Tick-borne disease has become increasingly prevalent across Europe. Despite the effectiveness of protective behaviors, relatively few people adopt them when in areas where ticks are known to be present. In this systematic review we identified studies that assessed the impact of any educational or behavioral interventions intended to encourage the widespread use of protective behaviors against tick-borne disease. An extensive search of electronic databases returned a total of only nine such studies. Only two of these were fully randomized controlled trials, with the remaining studies using weaker designs and often relying solely on selfreports to assess behavior. The majority of research in this area has not explicitly noted the consideration of any formal psychological theory on how best to promote behaviors that protect health. Nonetheless, the results show that both knowledge of and attitudes towards tick-borne disease are amenable to change, although the stability of these changes over time has not yet been determined. Not all intervention strategies have proved effective, with some producing detrimental effects. More theory-based, methodologically-robust studies are urgently required if we are to gain a better understanding of the most effective strategies for encouraging members of the public to adopt behaviors known to protect against tick-borne disease.

The objective of this research was to determine the most appropriate protective behaviours to promote in order to protect members of the public from Lyme borreliosis, to identify the drivers and barriers for these behaviours, and to determine the strongest predictors of tick-protective behaviour. We used a mixed methods study with qualitative interviews and a quantitative web survey. Interviews with topic experts and members of the public suggested that predictors of tick checking included perceived disease likelihood and severity as well as overall awareness of ticks and tick-borne disease. Twenty-four percent of participants regularly checked for ticks after walking in a tick-endemic area. The strongest predictors of checking for ticks were greater levels of knowledge, perceived likelihood of being bitten, self-efficacy about tick removal, and lower levels of disgust about ticks. Barriers to checking included forgetfulness and lacking time. At-risk members of the UK public require information to increase awareness of ticks and protective behaviours, particularly tick checking. Information may be most effective if it focuses on increasing self-efficacy while also reducing disgust.

Objective. Vaccination is an effective preventive measure to reduce influenza transmission, especially important in a pandemic. Despite messages encouraging vaccination during the last pandemic, uptake remained low (37.6% in clinical risk groups). This study investigated the effect of different types of messages regarding length, content type, and framing on vaccination intention.Method. An online experiment was conducted in February 2015. A representative sample of 1424 people living in England read a mock newspaper article about a novel influenza pandemic before being randomised to one of four conditions: standard Department of Health (DoH) (long message) and three brief theory-based messages -an abridged version of the standard DoH and two messages additionally targeting pandemic influenza severity and vaccination benefits (framed as risk-reducing or healthenhancing, respectively). Intention to be vaccinated and potential mediators were measured.Results. The shortened DoH message increased vaccination intention more than the longer one, by increasing perceived susceptibility, anticipated regret and perceived message personal relevance while lowering perceived costs, despite the longer one being rated as slightly more credible. Intention to be vaccinated was not improved by adding information on severity and benefits, and the health-enhancing message was not more effective than the risk-reducing. Conclusion.A briefer message resulted in greater intention to be vaccinated, whereas emphasising the severity of pandemic influenza and the benefits of vaccination did not. Future campaigns should consider using brief theoretically-based messages, targeting knowledge about influenza and precautionary measures, perceived susceptibility to pandemic influenza, and the perceived efficacy and reduced costs of vaccination.

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