Misinformation in Conversations about Ticks and Tick-borne Disease in Public Facebook Groups

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McDonald, Haley Warzecha, Emily M. McDonald, Maxwell Le May, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4601605/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Health-related misinformation on social media can negatively impact public health outcomes. Effective interventions to combat misinformation require an understanding of the underlying topics and their associated misperceptions. Ticks and the pathogens they carry are increasing worldwide, raising concerns about the disease burden these pathogens cause. Our goal is to identify prevalent misconceptions about ticks and tick-borne diseases to inform and restructure public health education efforts, thereby reducing the health burden related to tick-borne diseases. Methods We collected public Facebook posts and comments during summer 2021 and used summative content analysis to characterize misinformation themes. In total, 170 posts and 2483 comments were analyzed. Results A total of 30 posts (17% of the total) contained misinformation, the majority of which (78%) occurred in the context of tick biology and ecology and 5% and 4% were about repelling and removing ticks, respectively. Conclusions These findings suggest that public health education campaigns should focus on dispelling common misperceptions related to tick biology, ecology, and species identification. Arthropod vectors Lyme disease public health qualitative study social media Figures Figure 1 Figure 2 Background Identifying and dispelling health-related misinformation is a significant but critical challenge to keeping communities safe and healthy ( 1 ). The rise of health-related misinformation has caused a breakdown of trust in medical institutions ( 2 ) and led to poorer health outcomes ( 3 ). Misinformation is defined in a number of ways ( 4 , 5 ) but is generally taken to mean information that is scientifically uncorroborated and distributed without the knowledge that it is unsubstantiated, and thus not intended to cause harm ( 6 ). An imminent concern relates to the spread of misinformation on social media ( 7 ). Although social media can be used to quickly distribute information ( 8 ), it also provides a space for misinformation to proliferate rapidly and expansively ( 9 ). Social media platforms promote interpersonal connections via multiple pathways, including shared interests. On Facebook, for example, “Facebook Groups” allow individuals with common interests to form an online community. Within these groups trust is likely to be higher, especially if individuals are similar ( 10 ), and both positive behaviors (e.g., meaningful connections( 11 )) and misinformation can be more likely to spread. Thus, the capacity of social media to spread health-related misinformation that may impact personal or public health is of concern ( 12 ). The power of health misinformation, spread through social networks, to negatively impact decision making around health has been evident for more than a decade. Online anti-vaccine health misinformation about influenza A (H1N1) is negatively correlated with CDC-estimated vaccination rates by region ( 13 ). Similarly, individuals susceptible to misinformation about COVID-19 are at increased risk of noncompliance with public health recommendations such as vaccinations ( 14 ). Further, misinformation spread, particularly with respect to COVID-19, is found under the topic of “health tips” ( 15 ) and perceived misinformation was encountered by more than half of participants when seeking information regarding COVID-19 ( 16 ). Identifying themes of health misinformation can aid public health strategies in dispelling such misinformation and may aid in preventing future dissemination of misinformation. Tick-borne diseases (TBD) are a significant and growing health concern ( 17 ) in multiple regions of the US ( 18 ). Ticks are obligate blood-feeding parasites that rely on a variety of vertebrate hosts to complete their life cycle and reproduce. Many ticks require multiple hosts and subsequently vector pathogens from host to host. Humans are often incidental hosts to which the transmission of pathogens can occur, resulting in disease. Reported cases of TBD, such as anaplasmosis, Rocky Mountain Spotted Fever, babesiosis, and Lyme disease have increased over the last few decades( 19 , 20 ), taking an immense toll on public health ( 21 ) and local economies in areas where disease incidence is high or increasing ( 22 ). For example, treatment for Lyme disease and post-disease symptoms in the United States was estimated to cost upwards of $ 1 billion annually nearly a decade ago ( 23 ) - $ 1.31B in 2024 dollars. With the geographic expansion of ticks due to climate change ( 24 ) and the rise in tick abundance ( 25 ), many people are increasingly aware of TBDs ( 26 , 27 ). As with many personal health topics, people turn to social media for knowledge and advice ( 28 ). Whether it is the tick life cycle, feeding behavior, or disease transmission, a plethora of informational resources exist for those concerned about TBD. Although people generally share information to help others, we hypothesize that sometimes they share information that is inconsistent with the scientific literature and could lead to a greater risk for TBD. However, there is currently limited published literature about the types of misperceptions individuals have about ticks and TBD. While studies have examined knowledge, attitudes, and beliefs regarding TBD prevention ( 29 ) or identified a lack of trust regarding government-supported informational resources ( 30 ), to our knowledge no studies have examined the types of misinformation regarding ticks and TBD that exist on social media. This study seeks to fill that gap by analyzing all conversations around ticks and TBD that took place within 10 focal public Facebook groups in the northeastern United States during Summer 2021. Our goal is to identify prevalent misconceptions about ticks and tick-borne diseases that can be used to inform or restructure public education efforts. Methods Data collection We obtained ethical approval from Dartmouth College’s Committee for the Protection of Human Rights prior to beginning data collection (CPHR# STUDY00032237). Additionally, to protect personally identifiable information, the illustrative quotes in this manuscript are paraphrased, not reported verbatim, and the Facebook group names will not be shared to protect anonymity. We identified the focal Facebook groups through a series of steps. First, between February and April 2021, we selected 26 Facebook groups for consideration based on privacy status (must be public) and geographic location (located in the vicinity of New England). We then narrowed this list by assessing the number of members, growth rate, and general activity level. The most important factor in narrowing the selection was the number of posts and interactions regarding the keywords “ticks” and “Lyme disease” over the preceding 12 months (Additional File 1), as assessed using the public insights tool CrowdTangle ( 31 ). Groups on the higher end of tick and Lyme disease-specific activity, with a larger membership size and general activity level, were selected. One of the research team members then joined each of the selected groups using a nascent Facebook account. Although we initially joined 12 groups, two subsequently went private and so were removed from our analyses, resulting in the 10 focal groups. As a part of a larger, related study, groups were then split into intervention (n = 5) and control (n = 5) groups. Briefly, intervention groups contained local “digital” community health workers who proactively posted tick related evidence-based educational materials and responded to posts containing tick-related misinformation. Control groups did not have any intervention. No distinction is made between these groups in our analyses. Selected Facebook groups were monitored approximately every two weeks from 1 May to 30 September 2021, a period of high tick activity and disease transmission in the northeastern United States ( 32 ). During each check-in, group content was searched using the keywords “tick” and “Lyme disease” chronologically from the last date the group was checked. All posts and affiliated comments containing the two keywords or arthropod-related content were manually collected by cutting and pasting into spreadsheets for further evaluation and summative content analysis. Manually collecting posts and comments over time, rather than taking a single “snapshot” of data, resulted in slight changes in numbers of comments and posts collected. For example, we endeavored to collect all posts from the previous two weeks in a single sitting but there were instances