Interactive training, including games, appeared to help children improve their confidence and ability to prevent Lyme disease.

It is often said that “knowledge is power.” Brigham and Women’s Hospital (BWH) rheumatologist Dr. Nancy Shadick, however, has discovered that knowledge alone is not enough when it comes to effectively preventing Lyme disease,a tick-borne infection that can cause neurological and joint problems.

Through her research, Dr. Shadick has found that increasing knowledge about Lyme disease is a good start, but that we also need to proactively increase people’s motivations and readiness in order to change their behaviors. That’s why her team developed interactive programs to not only increase people’s knowledge about the disease, but also heighten the sense of their susceptibility and the potential consequences of the disease, promote the perception that taking preventive measures will provide worthwhile benefits, and, most importantly, increase people’s confidence that they can do something on their own to prevent it (self-efficacy).

They initially tested this theory on over 30,000 people traveling by ferry to Nantucket Island, home to a large tick population. People on half of the boats received written material about bicycle safety, and people on the other boats received interactive Lyme disease prevention training and coaching from a performer. While entertaining the travelers, a juggler demonstrated how to remove a tick on a mannequin arm and invited people to try it themselves. He emphasized the risk of getting a tick-borne illness, but mostly how people can easily recognize the most common symptoms. Following the training, he gave people take-home tools, such as tick feel cards demonstrating how a tick looks and feels and a tick check instruction card to hang in the shower.

Three months later, Shadick’s team asked study participants to report on whether they had been diagnosed with Lyme disease. Among those who experienced the interactive training, there was nearly a 40 percent reduction in diagnosed cases as compared to those who didn’t receive the training.

“We piqued their interest and then improved their self-efficacy,” says Dr. Shadick. “If they felt they could see, recognize, and remove a tick, they tended to perform the behavior. If they didn’t, they tended not to take precautions.”

Based on this success, Dr. Shadick’s team decided to take their program to those people found to be the most vulnerable group for Lyme disease – children aged 5-14 years. Funded by the Centers for Disease Control and Prevention, researchers developed a Lyme disease prevention curriculum and deployed the juggler to the North Shore of Massachusetts, another hotbed for ticks, to interact with school-aged children. Similar to the Nantucket study, children at 8 schools received no training, while children at 11 other schools received the interactive training. The children who participated in interactive training were given tools similar to what the adults received, along with games.  (The children in the control group also received interactive training after the study was completed.)

The researchers measured children’s knowledge of Lyme disease and their confidence in being able to take protective measures, especially checking behind their knees and other high-risk areas. Although smaller than the Nantucket study, the outcomes from this study also supported the notion that increasing motivations and readiness is critical for changing behaviors. When quizzed several months after receiving either no training or the short (30-minute) training session, the children who received training showed significantly greater understanding of Lyme disease and greater confidence in their own ability to take the actions necessary to prevent Lyme disease.

Stay Vigilant All Year

Having the motivation to take preventive measures is particularly important for those who live in the Northeast, where most confirmed cases of Lyme disease have occurred in recent years. It’s also important to be vigilant throughout the year. Although most Lyme disease cases are caused by bites during the spring or summer, ticks are active even when the temperature just nudges above freezing.

“If it’s above freezing, they can wake up and potentially bite you,” says Dr. Shadick. “People need to be aware of this, as many believe that you can only contract Lyme disease in the spring, summer, or fall.”

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- Chris P.
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