Table 6 Summary of the key findings and implications concerning Lyme disease perceptions

• There was a wide range of experience and concern about Lyme disease, with most participants lacking detailed knowledge on Lyme disease and some sharing misinformation.

• While public health communication efforts have been successful in increasing awareness of Lyme disease, more specific education and ‘myth busting’ information is needed.

• Despite discussions of the disease as serious, the majority of participants are not worried about the risk of Lyme disease.

• Public health communication may consider emphasizing the benefits and ease of adopting preventative behaviours, if risk messaging is not sufficient to motivate behavioural change and associated safety.

• Differences in perceptions emerged according to urban and rural groups, with rural groups having more awareness and preventative behaviours related to ticks generally. In this way, rural people seemed to be leaders in Lyme disease adaptation, and were uncomfortable with climate change being presented as a rationale for health prevention.

• Despite significant research that suggests “coupling” climate and health information to spur action, this exploratory study suggests that with climate skeptical audiences this “coupling” might be counter-productive. Indeed, people may question the importance of health adaptation when it is conflated with their pre-existing doubt and denial of climate change.

• While skepticism arose in some discussion of Lyme disease – particularly concerning the connection between climate change and Lyme disease – there was no denial of the disease.

• The ways in which skepticism arises in discussions of Lyme disease – especially when explicitly linked with climate change – suggests that decoupling the issues in communication materials might be beneficial especially in regions with known skepticism.