where this was not possible, resulting in posts or comments being added or deleted in the intervals between data collection. Data were thoroughly inspected prior to analysis to remove any duplicates or posts that were outside of the study scope. A total of 218 posts were identified; 170 were included in our analysis. The 48 posts removed at this stage were found to be duplicates that had been collected in error or singular advertisements that did not fit within the scope of the study. Summative content analysis Two researchers coded all collected Facebook posts and comments, employing a summative content analysis approach whereby themes of misinformation were first identified and quantified, and then further analyzed to examine underlying themes of misinformation ( 33 ). Data were identified as misinformation based on their deviation from scientific findings or public health recommendations, as represented by peer-reviewed or evidence-based sources (Additional File 2). This study did not examine disinformation, which involves false information intentionally being disseminated to cause harm ( 34 ), or statements considered to be anecdotal, hyperbole, or personal. For example, we did not code statements such as “The ticks are insane this year, can’t go outside without getting several on me,” “There are millions of ticks in my backyard!” or “I suffer from Lyme disease.” Our estimates of what constitutes misinformation were conservative in that we removed all anecdotal/personal stories and hyperbole prior to analysis, which may contain accounts that are unsupported by scientific evidence. Anecdotal reasoning can influence a person's decision making ( 35 ) especially when related to health ( 36 ); however, identifying misinformation in a personal story remains difficult. The final misinformation codebook used a parent/child code category hierarchy to classify the collected posts: the parent codes represent broad categories of misinformation, with child codes tailored for the specific parent context. The coding process was iterative; we derived the initial parent codebook categories from a preliminary study conducted in 2020 (Additional File 3), while initial child codes were generated from one researcher conducting a preliminary read through of the data. For example, posts about where ticks are typically found (tall grass, the woods, etc.) were identified as broadly associated with tick biology and ecology (the parent code); a subsequent child code was determined to be habitat, further clarifying the nature of the posts. All data were coded manually in Nvivo (version 14, Release 1.5 Software for Mac, Lumivero, Denver, CO). Questions about codes were handled in a conversation with the other study team members until an agreement about the most appropriate code was reached. After all data had been coded, the authors reviewed and discussed unused codes which were then removed or revised and incorporated into other child codes before summarizing the findings. To summarize the results of the coding process, the number of times each code category appeared in the data was counted, resulting in frequency counts for each category included in the final codebook. Results We examined a total of 170 posts and 2483 comments for misinformation. Instances of misinformation were identified in 30 posts (Fig. 1 ), comprising approximately 17% of the data (Additional File 4). Posts containing misinformation varied in the number of comments (min = 0, max = 366, median = 28) and in the proportion of comments that contained misinformation (Fig. 1 ). There was a strong right skew to both interactions and misinformation: some posts and comments had very little misinformation, whereas others had a great deal (Fig. 1 ). The types of misinformation included contradictory species identification, movement (e.g. jumping), and inappropriate tick removal guidance (Table 1 ). Table 1 Examples of misinformation and rationale for coding. Parent Codes a Rationale for identifying as misinformation Disease 1) “All ticks carry Lyme disease these days.” 2) “Dog and deer ticks carry Lyme disease, they can all mess you up if you're bitten!” 3) “Ticks can transmit Lyme disease at any time, 24–48 hours is a common mistake people make.” 4) “Doctors cannot treat Lyme. The CDC thinks chronic Lyme disease doesn't exist.” 1–3) Misrepresentation of the species/ proportion of ticks that carry pathogens and transmission time of Lyme disease. 4) Misperception regarding government organization stance on LD Tick Biology & Ecology 5) “That doesn't look like a tick to me, it looks like a bedbug.” 6) “That's a harmless kind of tick.” 7) “Definitely not a deer tick, probably a dog or wood tick.” 8) “Ticks are attracted to the heat and will drop from trees or horizontally jump to transport themselves.” 9) Ticks will lay multiple hundreds of eggs many times in one year.” 10) “Turkeys can eat up to 200 ticks every day. 5–7) Conflicting identifications provided by those responding to the original post 8–9) Misperceptions regarding tick biology (e.g. oviposition frequency). 10) Lack of sufficient evidence regarding predators of ticks Education 11) “You can burn the ticks. Especially if it has already burrowed into your skin.” 12) “Use cedarcide spray.” 13) “Use a mix of peppermint oil and coconut oil on your skin.” 14) “Don't eat red meat. I heard that ticks are not attracted to people that don't eat red meat. I have not eaten it in a decade and I've never seen a tick.” 11–14) Identified as misinformation due to the paucity of research regarding the efficacy of chemicals, compounds, or diets, at repelling ticks following application. Treatment 15) “Put vaseline on the tick. It will kill it if it's embedded.” 16) “I heard that rubbing alcohol makes the tick back out.” 17) “To remove an attached tick, my dad poured gasoline on it.” 18) “You can spin the ticks by the body and make the two small legs bend so it can't stay in. Pops out without breaking its head off inside you. “ 15–18) Inaccurate guidance given regarding the proper removal of a tick. a Examples have been paraphrased in order to de-identify the original post. We coded misinformation under four parent codes (Tables 1 , 2 ), but 78% of it occurred in the parent code Tick Biology & Ecology (Fig. 2 ), especially the child codes Identification and Predators (Table 2 ). Posts related to tick-borne Disease had the second highest frequency of misinformation (Fig. 2 ), especially within the child code Incidence and Prevalence (Table 2 ). The remaining parent codes, Education and Treatment , occurred at similar frequencies and the child codes Repellents and Removal had the highest frequencies within these parent codes, respectively (Table 2 ). Table 2 Codebook of parent and child codes for the types of misinformation observed in public Facebook groups, together with the counts of the number of times each code occurred, and a description of each code used. Parent Code Child Code a Description Count Disease 26 Incidence & Prevalence Tick borne diseases (TBDs) and the number or amount ( e.g. 50% of ticks carry Lyme Disease ) 12 Natural History & Symptomatology Concerning where TBDs originated; what symptoms result from infection 3 Transmission Transmission of TBD from tick to host (incl. human) 11 Tick Biology & Ecology 217 Behavior & Host-Seeking Tick behavior or how a tick finds its host ( e.g. questing, hunting ) 11 Habitat Where ticks are commonly found in nature ( e.g. tall grass, woods ) 11 Identification & Morphology What a tick looks like, including identifying a picture ( e.g. number of legs, shape ) 154 Life Cycle Life of a tick ( e.g. how long it lives, how many life stages, etc. ) 5 Movement Tick movement ( e.g. crawling, jumping, hopping, flying ) 3 Population Number of ticks in an area or how the number of ticks has changed over time 1 Predators What predates on ticks ( e.g. Opossums, chickens ) 30 Seasonality When ticks are active throughout the year 2 Education 17 Primary Prevention Intervention before health effects occur (Reisinger et al., 2012) 3 Repellents Chemical compounds intended to repel ticks ( e.g. essential oils, DEET ) 14 Treatment 16 Lyme Literate Medical Doctors (LLMDs) Medical professionals who have knowledge or specific experience with Lyme disease 1 Removal & Disposal How to remove or dispose of a tick 12 Testing & Diagnosis When and how to seek testing/diagnosis for a TBD 2 Non-traditional Treatment Treatment that is not typically provided in a traditional medical or hospital setting 1 a Codes with a zero-reference count were removed from further analysis Discussion Sourcing of health information from online community groups is a common phenomenon that can have significant implications for public health ( 37 ). In this study, the vast majority of misinformation identified about ticks and tick-borne disease was related