post Conclusions Students demonstrated considerable knowledge of Lyme disease health risks and prevention on the pre-test, with the exception of certain questions. Top three questions students got wrong on the pre-test:: Subjects: A Lyme disease awareness study was be conducted at a regional University in Kentucky during January through March, 2014. A convenience sample of 87 female and male students enrolled in three sections of a university-required course, predominately for freshman, were asked to participate in an educational session on Lyme disease, preceded and followed by pre-and post-testing. Permission from faculty to allow their classes to participate in the study was solicited and student participation in each section was voluntary and anonymous. Questionnaire: The Health Belief Model, involving perceptions about the susceptibility to Lyme disease as well as the disease’s potential severity of consequences, was used as a framework for the development of the questionnaire. The benefits of Lyme disease education and prevention were examined along with any barriers to prevention. The questionnaire was developed as part of the study and has been tested for validity by review of three faculty members, as well as being pilot-tested by a group of students different from those in the test sample from research group.. The Lyme disease questionnaire was administered to three class sections on an anonymous matched-pair basis. Findings Chi-Square Crosstabs testing demonstrated that all three groups tested did not differ significantly in knowledge either in pre- or post-testing on questions 1 through 12. Chi-Square Crosstabs testing demonstrated that all three groups tested did not differ significantly by grade or by having previously been diagnosed with Lyme disease, in knowledge either in pre- or post-testing on questions 1 through 12. ANOVA Test of Means testing demonstrated that there was no significant difference by group in terms of age on the pre-test and post-test total scores. A paired-samples t-test was conducted to evaluate the impact of the Lyme disease education presentation intervention. There was a statistically significant increase in Lyme Disease Survey scores from pre-test (M=9.44,SD=.173) to post-test (M=11.73, SD=.070) with a t score of (-13.89) and a significant p-value p<.0005 (two-tailed). The average increase in Lyme Disease Survey scores was 2.29 out of 12. (Missed by 52 of 87 on pre-test, but only 9 on post-test): Once bitten by a Lyme disease carrier, people often develop (a/an) __________________ at the site of the bite: a. Blister b. Bull’s eye-like rash c. Open sore d. Hives e. All of the above f. None of the above Nevertheless, significant improvement was demonstrated across the post-test scores. Areas of particular improvement occurred on questions relating to Lyme disease symptoms, health effects, and the proper removal of ticks. (Missed by 51 of 87 on pre-test, but only 1 on post-test): The correct way to remove a Lyme disease carrier insect from the skin is: a. Burn it off with a hot match b. Smother it with petroleum jelly c. Smother it with nail polish d. Grasp it with tweezers close to the skin and pull e. All of the above will work f. None of the above will work Students demonstrated increased knowledge of Lyme disease health risks and preventative measures after the educational intervention as measured by post-test scores. Future Directions Other instruments and/ larger sample sizes could be used to measure the increase in knowledge of Lyme disease health risks and preventative measures, among students and youth in general throughout Kentucky. (Missed by 40 of 87 on pre-test, but only 5 on post-test): If untreated, Lyme disease may lead to: a. Arthritis, especially of the knees b. Heart problems c. Neurological problems d. Fatigue e. All of the above f. None of the above Pretest Score % Correct Post-test Score % Correct You can get Lyme disease while living in Kentucky, T/F 100% 100% Lyme disease is caused by the bite of a: Mosquito, Cat, Tick, Fly, None of the above 88.5% 100% You can get Lyme disease during this time period: Summer only, All year round, None of the above 89.7% 100% Once bitten by a Lyme disease carrier, people often develop (a/an) ______________ at the site of the bite: Blister, Bull’s eye-like rash, Open sore, Hives, All of the above, None of the above 40.2% 89.7% Once bitten by a Lyme disease carrier, people may also develop: Flu-like symptoms, Fever, Headache, Fatigue, All of the above, None of the above 81.6% 92.0% If untreated, Lyme disease may lead to: Arthritis - especially of the knees, Heart problems, Neurological problems, Fatigue, All of the above, None of the above 52.9% 94.2% Question The best way to avoid being bitten by a Lyme disease carrier and contracting Lyme disease includes the following actions when you go outdoors: Wear lightcolored clothing, Use DEET at 20 – 30% strength, Wear clothing treated with Permethrin, Wear long-sleeved shirts and tuck pant legs into socks, All of the above, None of the above 74.1% 98.8% Showering and doing a full-body skin check for disease carrier after spending time outside is an effective way to prevent Lyme disease. T/F 97.6% 98.8% Your chances of getting Lyme disease are significantly reduced if you remove the Lyme disease carrier from your skin within the first _______ hours of being bitten: 72, 24 91.8% 100% The correct way to remove a Lyme disease carrier insect from the skin is: Burn it off with a hot match, Smother it with petroleum jelly, Smother it with nail polish, All of the above will work, None of the above will work. 39.3% 98.8% Lyme disease carriers often enter the home on pets. T/F 94.1% 97.7% Lyme disease is contagious from person to person. T/F 92.9% 97.7% Additional questions having to do with attitudes the about Lyme disease could be added to the instrument to test changes on pre- and pots-test scores. Lyme disease is a potentially deadly disease. More education about prevention and early detection is imperative to save lives and preserve health. References Aucott, J., Morrison, C., Munoz, B., Rowe, P. C., Schwarzwalder, A., & West, S. K. (2009). Diagnostic challenges of early Lyme disease: Lessons from a community case series. BMC Infectious Diseases, 9(1), 1-8. doi:10.1186/1471-2334-9-79 Aucott, J. N., Seifter, A., & Rebman, A. W. (2012). Probable late Lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection. BMC Infectious Diseases, 12(1), 173-182. doi:10.1186/1471-2334-12-173 Centers for Disease Control and Prevention. (2013). CDC provides estimate of Americans diagnosed with Lyme disease each year. Retrieved from http://www.cdc.gov/media/releases/2013/p0819lyme-disease.html Hamer, S. A., Lehrer, E. E., & Magle, S. B. (2012). Wild birds as sentinels for multiple zoonotic pathogens along an urban to rural gradient in greater Chicago, Illinois. Zoonoses & Public Health, 59(5), 355-364. doi:10.1111/j.1863-2378.2012.01462.x Radolf, J. D., Caimano, M. J., Stevenson, B., & Hu, L. T. (2012). Of ticks, mice, and men: Understanding the dual-host lifestyle of Lyme disease spirochaetes. Microbiology, 10, 87-99.