Lyme Disease
Conditions
Keywords
Lyme disease, educational intervention for children, tick borne illness, prophylactic therapy in children, Self-efficacy, tick prevention, tick avoidance, health behavior modification
Brief summary
Our overall purpose of this study is evaluate whether a short in-class Lyme Disease education program based on social learning theory and the Health Belief Model can impact a child's knowledge, attitude, and preventive behavior. 1\. Deliver an educational program in schools to promote personal protective practices, encourage early disease detection and modify residential habitats to reduce tick density. 3\. Evaluate the program's efficacy by comparing the acceptability and practice of precautionary behavior, tick density in residential areas and rates of Lyme disease between groups using primary and surveillance data sources Evaluate the contribution of knowledge, attitudes, and parental involvement to children's adoption of prevention strategies. Hypothesis The community intervention will reduce the incidence of Lyme disease among children and families living in endemic areas by increasing the practice of precautionary behavior and reducing tick density in residential areas. Specifically, we hypothesize that: 1. The educational intervention will reduce the incidence of Lyme disease among children and families living in an endemic area. 2. The educational intervention will improve the childrens' self-confidence (behavioral self-efficacy), intention to perform, and actual practice of Lyme disease prevention behaviors.
Detailed description
The description of Lyme disease in 1976 and subsequent characterization of its mode of transmission, causative organism and treatment is one of the most remarkable advances in medicine in the last 25 years1-3. Nevertheless, Lyme disease continues to grow as a public health problem4. While Lyme disease affects all age groups, children have one of the highest rates4. Prevention remains a challenge in this group. The Lyme vaccine has been withdrawn from the market in February 20025, 6, and educational strategies among at-risk school children have been inadequately evaluated and none have been institutionalized. We will target school-aged children living in Nantucket, Dukes County and Essex County. We have collaborated with the teachers and administration in many of the schools. We have collaborated with the teachers and administration in many of the schools. The intervention will be delivered by a member of our staff in conjunction with the teacher as well as a health education entertainer ('Screaming with Pleasure Productions'). Research assistants will distribute the enrollment questionnaires and goody bags. The basic content of the educational message has been designed by Drs. Shadick, Liang, DeJong and the late Dr. Daltroy, and has been used extensively on the Nantucket ferry study and in the Feel Find Free Program. The timing takes advantage of the classroom audience, is humorous and entertaining and the message is relevant to anticipated outdoor activities. Primary Outcome: The educational intervention will reduce the incidence of Lyme Disease among children and families living in an endemic area. Secondary Outcomes: The educational intervention will improve the children's self-confidence (behavioral self-efficacy), intention to perform, and actual practice of Lyme disease prevention behaviors.
Interventions
BEHAVIORALEducation
Students receive an educational intervention delivered by a member of our staff in conjunction with the teacher as well as a health education entertainer
BEHAVIORALControl (pre and post surveys)
Students fill out a pre and post survey and then receive the same intervention given to the controls.
Sponsors
Centers for Disease Control and Prevention
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
7 Years to 12 Years
Healthy volunteers
Yes
Inclusion criteria
Inclusion: * Child age 7-12 and their parents living in the selected endemic areas Exclusion: * No exclusions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Incidence of Lyme Disease Among Children and Families Living in an Endemic Area Using an Educational Intervention | baseline - 1 year | Parents of children were asked at baseline to report any new case of Lyme Disease within the past 12 months. This question was asked again a year later after receiving the educational intervention was given. We then will compare the number of reported Lyme Disease cases at baseline to the number of Lyme disease cases reported a year later. New cases of Lyme Disease had to be confirmed by medical record review. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Educational Intervention Will Improve the Children's Self-confidence (Behavioral Self-efficacy), Intention to Perform, and Actual Practice of Lyme Disease Prevention Behaviors. | baseline -1 year | Three outcome measures, knowledge of LD transmission, self reported tick bite precautionary behaviors and attitudes towards taking precautions were measured. A Lyme Disease knowledge score was created from totaling the number of correct answers on the 6 knowledge questions, ranging from 0-6. A score with a higher value indicated an increase in the desired behavior. These questions were asked before and after the intervention to compared the change from preintervention with postintervention between intervention and control students, adjusted for age, sex and pre-knowledge score. Precautionary behavior outcomes were graded on a linear scale quantifying the amount of practice. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Education Students who receive an educational intervention which consists of a 45 minute interactive presentation as well as a 30 minute health education entertainment by a juggler.