to the biology and ecology of ticks. Crowd-sourcing the identification of ticks was a common practice in the study groups, potentially with implications for an individual’s decision-making process after being bitten by a tick (Table 1 ; examples 5–7). Here, current public health guidelines recommend prompt removal of all ticks and consulting with one’s healthcare provider in regions where tick borne diseases are common (e.g., Lyme disease in New England) ( 38 ). If responders misidentify the arthropod in question, the person who made the post may think they are at low or no risk for diseases that require treatment. In fact, one post soliciting help with identification contained a comment that pointed out conflicting species identifications: “It’s hilarious that a bunch of people have said, very confidently, that this is several different ticks.” The potential delay in seeking medical care, due to misidentification or being unsure of the risk of disease, could be particularly risky for Lyme disease, where delayed treatment may incur an additional health burden ( 39 ). Further, the global pandemic has potentially exacerbated treatment delays for tick-borne diseases whose symptoms are similar to those of COVID-19 ( 40 ). Species misidentification could be compounded by the prevalence of misinformation regarding which tick species vector which pathogens to humans, further altering an individual's risk perception. For instance, comments coded in this study discussed tick species that are able to transmit Lyme disease to humans, with some commenters asserting that all ticks are capable of transmitting the causative agent of Lyme disease. Currently, only Ixodes spp. are known to transmit the bacteria ( 41 ), though the high awareness of the prevalence of Lyme disease in New England ( 42 ) may lead individuals to conflate species of ticks that can transmit the causative agent of Lyme (Table 1 ; examples 1–2). There also seemed to be misperceptions on which species of tick can transmit Rocky Mountain Spotted Fever (RMSF) and where it is found in the US, with users divided on whether RMSF is transmitted in New England. For instance, one individual claimed: “Dog/blacklegged ticks can carry diseases like RMSF” and another stated “stop making false statements, RMSF is not in New England.” As of 2021, RMSF has been identified in New England; however, incidence is low ( 43 ) and it is unclear if the causal bacteria were acquired, via a tick vector, from another location where prevalence may have been higher. The time it takes for a pathogen, specifically the causative agent of Lyme disease, to be acquired was also a common discussion point, with commenters discussing the duration a tick must be attached to transmit Lyme disease. Current evidence suggests that it takes between 24–48 hours ( 44 ), but discussion often provided estimates ranging from instantaneous to 48 hours (Table 1 ; example 3). Conversations surrounding tick repellents and appropriate ways to remove a tick (from a human) included poorly supported recommendations that have the risk of being misinformation. The promotion of alternative tick repellents, whose efficacy ( 45 ) and safety has not been evaluated, or that may not be as effective as active ingredients like DEET ( 46 ), may result in the perpetuation of misinformation that could have significant implications for public health. Individuals whose trusted networks promote the use of unstudied repellents and decry safe and effective repellents may detract and confuse individuals about the correct course of preventative action. There are several well-studied and regulated tick repellents recommended by state and federal agencies charged with providing guidance on appropriate application and use ( 47 , 48 ). Common active ingredients in these repellents include DEET, permethrin, IR3535, and oil of lemon eucalyptus ( 49 ). Resources such as the EPA’s “Find the Repellent that is Right for You” ( 50 ) search tool provide a public-facing, accessible way for individuals to find repellents that suit their needs. Finally, the appropriate way to remove a tick comprised 75% of the Treatment parent code and contained numerous unsubstantiated suggestions (Table 1 ; examples 15–18). Suggestions such as covering the tick with petroleum jelly or hydrogen peroxide to encourage the tick to detach contrast with current CDC recommendations to remove the tick, using tweezers, as soon as possible. Prompt removal of an attached tick is critical in reducing the risk of pathogen transmission ( 44 ), and numerous resources exist on the best way to remove a tick ( 38 , 51 ). Conclusions Social media can offer individuals access to communities where shared values or interests are commonly expressed, creating spaces for trusted networks ( 10 ). However, social media may also contain health misinformation, making it difficult for individuals to discern anecdotal stories from evidence-based recommendations ( 35 ); this lack of clarity may lead to poor health decisions. Ticks are ubiquitous throughout the northeastern U.S. and the discussions examined in this study regarding ticks and Lyme disease reflect the public's concern about these issues given the enormous health-related burden of those affected. Ticks and the diseases they transmit have become increasingly prioritized in research and policy ( 52 ); and dispelling misinformation surrounding ticks and tick borne diseases will improve public awareness and may help better align public understanding with disease risk ( 53 ). To our knowledge, this is the first study to examine what misinformation about ticks exists in public Facebook groups. Based on our findings, opportunities exist to educate the public on the biology and ecology of ticks, with emphasis on improving self-efficacy in distinguishing between ticks and other arthropods and increasing awareness regarding what species of tick transmit which diseases. Though many tick education initiatives exist, the lack of published literature about the types of misinformation and misunderstandings surrounding ticks and tick-borne diseases means that current initiatives are not (yet) grounded in an understanding of the misperceptions that individuals have. This study lays the groundwork for expanding evidence-based public health education to specifically address misperceptions. Other formats, such as in-school curricula ( 54 ), trusted influencers within communities, and digital campaigns can also be opportunities to educate individuals and address misperceptions. Designing educational materials to directly address misinformation, and distributing them in the right places, will empower individuals at-risk for tick-borne diseases with increased knowledge about how to prevent and react to a tick encounter. Abbreviations TBD Tick borne disease Declarations Ethics approval and consent to participate We obtained ethical approval from Dartmouth College’s Committee for the Protection of Human Rights prior to beginning data collection (CPHR# STUDY00032237). Consent for publication “Not applicable” Availability of data and materials To protect personally identifiable information, including searchable verbatim posts and comments, group membership and user information; only summarized, de-identified data will be available in the supplementary materials. Authors' contributions KM, HW, EM, and KC contributed to the original research idea/development. KM developed methods, analyzed data, and led manuscript preparation. HW collected and analyzed data and provided significant contributions to the manuscript. ML analyzed data and provided input to the manuscript. EM developed methods and provided significant contributions to the analysis and manuscript refinement. KC analyzed data, generated figures and provided significant contributions to manuscript preparation and refinement. All authors have approved this manuscript for submission. Acknowledgements We thank Casimiro Cosmo and Elizabeth Berendsen for help with data collection, our digital community health workers Carolyn Nicoli, Lindsey A. Boisvert, and Anastasia Kanishcheva for engaging with Facebook group members, and members of the Cottingham lab for discussions. This work represents the views of the authors and does not necessarily represent the views of the U.S. Food and Drug Administration. Funding This project was funded by an unrestricted gift from Facebook as part of the 2020Foundational Integrity Research: Misinformation & Polarization Request for Proposals. Competing interests The authors declare no competing interests. References Sylvia Chou WY, Gaysynsky A, Cappella JN. Where we go from here: health misinformation on social media. 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Epidemiology and statistics of spotted fever rickettsioses | CDC. Centers for Disease Control and Prevention. Published January 11, 2024. Accessed April 30, 2024. Available from: https://www.cdc.gov/rmsf/stats/index.html. Eisen L. Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks. Ticks Tick Borne Dis. 2018;9(3):535-542. doi:10.1016/j.ttbdis.2018.01.002. Eisen L. Efficacy of unregulated minimum risk products to kill and repel ticks. Emerg Infect Dis. 2024;30(1):1-7. doi:10.3201/eid3001.230813. Meng H, Li AY, Costa Junior LM, Castro-Arellano I, Liu J. Evaluation of DEET and eight essential oils for repellency against nymphs of the lone star tick, Amblyomma americanum (Acari: Ixodidae). Exp Appl Acarol. 2016;68(2):241-249. doi:10.1007/s10493-015-9994-0. Preventing tick bites on people. Centers for Disease Control and Prevention. Published July 1, 2020. Accessed April 30, 2024. Available from: https://www.cdc.gov/ticks/avoid/on_people.html. US EPA. Repellents: protection against mosquitoes, ticks and other arthropods. Published July 9, 2013. Accessed March 14, 2024. Available from: https://www.epa.gov/insect-repellents. Bissinger BW, Roe RM. Tick repellents: Past, present, and future. Pestic Biochem Phys. 2010;96(2):63-79. doi:10.1016/j.pestbp.2009.09.010. US EPA. Find the Repellent that is right for you. Published August 20, 2013. Accessed March 14, 2024. Available from: https://www.epa.gov/insect-repellents/find-repellent-right-you. Tick Free NH Home. Tick Free NH. Accessed April 30, 2024. Available from: https://tickfreenh.org/. Health (ASH). The Kay Hagan Tick Act. Published August 27, 2023. Available from: https://www.hhs.gov/ash/osm/innovationx/vector-borne-disease-national-strategy/kay-hagan-tick-act/index.html. Slunge, D., Jore, S., Krogfelt, K.A. et al. Who is afraid of ticks and tick-borne diseases? Results from a cross-sectional survey in Scandinavia. BMC Public Health 19 , 1666 (2019). https://doi.org/10.1186/s12889-019-7977-5 Dartmouth Rural STEM Educator Partnership. Accessed March 14, 2024. Available from: https://sepa.host.dartmouth.edu/. Additional Declarations No competing interests reported. Supplementary Files additionalFile1BMC.pdf additionalFile2BMC.xlsx additionalFile3BMC.xlsx additionalFile4BMC.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4601605","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316691116,"identity":"e4ba4041-29cd-43a0-9099-c3f2cd9c0053","order_by":0,"name":"Kaitlin M. McDonald","email":"data:image/png;base64,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","orcid":"","institution":"Dartmouth College","correspondingAuthor":true,"prefix":"","firstName":"Kaitlin","middleName":"M.","lastName":"McDonald","suffix":""},{"id":316691117,"identity":"c18403da-a877-49ae-bb5f-fc84aa659991","order_by":1,"name":"Haley Warzecha","email":"","orcid":"","institution":"Dartmouth College","correspondingAuthor":false,"prefix":"","firstName":"Haley","middleName":"","lastName":"Warzecha","suffix":""},{"id":316691118,"identity":"7e9cc4b1-9a22-4e43-bef4-cfb1fae85be2","order_by":2,"name":"Emily M. McDonald","email":"","orcid":"","institution":"United States Food and Drug Administration","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"M.","lastName":"McDonald","suffix":""},{"id":316691119,"identity":"9d3c8875-f9ba-4f87-8c2d-fd0043ef00d7","order_by":3,"name":"Maxwell Le May","email":"","orcid":"","institution":"Brown University","correspondingAuthor":false,"prefix":"","firstName":"Maxwell","middleName":"Le","lastName":"May","suffix":""},{"id":316691120,"identity":"08dacd4d-afcc-4eba-9794-9b7351886146","order_by":4,"name":"Kathryn L. Cottingham","email":"","orcid":"","institution":"Dartmouth College","correspondingAuthor":false,"prefix":"","firstName":"Kathryn","middleName":"L.","lastName":"Cottingham","suffix":""}],"badges":[],"createdAt":"2024-06-18 17:54:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4601605/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4601605/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59667428,"identity":"951f58da-ce38-489b-a100-2c9e6ef69e68","added_by":"auto","created_at":"2024-07-04 13:32:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53058,"visible":true,"origin":"","legend":"\u003cp\u003eThirty of the collected posts and associated comments (Facebook cases) contained misinformation. Blue bars represent the proportion of comments not containing misinformation, red bars represent comments that contain misinformation. Total length represents the number of comments and the original post.\u003c/p\u003e","description":"","filename":"fig1BMC.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/61910ea1076079a1d34d3fd2.jpeg"},{"id":59667429,"identity":"69766176-9a7d-4f4f-9e73-e6c54dcf6e4f","added_by":"auto","created_at":"2024-07-04 13:32:54","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":83936,"visible":true,"origin":"","legend":"\u003cp\u003eThe majority of misinformation was found in the parent code Tick Biology and Ecology (light green) with the child code Identification and Morphology comprising most of the misinformation. The area of each box represents the proportion of codes within each labeled category. Parent codes are colored as described in the legend; Child codes (frequency ≥ 5) are labeled as shown.\u003c/p\u003e","description":"","filename":"fig2BMC.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/83c6a97855a02a711d3ffee7.jpeg"},{"id":91308856,"identity":"6590ebc7-956f-4117-b35e-8bbd02d061b4","added_by":"auto","created_at":"2025-09-15 06:54:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937268,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/cabf01d6-e69d-4405-8455-7ddb51b4f897.pdf"},{"id":59667425,"identity":"2589092a-aec8-4109-a984-6a37aedc6b5f","added_by":"auto","created_at":"2024-07-04 13:32:53","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":57790,"visible":true,"origin":"","legend":"","description":"","filename":"additionalFile1BMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/989b8facaefd2dc094118b1f.pdf"},{"id":59667427,"identity":"8812575c-e298-49e3-89d7-934a77520dd0","added_by":"auto","created_at":"2024-07-04 13:32:53","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13604,"visible":true,"origin":"","legend":"","description":"","filename":"additionalFile2BMC.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/286c6d7f187b20f433048bc5.xlsx"},{"id":59667426,"identity":"f22f742f-888b-4cda-893e-5c594561550e","added_by":"auto","created_at":"2024-07-04 13:32:53","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":8532,"visible":true,"origin":"","legend":"","description":"","filename":"additionalFile3BMC.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/96586f323274b4609b281fa4.xlsx"},{"id":59667430,"identity":"ba4cfa4c-fc4c-4209-b6d5-3c875228dc26","added_by":"auto","created_at":"2024-07-04 13:32:54","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":15059,"visible":true,"origin":"","legend":"","description":"","filename":"additionalFile4BMC.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4601605/v1/bcbf465df71ce444ce2d6ad2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Misinformation in Conversations about Ticks and Tick-borne Disease in Public Facebook Groups","fulltext":[{"header":"Background","content":"\u003cp\u003eIdentifying and dispelling health-related misinformation is a significant but critical challenge to keeping communities safe and healthy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The rise of health-related misinformation has caused a breakdown of trust in medical institutions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and led to poorer health outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Misinformation is defined in a number of ways (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) but is generally taken to mean information that is scientifically uncorroborated and distributed without the knowledge that it is unsubstantiated, and thus not intended to cause harm (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn imminent concern relates to the spread of misinformation on social media (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Although social media can be used to quickly distribute information (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), it also provides a space for misinformation to proliferate rapidly and expansively (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Social media platforms promote interpersonal connections via multiple pathways, including shared interests. On Facebook, for example, \u0026ldquo;Facebook Groups\u0026rdquo; allow individuals with common interests to form an online community. Within these groups trust is likely to be higher, especially if individuals are similar (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and both positive behaviors (e.g., meaningful connections(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)) and misinformation can be more likely to spread. Thus, the capacity of social media to spread health-related misinformation that may impact personal or public health is of concern (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe power of health misinformation, spread through social networks, to negatively impact decision making around health has been evident for more than a decade. Online anti-vaccine health misinformation about influenza A (H1N1) is negatively correlated with CDC-estimated vaccination rates by region (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, individuals susceptible to misinformation about COVID-19 are at increased risk of noncompliance with public health recommendations such as vaccinations (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Further, misinformation spread, particularly with respect to COVID-19, is found under the topic of \u0026ldquo;health tips\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and perceived misinformation was encountered by more than half of participants when seeking information regarding COVID-19 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Identifying themes of health misinformation can aid public health strategies in dispelling such misinformation and may aid in preventing future dissemination of misinformation.