Efficacy of the Theory of Planned Behavior in Predicting the Intention to Engage in Tick-Borne Disease Personal Protective Behavior Amongst Visitors to an Outdoor Recreation Center

Abstract

The risk of tick exposure and tick-borne diseases (TBD) can be high in nature-based outdoor recreation settings. In the absence of available vaccines, adoption of personal protective behaviors (PPB) recommended by the U.S. Centers for Disease Control and Prevention (CDC) such as wearing long pants and long-sleeved shirts, tucking pants into socks, using insect repellents on clothes and body, and avoiding wooded or grassy areas are necessary for reducing the risk of TBD infection when engaging in nature-based outdoor activities. Despite their established effectiveness, few people adopt these PPB and they remain unprotected against the risk of TBD while recreating in natural areas. Few theory-driven studies have addressed factors affecting intention to engage in tick-borne disease personal protective behavior (TBD PPB) among especially at risk-populations such as college students. This study investigated the efficacy of the Theory of Planned Behavior in predicting intention to engage in TBD PPB amongst visitors to the University of Florida's Lake Wauburg outdoor recreation center in North Central Florida. The intercept method was used to administer a 41 item survey to a random cross-section of visitors over a 3-week period in the summer of 2014. Seventy-five percent of survey participants were college students. Fifty-one percent had previous contact with ticks, and of this number, 83% reported place of exposure as recreational. Eighty-one percent ‘routinely check for ticks on skin and clothes', 73% ‘choose to walk the center of trails', 38% ‘wear long pants, long-sleeved shirts, or light colored clothing', and 27% ‘tuck pants into socks' (27%). From multivariate logistic regression analysis, attitude toward TBD PPB was a significant predictor of the intention to adopt 5 different TBD PPB. TBD perception within the survey respondents' social circle was not a significant predictor of any TBD PPB. Respondents who agreed that there were health benefits of engaging in TBD PPB were significantly less likely to use tick repellents on skin or clothing but they were significantly more likely to routinely check for ticks on clothes or body. Study findings suggest that the Theory of Planned Behavior is effective for predicting the intention to engage in TBD PPB. This study has implications for the planning, development and operationalization of TBD policy and prevention programs for Lake Wauburg and other nature-based outdoor recreation destinations where TBD presents a risk for visitors.