The Use of Ecological Momentary Assessments to Assess Tick-borne Disease Risk

In the United States, several online and smart-phone apps are available to ID a tick (TickID app, North Carolina State University), submit a picture of a tick (TickSpotters.org, an outreach tool within the larger TickEncounter resource center by the University of Rhode Island) or submit a tick for testing (among other public health agencies, TickReport.com by the University of Massachusetts Amherst). Although these tools are accessible throughout the U.S., they focus on the Northeast. In addition, they do not assess human behavior and tick encounters nor do these tools evaluate prevention and education strategies. A recent study in the Netherlands evaluated the use and effectiveness of a preventative and educational tick app ("Tekenbeet"). This app was well-appreciated, well-used, and improved the user's intention to implement preventative measures. This also illustrates the move of information acquisition from in-hand leaflets to information provision through smartphones.

In this study, data on human behavior regarding tick encounters and tick prevention measures will be obtained from a smartphone application using momentary assessments methodology to assess real time behavior and movement. Ecological momentary assessments are a methodological tool for gathering quantitative behavioral data in real-time, or within the framework of a participant's daily routine.

The daily logs feature provides researchers information about what the participant's activity, location, tick encounters, and prevention measures used. This study will analyze participants who complete 7 daily logs. Their daily logs will be analyzed against the types of educational messaging presented to them within the Tick App.

During a portion of the year the opening screen will contain a prevention message and daily log reminder instead of the home screen. The screen will provide a tick check reminder, a link to the daily log and for half the users the screen will also include a reminder about another prevention behavior (for example bathing/showering). Users will be randomly assigned to the two groups to assess if the additional prevention message increases prevention behavior (tick checks and showering/bathing) and the number of tick encounters.