\u003c/p\u003e \u003cp\u003eTick-borne diseases (TBD) are a significant and growing health concern (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) in multiple regions of the US (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Ticks are obligate blood-feeding parasites that rely on a variety of vertebrate hosts to complete their life cycle and reproduce. Many ticks require multiple hosts and subsequently vector pathogens from host to host. Humans are often incidental hosts to which the transmission of pathogens can occur, resulting in disease. Reported cases of TBD, such as anaplasmosis, Rocky Mountain Spotted Fever, babesiosis, and Lyme disease have increased over the last few decades(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), taking an immense toll on public health (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and local economies in areas where disease incidence is high or increasing (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). For example, treatment for Lyme disease and post-disease symptoms in the United States was estimated to cost upwards of \u003cspan\u003e$\u003c/span\u003e1\u0026nbsp;billion annually nearly a decade ago (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) - \u003cspan\u003e$\u003c/span\u003e1.31B in 2024 dollars.\u003c/p\u003e \u003cp\u003eWith the geographic expansion of ticks due to climate change (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and the rise in tick abundance (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), many people are increasingly aware of TBDs (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). As with many personal health topics, people turn to social media for knowledge and advice (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Whether it is the tick life cycle, feeding behavior, or disease transmission, a plethora of informational resources exist for those concerned about TBD. Although people generally share information to help others, we hypothesize that sometimes they share information that is inconsistent with the scientific literature and could lead to a greater risk for TBD. However, there is currently limited published literature about the types of misperceptions individuals have about ticks and TBD. While studies have examined knowledge, attitudes, and beliefs regarding TBD prevention (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) or identified a lack of trust regarding government-supported informational resources (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), to our knowledge no studies have examined the types of misinformation regarding ticks and TBD that exist on social media. This study seeks to fill that gap by analyzing all conversations around ticks and TBD that took place within 10 focal public Facebook groups in the northeastern United States during Summer 2021. Our goal is to identify prevalent misconceptions about ticks and tick-borne diseases that can be used to inform or restructure public education efforts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eData \u003cem\u003ecollection\u003c/em\u003e\u003c/p\u003e \u003cp\u003eWe obtained ethical approval from Dartmouth College\u0026rsquo;s Committee for the Protection of Human Rights prior to beginning data collection (CPHR# STUDY00032237). Additionally, to protect personally identifiable information, the illustrative quotes in this manuscript are paraphrased, not reported verbatim, and the Facebook group names will not be shared to protect anonymity.\u003c/p\u003e \u003cp\u003eWe identified the focal Facebook groups through a series of steps. First, between February and April 2021, we selected 26 Facebook groups for consideration based on privacy status (must be public) and geographic location (located in the vicinity of New England). We then narrowed this list by assessing the number of members, growth rate, and general activity level. The most important factor in narrowing the selection was the number of posts and interactions regarding the keywords \u0026ldquo;ticks\u0026rdquo; and \u0026ldquo;Lyme disease\u0026rdquo; over the preceding 12 months (Additional File 1), as assessed using the public insights tool CrowdTangle (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Groups on the higher end of tick and Lyme disease-specific activity, with a larger membership size and general activity level, were selected. One of the research team members then joined each of the selected groups using a nascent Facebook account. Although we initially joined 12 groups, two subsequently went private and so were removed from our analyses, resulting in the 10 focal groups. As a part of a larger, related study, groups were then split into intervention (n\u0026thinsp;=\u0026thinsp;5) and control (n\u0026thinsp;=\u0026thinsp;5) groups. Briefly, intervention groups contained local \u0026ldquo;digital\u0026rdquo; community health workers who proactively posted tick related evidence-based educational materials and responded to posts containing tick-related misinformation. Control groups did not have any intervention. No distinction is made between these groups in our analyses. Selected Facebook groups were monitored approximately every two weeks from 1 May to 30 September 2021, a period of high tick activity and disease transmission in the northeastern United States (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). During each check-in, group content was searched using the keywords \u0026ldquo;tick\u0026rdquo; and \u0026ldquo;Lyme disease\u0026rdquo; chronologically from the last date the group was checked.\u003c/p\u003e \u003cp\u003eAll posts and affiliated comments containing the two keywords or arthropod-related content were manually collected by cutting and pasting into spreadsheets for further evaluation and summative content analysis. Manually collecting posts and comments over time, rather than taking a single \u0026ldquo;snapshot\u0026rdquo; of data, resulted in slight changes in numbers of comments and posts collected. For example, we endeavored to collect all posts from the previous two weeks in a single sitting but there were instances where this was not possible, resulting in posts or comments being added or deleted in the intervals between data collection.\u003c/p\u003e \u003cp\u003eData were thoroughly inspected prior to analysis to remove any duplicates or posts that were outside of the study scope. A total of 218 posts were identified; 170 were included in our analysis. The 48 posts removed at this stage were found to be duplicates that had been collected in error or singular advertisements that did not fit within the scope of the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSummative content analysis\u003c/h2\u003e \u003cp\u003eTwo researchers coded all collected Facebook posts and comments, employing a summative content analysis approach whereby themes of misinformation were first identified and quantified, and then further analyzed to examine underlying themes of misinformation (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Data were identified as misinformation based on their deviation from scientific findings or public health recommendations, as represented by peer-reviewed or evidence-based sources (Additional File 2). This study did not examine disinformation, which involves false information intentionally being disseminated to cause harm (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), or statements considered to be anecdotal, hyperbole, or personal. For example, we did not code statements such as \u003cem\u003e\u0026ldquo;The ticks are insane this year, can\u0026rsquo;t go outside without getting several on me,\u0026rdquo; \u0026ldquo;There are millions of ticks in my backyard!