Social-cognitive determinants of the tick check: a cross-sectional study on self-protective behavior in combatting Lyme disease.

Background: Performing a tick check after visiting nature is considered the most important preventive measure to avoid contracting Lyme disease. Checking the body for ticks after visiting nature is the only measure that can fully guarantee whether one has been bitten by a tick and provides the opportunity to remove the tick as soon as possible, thereby greatly reducing the chance of contracting Lyme disease. However, compliance to performing the tick check is low. In addition, most previous studies on determinants of preventive measures to avoid Lyme disease lack a clear definition and/or operationalization of the term "preventive measures". Those that do distinguish multiple behaviors including the tick check, fail to describe the systematic steps that should be followed in order to perform the tick check effectively. Hence, the purpose of this study was to identify determinants of systematically performing the tick check, based on social cognitive theory.

Methods: A cross-sectional self-administered survey questionnaire was filled out online by 508 respondents (M = 51.7, SD = 16.0; 50.2% men; 86.4% daily or weekly nature visitors). Bivariate correlations and multivariate regression analyses were conducted to identify associations between socio-cognitive determinants (i.e. concepts related to humans' intrinsic and extrinsic motivation to perform certain behavior), and the tick check, and between socio-cognitive determinants and proximal goal to do the tick check.

Results: The full regression model explained 28% of the variance in doing the tick check. Results showed that performing the tick check was associated with proximal goal (β = .23, p < 0.01), self-efficacy (β = .22, p < 0.01), self-evaluative outcome expectations (β = .21, p < 0.01), descriptive norm (β = .16, p < 0.01), and experience (β = .13, p < 0.01).

Conclusions: Our study is among the first to examine the determinants of systematic performance of the tick check, using an extended version of social cognitive theory to identify determinants. Based on the results, a number of practical recommendations can be made to promote the performance of the tick check.