Download University Students` Lyme Disease Knowledge and

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.