\u0026rdquo;\u003c/em\u003e or \u003cem\u003e\u0026ldquo;I suffer from Lyme disease.\u0026rdquo;\u003c/em\u003e Our estimates of what constitutes misinformation were conservative in that we removed all anecdotal/personal stories and hyperbole prior to analysis, which may contain accounts that are unsupported by scientific evidence. Anecdotal reasoning can influence a person's decision making (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) especially when related to health (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e); however, identifying misinformation in a personal story remains difficult.\u003c/p\u003e \u003cp\u003eThe final misinformation codebook used a parent/child code category hierarchy to classify the collected posts: the parent codes represent broad categories of misinformation, with child codes tailored for the specific parent context. The coding process was iterative; we derived the initial parent codebook categories from a preliminary study conducted in 2020 (Additional File 3), while initial child codes were generated from one researcher conducting a preliminary read through of the data. For example, posts about where ticks are typically found (tall grass, the woods, etc.) were identified as broadly associated with tick biology and ecology (the parent code); a subsequent child code was determined to be habitat, further clarifying the nature of the posts.\u003c/p\u003e \u003cp\u003eAll data were coded manually in Nvivo (version 14, Release 1.5 Software for Mac, Lumivero, Denver, CO). Questions about codes were handled in a conversation with the other study team members until an agreement about the most appropriate code was reached. After all data had been coded, the authors reviewed and discussed unused codes which were then removed or revised and incorporated into other child codes before summarizing the findings.\u003c/p\u003e \u003cp\u003eTo summarize the results of the coding process, the number of times each code category appeared in the data was counted, resulting in frequency counts for each category included in the final codebook.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe examined a total of 170 posts and 2483 comments for misinformation. Instances of misinformation were identified in 30 posts (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), comprising approximately 17% of the data (Additional File 4). Posts containing misinformation varied in the number of comments (min\u0026thinsp;=\u0026thinsp;0, max\u0026thinsp;=\u0026thinsp;366, median\u0026thinsp;=\u0026thinsp;28) and in the proportion of comments that contained misinformation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was a strong right skew to both interactions and misinformation: some posts and comments had very little misinformation, whereas others had a great deal (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The types of misinformation included contradictory species identification, movement (e.g. jumping), and inappropriate tick removal guidance (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExamples of misinformation and rationale for coding.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent Codes\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRationale for identifying as misinformation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1) \u003cem\u003e\u0026ldquo;All ticks carry Lyme disease these days.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e2) \u003cem\u003e\u0026ldquo;Dog and deer ticks carry Lyme disease, they can all mess you up if you're bitten!\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e3) \u003cem\u003e\u0026ldquo;Ticks can transmit Lyme disease at any time, 24\u0026ndash;48 hours is a common mistake people make.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e4) \u003cem\u003e\u0026ldquo;Doctors cannot treat Lyme. The CDC thinks chronic Lyme disease doesn't exist.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3) Misrepresentation of the species/ proportion of ticks that carry pathogens and transmission time of Lyme disease.\u003c/p\u003e \u003cp\u003e4) Misperception regarding government organization stance on LD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTick Biology \u0026amp; Ecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5) \u003cem\u003e\u0026ldquo;That doesn't look like a tick to me, it looks like a bedbug.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e6) \u003cem\u003e\u0026ldquo;That's a harmless kind of tick.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e7) \u003cem\u003e\u0026ldquo;Definitely not a deer tick, probably a dog or wood tick.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e8) \u003cem\u003e\u0026ldquo;Ticks are attracted to the heat and will drop from trees or horizontally jump to transport themselves.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e9) \u003cem\u003eTicks will lay multiple hundreds of eggs many times in one year.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e10) \u003cem\u003e\u0026ldquo;Turkeys can eat up to 200 ticks every day.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;7) Conflicting identifications provided by those responding to the original post\u003c/p\u003e \u003cp\u003e8\u0026ndash;9) Misperceptions regarding tick biology (e.g. oviposition frequency).\u003c/p\u003e \u003cp\u003e10) Lack of sufficient evidence regarding predators of ticks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11) \u003cem\u003e\u0026ldquo;You can burn the ticks. Especially if it has already burrowed into your skin.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e12) \u003cem\u003e\u0026ldquo;Use cedarcide spray.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e13) \u003cem\u003e\u0026ldquo;Use a mix of peppermint oil and coconut oil on your skin.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e14) \u003cem\u003e\u0026ldquo;Don't eat red meat. I heard that ticks are not attracted to people that don't eat red meat. I have not eaten it in a decade and I've never seen a tick.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;14) Identified as misinformation due to the paucity of research regarding the efficacy of chemicals, compounds, or diets, at repelling ticks following application.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15) \u003cem\u003e\u0026ldquo;Put vaseline on the tick. It will kill it if it's embedded.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e16) \u003cem\u003e\u0026ldquo;I heard that rubbing alcohol makes the tick back out.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e17) \u003cem\u003e\u0026ldquo;To remove an attached tick, my dad poured gasoline on it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e18) \u003cem\u003e\u0026ldquo;You can spin the ticks by the body and make the two small legs bend so it can't stay in. Pops out without breaking its head off inside you. \u0026ldquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;18) Inaccurate guidance given regarding the proper removal of a tick.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cem\u003ea\u003c/em\u003e \u003c/sup\u003e \u003cem\u003eExamples have been paraphrased in order to de-identify the original post.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWe coded misinformation under four parent codes (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), but 78% of it occurred in the parent code \u003cem\u003eTick Biology \u0026amp; Ecology\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), especially the child codes \u003cem\u003eIdentification\u003c/em\u003e and \u003cem\u003ePredators\u003c/em\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Posts related to tick-borne \u003cem\u003eDisease\u003c/em\u003e had the second highest frequency of misinformation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), especially within the child code \u003cem\u003eIncidence and Prevalence\u003c/em\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The remaining parent codes, \u003cem\u003eEducation\u003c/em\u003e and \u003cem\u003eTreatment\u003c/em\u003e, occurred at similar frequencies and the child codes \u003cem\u003eRepellents\u003c/em\u003e and \u003cem\u003eRemoval\u003c/em\u003e had the highest frequencies within these parent codes, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCodebook of parent and child codes for the types of misinformation observed in public Facebook groups, together with the counts of the number of times each code occurred, and a description of each code used.