title: Experience of Lyme disease and preferences for precautions: a cross-sectional survey of UK patients.
abstract: BACKGROUND
  Lyme disease (LD) is a tick-borne zoonosis currently affecting approximately 1000 people annually in the UK (confirmed through serological diagnosis) although it is estimated that the real figures may be as high as 3000 cases. It is important to know what factors may predict correct appraisal of LD symptoms and how the experience of LD might predict preferences for future precautionary actions.
  
  
  METHODS
  A cross-sectional survey was conducted with early LD patients via the Lyme Borreliosis Unit at the Health Protection Agency. One hundred and thirty participants completed measures of awareness of having been bitten by ticks, knowledge of ticks and LD, interpretation of LD symptoms, suspicions of having LD prior to seeing the General Practitioner (GP), and preferences for precautionary actions during future countryside visits. Chi-square tests and logistic regression were used to identify key predictors of awareness of having been bitten by ticks and of having LD. t-tests assessed differences between groups of participants on suspicions of having LD and preferences for future precautions. Pearson correlations examined relationships between measures of preferences for precautions and frequency of countryside use, knowledge of ticks and LD, and intentions to avoid the countryside in the future.
  
  
  RESULTS
  73.8% of participants (n = 96) reported a skin rash as the reason for seeking medical help, and 44.1% (n = 64) suspected they had LD before seeing the GP. Participants reporting a direct event in realizing they had been bitten by ticks (seeing a tick on skin or seeing a skin rash and linking it to tick bites) were more likely to suspect they had LD before seeing the doctor. Participants distinguished between taking precautions against tick bites during vs. after countryside visits, largely preferring the latter. Also, the more frequently participants visited the countryside, the less likely they were to endorse during-visit precautions.
  
  
  CONCLUSIONS
  The results suggest that the risk of LD is set in the context of the restorative benefits of countryside practices, and that it may be counterproductive to overemphasize pre- or during-visit precautions. Simultaneously, having experienced LD is not associated with any withdrawal from countryside.
authors.affiliation: Department of Information Systems and Computing, Brunel University, Kingston Lane, Uxbridge UB8 3PH, UK. Afrodita.Marcu@brunel.ac.uk
authors.forename: Afrodita
authors.initials: A
authors.lastname: Marcu
authors.forename: Julie
authors.initials: J
authors.lastname: Barnett
authors.forename: David
authors.initials: D
authors.lastname: Uzzell
authors.forename: Konstantina
authors.initials: K
authors.lastname: Vasileiou
authors.forename: Susan
authors.initials: S
authors.lastname: O'Connell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D008875:Middle Aged; D057240:Patient Preference; D011795:Surveys and Questionnaires; D013984:Tick Infestations; D013987:Ticks / Q000382:microbiology*; D006113:United Kingdom; D055815:Young Adult