testing or focus group feedback during the refinement process should have similar de- mographics and characteristics to the target population (Dignan, 1995). Purpose Although there have been numerous studies of the knowledge, perception, and/or behav- iors of various populations pertaining to spe- cific tickborne diseases (Beck et al., 2022; Niesobecki et al., 2019; Noden et al., 2017), no comprehensive survey exists that is usable for any location, population, or tickborne disease. Therefore, our research goal was to create a survey instrument that could be used in all populations and geographic locations throughout the U.S. regardless of tick species or tickborne illness.
TABLE 1
Knowledge Section From the Survey to Assess Knowledge, Attitudes, and Behaviors Regarding Tickborne Diseases
Question
Answer Choices
Symptoms of having a disease spread by ticks include:
A. Fever B. Joint pain C. Headache D. Rash E. Muscle pain F. All of the above G. Only B and D H. Do not know
Symptoms of tickborne diseases usually appear how soon after being infected.
A. Days B. Weeks C. Months D. Depends on the disease E. Do not know
Ticks are most likely to be actively seeking food between:
A. April–July B. April–September C. May–July
Methods
D. May–August E. Do not know
Instrument Development We developed a 57-item survey instrument using a combination of modified questions found in the literature (Arikan et al., 2010; Cartter et al., 1989; de Vries & van Dillen, 2002; Gould et al., 2008; Herrington, 2002, 2004) and new questions created by the prin- cipal investigator (PI) of our study. Content validity was reviewed by a public health ento- mologist, an assistant professor of health edu- cation, and an assistant professor in a depart- ment of psychology. These professionals were selected because of their status within their fields and their knowledge of vectorborne diseases occurring in the Midwest region of the U.S., health education theories, and/or survey development. Participant Recruitment A total of 91 college students participated in the focus groups. Participants were ran- domly approached at locations on a uni- versity campus until focus group slots were filled. For the 15 students for each focus group, names and emails were obtained. Email reminders were sent twice prior to the scheduled focus group meeting time. Focus Groups To minimize respondent fatigue and allow for more in-depth discussions, the survey instru- ment was divided into three sections: demo- graphics and knowledge, demographics and attitudes, and demographics and behaviors.
Besides avoiding places where ticks live, the most effective way to prevent a tick bite is to:
A. Use a repellent containing DEET B. Wear light-colored clothing C. Use a repellant containing natural oils D. Wear permethrin-treated clothing
E. Combination of A and D F. Combination of B and C G. Do not know
Ticks that can spread disease to humans most commonly live in this area:
A. Open environments (grass/trees/shrubs) B. On warm-blooded animals C. Sheltered environments (bird nests, pavilions) D. Do not know
To help with removing a tick, it is best to apply:
A. Fingernail polish B. Vaseline C. Heat D. Nothing E. Do not know
To reduce the chances of getting a disease from ticks, the tick should be removed within:
A. 12 hr B. 24 hr C. 48 hr D. 72 hr E. Do not know A. True B. False C. Do not know A. True B. False C. Do not know A. True B. False C. Do not know
To kill a tick, you should crush the tick with your fingers after removal.
Tweezers should be used to properly remove ticks.
Owning a pet increases your chances of a tick bite.
Note. Survey takers are instructed to select only one answer for each question. DEET = N,N-Diethyl-m-toluamide.
inform the researcher of any confusion or ambiguities present in the wording of sur- vey questions, which could help decrease
response bias and limit inadequate answers (Nassar-McMillan & Borders, 2002). Addi- tionally, individuals who are involved in pilot
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November 2024 • Journal of Environmental Health
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