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent Code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild Code\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDisease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence \u0026amp; Prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTick borne diseases (TBDs) and the number or amount (\u003cem\u003ee.g. 50% of ticks carry Lyme Disease\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNatural History \u0026amp; Symptomatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConcerning where TBDs originated; what symptoms result from infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTransmission of TBD from tick to host (incl. human)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTick Biology \u0026amp; Ecology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e217\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBehavior \u0026amp; Host-Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTick behavior or how a tick finds its host (\u003cem\u003ee.g. questing, hunting\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHabitat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhere ticks are commonly found in nature (\u003cem\u003ee.g. tall grass, woods\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentification \u0026amp; Morphology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat a tick looks like, including identifying a picture (\u003cem\u003ee.g. number of legs, shape\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLife Cycle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLife of a tick (\u003cem\u003ee.g. how long it lives, how many life stages, etc.\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMovement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTick movement (\u003cem\u003ee.g. crawling, jumping, hopping, flying\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of ticks in an area or how the number of ticks has changed over time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhat predates on ticks (\u003cem\u003ee.g. Opossums, chickens\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeasonality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhen ticks are active throughout the year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention before health effects occur (Reisinger et al., 2012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepellents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChemical compounds intended to repel ticks (\u003cem\u003ee.g. essential oils, DEET\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLyme Literate Medical Doctors (LLMDs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical professionals who have knowledge or specific experience with Lyme disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemoval \u0026amp; Disposal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHow to remove or dispose of a tick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTesting \u0026amp; Diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhen and how to seek testing/diagnosis for a TBD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-traditional Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTreatment that is not typically provided in a traditional medical or hospital setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e Codes with a zero-reference count were removed from further analysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSourcing of health information from online community groups is a common phenomenon that can have significant implications for public health (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In this study, the vast majority of misinformation identified about ticks and tick-borne disease was related to the biology and ecology of ticks. Crowd-sourcing the identification of ticks was a common practice in the study groups, potentially with implications for an individual\u0026rsquo;s decision-making process after being bitten by a tick (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; examples 5\u0026ndash;7). Here, current public health guidelines recommend prompt removal of all ticks and consulting with one\u0026rsquo;s healthcare provider in regions where tick borne diseases are common (e.g., Lyme disease in New England) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). If responders misidentify the arthropod in question, the person who made the post may think they are at low or no risk for diseases that require treatment. In fact, one post soliciting help with identification contained a comment that pointed out conflicting species identifications: \u003cem\u003e\u0026ldquo;It\u0026rsquo;s hilarious that a bunch of people have said, very confidently, that this is several different ticks.\u0026rdquo;\u003c/em\u003e The potential delay in seeking medical care, due to misidentification or being unsure of the risk of disease, could be particularly risky for Lyme disease, where delayed treatment may incur an additional health burden (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Further, the global pandemic has potentially exacerbated treatment delays for tick-borne diseases whose symptoms are similar to those of COVID-19 (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSpecies misidentification could be compounded by the prevalence of misinformation regarding which tick species vector which pathogens to humans, further altering an individual's risk perception. For instance, comments coded in this study discussed tick species that are able to transmit Lyme disease to humans, with some commenters asserting that all ticks are capable of transmitting the causative agent of Lyme disease. Currently, only \u003cem\u003eIxodes\u003c/em\u003e spp. are known to transmit the bacteria (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), though the high awareness of the prevalence of Lyme disease in New England (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) may lead individuals to conflate species of ticks that can transmit the causative agent of Lyme (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; examples 1\u0026ndash;2). There also seemed to be misperceptions on which species of tick can transmit Rocky Mountain Spotted Fever (RMSF) and where it is found in the US, with users divided on whether RMSF is transmitted in New England. For instance, one individual claimed: \u003cem\u003e\u0026ldquo;Dog/blacklegged ticks can carry diseases like RMSF\u0026rdquo;\u003c/em\u003e and another stated \u003cem\u003e\u0026ldquo;stop making false statements, RMSF is not in New England.\u0026rdquo;\u003c/em\u003e As of 2021, RMSF has been identified in New England; however, incidence is low (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and it is unclear if the causal bacteria were acquired, via a tick vector, from another location where prevalence may have been higher. The time it takes for a pathogen, specifically the causative agent of Lyme disease, to be acquired was also a common discussion point, with commenters discussing the duration a tick must be attached to transmit Lyme disease. Current evidence suggests that it takes between 24\u0026ndash;48 hours (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), but discussion often provided estimates ranging from instantaneous to 48 hours (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; example 3).\u003c/p\u003e \u003cp\u003eConversations surrounding tick repellents and appropriate ways to remove a tick (from a human) included poorly supported recommendations that have the risk of being misinformation. The promotion of alternative tick repellents, whose efficacy (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) and safety has not been evaluated, or that may not be as effective as active ingredients like DEET (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), may result in the perpetuation of misinformation that could have significant implications for public health. Individuals whose trusted networks promote the use of unstudied repellents and decry safe and effective repellents may detract and confuse individuals about the correct course of preventative action. There are several well-studied and regulated tick repellents recommended by state and federal agencies charged with providing guidance on appropriate application and use (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Common active ingredients in these repellents include DEET, permethrin, IR3535, and oil of lemon eucalyptus (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Resources such as the EPA\u0026rsquo;s \u0026ldquo;Find the Repellent that is Right for You\u0026rdquo; (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) search tool provide a public-facing, accessible way for individuals to find repellents that suit their needs.