Lyme borreliosis risk perceptions, disease knowledge, and training among at-risk groups

Lyme borreliosis (LB) is the most common tick-borne disease in Europe. Although there are indicators that disease risk is higher in the west of Ireland than other areas of Ireland, regional incidence data to confirm this, and to drive effective risk communication is sparse. Professions (e.g. farming, forestry) or recreational activities (e.g. hiking, trail running) that require spending time in tick habitats increase the risk of exposure. The present study is designed to provide baseline information on the perceptions, knowledge, and training of at-risk groups in Ireland relating to LB.

The study used an online questionnaire to gather data on perceived risk, disease-related knowledge, and the receipt of training by at-risk individuals (n = 443) in Ireland. Data were analysed using IBM SPSS Statistics version 29.0.1.0.

The study found a median perceived risk of 3/5 (i.e. moderate). There was no difference geographically in perceived risk, despite regional differences in environmental risk factors and cumulative neuroborreliosis rates. The majority (77%) of respondents identified woodlands/scrub as habitats carrying highest LB risk. Fewer than half (48%) of respondents mentioned or described the pathognomonic erythema migrans rash when asked to describe symptoms of LB, and 37% listed erythema migrans plus at least one flu-like symptom. As respondents' perception of risk increased, so did their ability to identify woodland/scrub as risk habitats, and early LB symptoms. However, when asked to rate the amount of training they had received on a 5-point scale (1 indicates no training and 5 indicates maximum training) respondents in at-risk professions indicated a minimal amount of training (median = 2/5) on tick bite and LB prevention, and people engaging in leisure activities gave a response which indicated no training (median = 1/5). Greater levels of training were associated with greater proportions of respondents indicating woodland/scrub habitats as high-risk habitats (p = 0.003, T = 8.876), and describing erythema migrans as a LB symptom (p = 0.08, T = 7.007).

These findings identify the need for more robust risk communication in Ireland, more training for at-risk groups, and the use of targeted awareness campaigns to address knowledge gaps. The implications of the study findings for international research are also discussed.