An Environmental Scan and Needs Assessment of Tick-Borne Disease Prevention Efforts in the Greater Danbury, Connecticut Area Público
Butler, Amber Danielle (2014)
Abstract
Diseases transmitted by Ixodes scapularis (blacklegged ticks), including Lyme disease, anaplasmosis, and babesiosis, are all of great public health concern. The geographic distribution of these tick-borne disease cases is highly specific to the northeastern and upper Midwestern United States. Tick-borne disease rates in the ten-town Greater Danbury, Connecticut area are further exacerbated as compared to the already high state rates. Greater Danbury is particularly primed to investigate tick-borne diseases and act upon suggested courses of action given the high rates of disease as well as the local interest in tick-borne disease prevention. The number of reported tick-borne disease cases continues to increase, thus underscoring the need for targeted prevention strategies, early disease recognition and treatment, and a sustainable surveillance system.
Through an in-depth environmental scan using interviews with key informants as well as surveys, this tick-borne disease prevention needs assessment sought to 1) catalog existing tick-borne disease prevention efforts and resources in Greater Danbury, Connecticut; 2) investigate Greater Danbury residents' knowledge of, beliefs about, and barriers to use of tick-borne disease prevention measures; and 3) recommend additional measures to prevent and reduce tick-borne disease rates in Greater Danbury using a social ecological approach. The primary goal of answering these questions is to provide tick-borne disease prevention practitioners at all levels of influence with the full scope and context of current tick-borne disease prevention efforts in Greater Danbury to create a practical, comprehensive framework for reducing the rates of tick-borne diseases in the area.
Given the range of tick-borne disease prevention challenges at all levels of influence, evidence-based recommendations for reducing the burden of disease in Greater Danbury are outlined. Where appropriate, recommendations are tailored to address more specifically the challenges present in and resources available within Greater Danbury.
Table of Contents
EXECUTIVE SUMMARY........................................................................i
CHAPTER 1: INTRODUCTION...............................................................1
Rationale for Needs Assessment..........................................................1
Purpose Statement............................................................................7
Statement of Significance..................................................................8
Needs Assessment............................................................................8
Social Ecological Approach.................................................................9
CHAPTER 2: REVIEW OF THE LITERATURE...........................................10
Lyme Disease.................................................................................13
Anaplasmosis.................................................................................23 Babesiosis.....................................................................................24Tick-Borne Disease Prevention Practices.............................................25
Summary of the Current Problem and Study Relevance.........................39
CHAPTER 3: METHODOLOGY..............................................................41
Research Design.............................................................................41
Limitations....................................................................................44CHAPTER 4: RESULTS......................................................................45
Interview Findings..........................................................................45
Public Survey.................................................................................56
Physician Survey............................................................................61
CHAPTER 5: CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS....65
Summary of Major Findings..............................................................65
Conclusions...................................................................................67 Recommendations..........................................................................70Community Action..........................................................................96
Continuous Improvement Process......................................................96
Conclusion....................................................................................98 REFERENCES.................................................................................99APPENDIX A: KEY INFORMANTS......................................................114
APPENDIX B: PHYSICIAN SURVEY....................................................115
APPENDIX C: PUBLIC SURVEY.........................................................117
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