\u003c/p\u003e \u003cp\u003eFinally, the appropriate way to remove a tick comprised 75% of the \u003cem\u003eTreatment\u003c/em\u003e parent code and contained numerous unsubstantiated suggestions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; examples 15\u0026ndash;18). Suggestions such as covering the tick with petroleum jelly or hydrogen peroxide to encourage the tick to detach contrast with current CDC recommendations to remove the tick, using tweezers, as soon as possible. Prompt removal of an attached tick is critical in reducing the risk of pathogen transmission (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), and numerous resources exist on the best way to remove a tick (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSocial media can offer individuals access to communities where shared values or interests are commonly expressed, creating spaces for trusted networks (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, social media may also contain health misinformation, making it difficult for individuals to discern anecdotal stories from evidence-based recommendations (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e); this lack of clarity may lead to poor health decisions. Ticks are ubiquitous throughout the northeastern U.S. and the discussions examined in this study regarding ticks and Lyme disease reflect the public's concern about these issues given the enormous health-related burden of those affected. Ticks and the diseases they transmit have become increasingly prioritized in research and policy (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e); and dispelling misinformation surrounding ticks and tick borne diseases will improve public awareness and may help better align public understanding with disease risk (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). To our knowledge, this is the first study to examine what misinformation about ticks exists in public Facebook groups. Based on our findings, opportunities exist to educate the public on the biology and ecology of ticks, with emphasis on improving self-efficacy in distinguishing between ticks and other arthropods and increasing awareness regarding what species of tick transmit which diseases.\u003c/p\u003e \u003cp\u003eThough many tick education initiatives exist, the lack of published literature about the types of misinformation and misunderstandings surrounding ticks and tick-borne diseases means that current initiatives are not (yet) grounded in an understanding of the misperceptions that individuals have. This study lays the groundwork for expanding evidence-based public health education to specifically address misperceptions. Other formats, such as in-school curricula (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), trusted influencers within communities, and digital campaigns can also be opportunities to educate individuals and address misperceptions. Designing educational materials to directly address misinformation, and distributing them in the right places, will empower individuals at-risk for tick-borne diseases with increased knowledge about how to prevent and react to a tick encounter.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTick borne disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained ethical approval from Dartmouth College’s Committee for the Protection of Human Rights prior to beginning data collection (CPHR# STUDY00032237).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e“Not applicable”\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo protect personally identifiable information, including searchable verbatim posts and comments, group membership and user information; only summarized, de-identified data will be available in the supplementary materials.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKM, HW, EM, and KC contributed to the original research idea/development. KM developed methods, analyzed data, and led manuscript preparation. HW collected and analyzed data and provided significant contributions to the manuscript. ML analyzed data and provided input to the manuscript. EM developed methods and provided significant contributions to the analysis and manuscript refinement. \u0026nbsp;KC analyzed data, generated figures and provided significant contributions to manuscript preparation and refinement. All authors have approved this manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Casimiro Cosmo and Elizabeth Berendsen for help with data collection, our digital community health workers Carolyn Nicoli, Lindsey A. Boisvert, and Anastasia Kanishcheva for engaging with Facebook group members, and members of the Cottingham lab for discussions. This work represents the views of the authors and does not necessarily represent the views of the U.S. Food and Drug Administration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;project was funded by an unrestricted gift from Facebook as part of the 2020Foundational Integrity Research: Misinformation \u0026amp; Polarization Request for Proposals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSylvia Chou WY, Gaysynsky A, Cappella JN. Where we go from here: health misinformation on social media. Am J Public Health. 2020;110(S3):S273-S275. doi:10.2105/AJPH.2020.305905.\u003c/li\u003e\n\u003cli\u003eBaker DW. Trust in health care in the time of COVID-19. 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Repellents: protection against mosquitoes, ticks and other arthropods. Published July 9, 2013. Accessed March 14, 2024. Available from: https://www.epa.gov/insect-repellents.\u003c/li\u003e\n\u003cli\u003eBissinger BW, Roe RM. Tick repellents: Past, present, and future. Pestic Biochem Phys. 2010;96(2):63-79. doi:10.1016/j.pestbp.2009.09.010.\u003c/li\u003e\n\u003cli\u003eUS EPA. Find the Repellent that is right for you. Published August 20, 2013. Accessed March 14, 2024. Available from: https://www.epa.gov/insect-repellents/find-repellent-right-you.\u003c/li\u003e\n\u003cli\u003eTick Free NH Home. Tick Free NH. Accessed April 30, 2024. Available from: https://tickfreenh.org/.\u003c/li\u003e\n\u003cli\u003eHealth (ASH). The Kay Hagan Tick Act. Published August 27, 2023. Available from: https://www.hhs.gov/ash/osm/innovationx/vector-borne-disease-national-strategy/kay-hagan-tick-act/index.html.\u003c/li\u003e\n\u003cli\u003eSlunge, D., Jore, S., Krogfelt, K.A. \u003cem\u003eet al.\u003c/em\u003e Who is afraid of ticks and tick-borne diseases? Results from a cross-sectional survey in Scandinavia. \u003cem\u003eBMC Public Health\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 1666 (2019). https://doi.org/10.1186/s12889-019-7977-5\u003c/li\u003e\n\u003cli\u003eDartmouth Rural STEM Educator Partnership. Accessed March 14, 2024. Available from: https://sepa.host.dartmouth.edu/.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Arthropod vectors, Lyme disease, public health, qualitative study, social media","lastPublishedDoi":"10.21203/rs.3.rs-4601605/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4601605/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth-related misinformation on social media can negatively impact public health outcomes. Effective interventions to combat misinformation require an understanding of the underlying topics and their associated misperceptions. Ticks and the pathogens they carry are increasing worldwide, raising concerns about the disease burden these pathogens cause. Our goal is to identify prevalent misconceptions about ticks and tick-borne diseases to inform and restructure public health education efforts, thereby reducing the health burden related to tick-borne diseases.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe collected public Facebook posts and comments during summer 2021 and used summative content analysis to characterize misinformation themes. In total, 170 posts and 2483 comments were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 30 posts (17% of the total) contained misinformation, the majority of which (78%) occurred in the context of tick biology and ecology and 5% and 4% were about repelling and removing ticks, respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest that public health education campaigns should focus on dispelling common misperceptions related to tick biology, ecology, and species identification.\u003c/p\u003e","manuscriptTitle":"Misinformation in Conversations about Ticks and Tick-borne Disease in Public Facebook Groups","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-04 13:32:47","doi":"10.21203/rs.3.rs-4601605/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e7a0954-cd6b-43f0-b3d2-5f616ea26dd3","owner":[],"postedDate":"July 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-15T06:53:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-04 13:32:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4601605","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4601605","identity":"rs-4601605","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}