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Qualitative Refinement of a Survey About Tickborne Disease
preventive action (Jongejan & Uilenberg, 2004; Wilson, 2002). With more people contracting tickborne diseases, it is important to understand the knowledge, attitudes, and preventive be- haviors of dierent populations related to these diseases. The resulting valuable infor- mation—gathered through the administra- tion of surveys—can help researchers better understand the priority opinions and per- ceptions of the surveyed populations. Fur- thermore, surveys are a way to easily gather quantitative information for large popula- tions. Surveys can also help researchers as- sess the characteristics of the target popula- tion (de Vaus, 1986). To best refine a survey, its language and the semantics of the survey must be examined to ensure they portray the desired context of each subject (Nassar-McMillan & Borders, 2002). Without survey refinement, respon- dents might find questions ambiguous or confusing, and the resulting data could be un- usable (Starr, 2012). When creating surveys, researchers should also keep in mind their target population’s perceptions and language usage. Survey wording should be kept as brief and accurate as possible while not limiting the scope by choosing words that are too simple to convey accurate meaning (de Vaus, 1986; Dillman, 2007). Similarly, the wording should be comfortable and recognizable to the target group without being condescending (Nassar- McMillan & Borders, 2002). Once a survey has been developed, a pilot study and/or focus group is advised to help Wendi K. Middleton, PhD, CHES Department of Health Professions, Northeastern State University Jennifer Becker, MD Southern Illinois University School of Medicine Aaron Peach, MPH, MD Indiana University School of Medicine Heather Tillewein, MPH, PhD, MCHES Department of Health and Human Performance, Austin Peay State University Johnny Bresett, PhD Department of Population Science and Policy, Southern Illinois University School of Medicine
Abstract Our project aim was to create a survey that could be used in all populations and geographic locations throughout the U.S., regardless of the tick species or tickborne diseases present. As a first step, we developed a 57-item survey to assess knowledge, attitudes, and behaviors regarding the prevention of tickborne diseases. The survey instrument was divided into sections: demographics and knowledge, demographics and attitudes, and demographics and behaviors. We recruited 91 college students to join focus groups, and each focus group was given only one section to discuss. Overall, each section was reviewed 5 times by five dierent focus groups. Feedback from the focus group participants showed that some questions had unclear terminology, resulting in participants having to guess at the meaning. We found that participants randomly selected responses if the answer they were looking for was not listed among the answer choices. Many participants were unfamiliar with the dierent repellents listed on the survey and recommended that we improve the survey by using or including brand names. Further, they suggested we provide more response options and relabel some responses. The focus group feedback resulted in a refined and more focused survey instrument that can be used to gather information for understanding how knowledge of and attitudes toward tickborne diseases can aect individual preventive behaviors. Keywords: ticks, tickborne disease, survey, qualitative
Introduction In the U.S., there are approximately 25 dif- ferent species of ticks currently known to transmit disease to humans (Centers for Disease Control and Prevention, 2024; Sonenshine, 2018) and 11 tick species that are known to transmit disease to compan- ion animals (Saleh et al., 2021). The preva- lence of tickborne disease from all tick species has notably increased over the last few decades (Rosenberg et al., 2018). As a result, tickborne diseases have now become the most common type of vectorborne dis- ease in the U.S., accounting for more than
75% of reported cases (Paules et al., 2018; Rosenberg et al., 2018). It is believed that knowledge about the health hazards that exist in nature aects how an individual perceives the level of risk associated with exposure (Johnson, 1993). Thus, for indi- viduals to understand their level of risk regarding tickborne diseases, it is important to be aware of the tickborne diseases that occur throughout their geographic area, the potential disease severity, and their personal susceptibility to these diseases. Know- ing this information can help to increase the probability that individuals will take
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Volume 87 • Number 4
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