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Apparently not everyone worries as much as me…

May 31, 2011

Pretty countryside - for attribution see below

As I mentioned here, I recently had a lovely holiday hill walking.  It was great.  Unfortunately I’m not very good at it (for ‘good at it’ you should probably actually read ‘fit’).  I also fell over.  A lot.

On one of the many occasions that I fell hands down into the heather and long grass I suddenly had a head full of images of all the creepy-crawlies I could have landed on.  Slugs and snails would have been one thing (mmmm… squelchy…) but I was more worried about ticks.

So why was I worried about ticks?  (In the interests of full disclosure I should probably stop at this point to warn you that I can, on occasion, be a wee teeny bit of a hypochondriac.)  Well in the part of the world I was stomping in the ticks are sometimes carrying Lyme Disease (LD from now on).

LD is caused by a bacterium (Borelia burgdorferi) that can be carried by ticks and passed on to humans when the ticks feed on them.  People infected by LD can get a ‘bulls eye’ skin rash (also sometimes described as a ‘target’-looking rash) and can get flu-like symptoms including headaches, muscle pains, joint aches and fever.  The disease can be treated successfully if treated early but if untreated it can lead to damage of the nervous system.

I didn’t panic overly (although my other half might tell you that in my case ‘overly’ is relative) because I figured

  1. I have had plenty of practice of removing ticks (admittedly from dogs, mostly, but that’s pretty much the same).
  2. I’d probably notice if a tick attached itself to my hands or wrists and so could remove it early, reducing the risk of disease spread.
  3. I already knew the symptoms listed above so if I did get bitten at the first sign of a rash I knew I could go to the doctor’s and get treatment.

But then I started wondering…

I learnt about this disease sitting in lectures staring at images of ticks projected 6ft high on the screen at the front.  What about all the other walkers we saw when out?  How much did they know?  And did they need to know more?

Being the happy little geek I am I came home and went straight to the literature and found this…

Marcu, A., et al., Making sense of unfamiliar risks in the countryside: The case of Lyme disease. Health & Place (2011), doi:10.1016/j.healthplace.2011.03.010

The researchers involved in this study were using LD as an example disease to identify how much people know about risks in the countryside and how they make sense of this risk when they go out in it.

They designed an interview and asked people in 3 different sites (representing ‘peri-urban park’, ‘accessible countryside’ and ‘remote upland’):

  1. What they thought was good/bad about the countryside
  2. What they thought about the provision of information on the risks in the countryside
  3. What they knew about LD
  4. What their motivations were for any precautionary measures they took against tick bites
  5. How they would prefer to get information about diseases like LD

(I’m going to mainly focus on the last 3  questions.)

The answer to question 3 was that, although most of the 82 participants had heard of LD, in many cases they ‘knew very little about its causes, symptoms, or prevention and were ostensibly unconcerned by this’.  Even interviewees who had previously had LD admitted to not knowing much about it.  Those unconcerned about the risk predominantly fell into two camps: the ‘it’s so rare it will never happen to me’ camp and the ‘I’ve been bitten by ticks hundreds of times and it’s never happened before’ camp.

When it came to precautions (either those used by the participant or those suggested by the interviewer) insect repellent was seen as a common sense, useful piece of advice, whereas the advice to wear long trousers and long-sleeved tops was seen as much less useful.  (Unsurprisingly the researchers found that people wanted to choose their clothing depending on the weather and not on the disease risk.)  Interestingly, even the idea of providing information to members of the public visiting an area came in for criticism, with people worrying about littering if leaflets were used and saying that large information boards would spoil the beauty of the countryside.

Importantly, however, (especially for public health officials etc.) the researchers report that from their work it looks like giving people information about zoonotic diseases in the countryside may not put them off visiting – the perceptions people hold of a quiet, relaxing countryside temper any panic or worry about disease threats.  (The researchers do point out that this may only be true for LD, and not other zoonotic disease risks.)

The researchers suggest that if people aren’t going to be panicked by information about the risks of LD then more information should be provided (especially as the participants in this study seemed to know so little about it).  This study also shows the importance of that information and advice being practical and not too intrusive if we want people to follow it.

I don’t know enough about the subject to know whether views on the countryside in the UK match up to views elsewhere around the world, (although I suspect that they don’t).  If they don’t then it is likely that this kind of study in a different country would produce different results as to what people think of zoonotic risks in the countryside and how they want to be informed about them.  If anyone out there has any more information I’d love to know.

The beautiful picture came from:

John Aldersey-Williams [CC-BY-SA-2.0], via Wikimedia Commons

Want to know more?

Info on Lyme disease

Marcu, A., Uzzell, D., & Barnett, J. (2011). Making sense of unfamiliar risks in the countryside: The case of Lyme disease Health & Place DOI: 10.1016/j.healthplace.2011.03.010

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