Reported incidence of Lyme disease (LD; also known as Lyme borreliosis) has increased in both North America and Europe, including the United Kingdom (UK). In 2011 there were 959 serologically confirmed cases in England and Wales
, and 229 in Scotland
 (incidence rates of 1.73 and 4.36, respectively, per 100,000 total population). Overall, the LD incidence rate in the UK is lower than that in the United States (US) of 7.8, where a total of 24,364 cases were reported in 2011
. Nonetheless, LD is becoming an important issue in public health management in the UK as increasing numbers of people use the countryside for recreation.
LD, caused by pathogenic genospecies of Borrelia burgdorferi sensu lato, is transmitted by ticks of the Ixodes ricinus complex. The most common clinical feature of early LD is an erythematous skin lesion, erythema migrans (EM), with other early features including flu-like symptoms, tiredness, headaches, myalgia, and arthralgia. LD is diagnosed primarily on clinical findings and a history of tick exposure, with serological testing only being required to confirm diagnosis in patients with less specific manifestations
Given the wide distribution of tick habitats
 and frequent use of the countryside for work and recreation, current management of LD risk in the UK is primarily channelled through the provision of precautionary information to countryside visitors, typically via leaflets (see
). Recommended precautions usually focus on prevention of tick bites (e.g. wearing protective clothing), frequent skin checks and early removal of attached ticks. It is unclear however to what extent such risk communication practices resonate with public preferences for precautionary measures. The adoption of precautionary measures against LD has been shown to be generally low in the UK
[7, 8] and in other countries such as the US
[9–11]. In a recent study, UK countryside visitors have been shown to be reluctant to adopt precautionary measures which they viewed as interfering with their enjoyment of nature, e.g. covering up on a warm day
Nonetheless, it is important for the public to recognize accurately the symptoms of LD and seek prompt medical help, as LD can become more severe if not treated timely. Therefore, in this study we explored lay experience of contracting and being diagnosed with acute LD in order to gain insights into how precautionary information on LD might be best formulated so that the public can accurately and promptly interpret its symptoms, and what preventive measures might be seen as most preferable. We focused on what leads people to appraise their symptoms correctly by the time they consult the General Practitioner (GP) and what factors might lead to this. Given the often extended timeline between being present in a tick habitat and having a set of symptoms that prompt a visit to the GP, it is valuable to understand the optimal points for taking precautionary and preventive actions
 as well as identifying key drivers of correct symptom appraisal.