'You adapt, and you try not to resent it': a qualitative study exploring impacts of living with ticks and barriers to adopting preventive measures in Canada.

Background: Lyme disease (LD) is Canada's most common tick-borne disease (TBD), with other tick-borne pathogens being detected with increasing frequency. Tick bite prevention remains the most effective preventive measure against TBDs, yet individual preventive behaviours are not always adopted by at-risk individuals. This is concerning, given that the incidence of TBDs is predicted to increase with climate change. The objectives were: (1) to understand the facilitators and barriers to adopting tick bite preventive behaviours for at-risk individuals, and (2) to explore whether adverse behaviours are developing among individuals living in LD endemic regions.

Methods: Residents of LD endemic regions were invited through social media platforms (including governmental and health authority) to participate in virtual focus groups. In total, 96 individuals participated in 22 focus groups across five provinces of Canada (BC, MB, ON, QC and NS) between October 2021 and January 2022. Thematic analysis was performed using an inductive-deductive iterative approach, and themes were organized using the COM-B model of behaviour.

Results: Participants identified several facilitators to adopting preventive behaviours, including habit formation and community awareness and influence. Reported barriers included inadequate, untimely, or changing knowledge, concerns about consequences, and lack of access to healthcare. A spectrum of adaptation across Canada was observed, ranging from low (BC) to high (MB and NS). For many individuals, living in a LD endemic region negatively impacted mental health, outdoor recreation, interaction with nature and/or views on pet ownership.

Conclusions: Adaptations to TBDs are not always easy, consistent, or positive. This study is the first to describe the barriers to adopting preventive behaviours and impacts of living with ticks across multiple Canadian provinces. The themes and impacts identified in this study should provide insight for a variety of initiatives to be developed, implemented, and evaluated to improve quality of life and health outcomes related to TBDs in Canada.