Education: Students receive an educational intervention delivered by a member of our staff in conjunction with the teacher as well as a health education entertainer | 1,562 |
| Control Students who fill out pre and post surveys and receive the intervention after the post-survey
Control (pre and post surveys): Students fill out a pre and post survey and then receive the same intervention given to the controls. | 2,008 |
| Total | 3,570 |
Baseline characteristics
| Characteristic | Control | Total | Education |
|---|---|---|---|
| Age, Continuous | 9.1 years STANDARD_DEVIATION 1.2 | 9.1 years STANDARD_DEVIATION 1.2 | 9.1 years STANDARD_DEVIATION 1.2 |
| Grade Fifth Grade | 528 participants | 921 participants | 393 participants |
| Grade Fourth Grade | 474 participants | 896 participants | 422 participants |
| Grade Missing | 3 participants | 5 participants | 2 participants |
| Grade Second Grade | 489 participants | 824 participants | 335 participants |
| Grade Third Grade | 514 participants | 924 participants | 410 participants |
| Sex: Female, Male Female | 1003 Participants | 1825 Participants | 822 Participants |
| Sex: Female, Male Male | 1005 Participants | 1745 Participants | 740 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 1,562 | 0 / 2,008 |
| other Total, other adverse events | 0 / 1,562 | 0 / 2,008 |
| serious Total, serious adverse events | 0 / 1,562 | 0 / 2,008 |
Outcome results
Primary
The Incidence of Lyme Disease Among Children and Families Living in an Endemic Area Using an Educational Intervention
Parents of children were asked at baseline to report any new case of Lyme Disease within the past 12 months. This question was asked again a year later after receiving the educational intervention was given. We then will compare the number of reported Lyme Disease cases at baseline to the number of Lyme disease cases reported a year later. New cases of Lyme Disease had to be confirmed by medical record review.
Time frame: baseline - 1 year
Population: Number of Lyme cases reported in the intervention and control groups
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Education | The Incidence of Lyme Disease Among Children and Families Living in an Endemic Area Using an Educational Intervention | 1 Number of cases incident Lyme disease |
| Control | The Incidence of Lyme Disease Among Children and Families Living in an Endemic Area Using an Educational Intervention | 1 Number of cases incident Lyme disease |
Secondary
The Educational Intervention Will Improve the Children's Self-confidence (Behavioral Self-efficacy), Intention to Perform, and Actual Practice of Lyme Disease Prevention Behaviors.
Three outcome measures, knowledge of LD transmission, self reported tick bite precautionary behaviors and attitudes towards taking precautions were measured. A Lyme Disease knowledge score was created from totaling the number of correct answers on the 6 knowledge questions, ranging from 0-6. A score with a higher value indicated an increase in the desired behavior. These questions were asked before and after the intervention to compared the change from preintervention with postintervention between intervention and control students, adjusted for age, sex and pre-knowledge score. Precautionary behavior outcomes were graded on a linear scale quantifying the amount of practice.
Time frame: baseline -1 year
Population: Composite knowledge score for intervention and control students post-intervention. Comparing the change in score between intervention and controls between pre and post evaluation.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Education | The Educational Intervention Will Improve the Children's Self-confidence (Behavioral Self-efficacy), Intention to Perform, and Actual Practice of Lyme Disease Prevention Behaviors. | 1.38 units on a scale | Standard Deviation 1.31 |
| Control | The Educational Intervention Will Improve the Children's Self-confidence (Behavioral Self-efficacy), Intention to Perform, and Actual Practice of Lyme Disease Prevention Behaviors. | 0.36 units on a scale | Standard Deviation 1.3 |
p-value: <0.0001Regression, Linear