Prévention de la maladie de Lyme : facteurs sociaux et priorisation des interventions

Lyme disease is the most common vector-borne disease in temperate countries and is emerging in many parts of the world. Several prevention strategies exist and include strategies at the individual level, such as wearing protective clothing, and at the population level, including tick control interventions in the environment. The effectiveness of these strategies can be influenced by various factors, including social factors such as knowledge, perceptions and behaviors of the target population, and by their potential impacts on various sectors such as on the environment and on the economy. Also, these social factors and impacts are likely to vary according to the epidemiological and social context of the target population. The objective of this thesis was to study the main social factors and issues of importance to consider for the prioritization of preventive interventions for Lyme disease in two populations living in different contexts, particularly with regard to their epidemiological situation, that is in Quebec, where the incidence of Lyme disease is low, but emerging, and Switzerland, where it is high and has been endemic for more than three decades. The approach and the design of this study were based on two main theoretical models, namely the Health Belief Model and the multicriteria decision analysis approach.  Factors associated with risk perception, that is the cognitive assessment of a person facing a risk, for Lyme disease were studied initially in the target populations. The results suggest that factors significantly associated with a high level of risk perception are different in the two regions. Then, the impact of knowledge on Lyme disease, exposure, perceptions on the adoption of individual preventive behavior and on the acceptability of tick control interventions were compared. The data suggest that the impact of these factors varies according to the type of behavior and interventions, but that the perception of efficacy is a common factor strongly associated with both aspects, and could be targeted in communication campaigns. The results also show that issues related to tick control interventions as perceived by the participants are common in both contexts, and shared by the stakeholders involved in the prevention of Lyme disease.  Finally, a multi-criteria analysis model was developed using a participatory approach for the Quebec context, adapted to the Swiss context and allowed to prioritize preventive interventions according to different stakeholder perspectives. Rankings produced by these models prioritized interventions that primarily target human populations in preference to tick control interventions. Applying the multi-criteria decision analysis approach in the context of Lyme disease prevention led to the development of a versatile decision model that can be adapted to different contexts, including the epidemiological situation. These studies show that this approach can offer a rigorous and transparent way to integrate the multiple perspectives of stakeholders and issues of prevention including those relating to public health, animal and environmental health, social impacts, as well as economic, operational and strategic considerations. Their use in public health practices could facilitate the adoption of a practical and applied “One health” approach to Lyme disease and other zoonosis prevention.  Keywords: Lyme disease, prevention, social factors, risk perception, acceptability, prioritization of interventions, tick control, Multi-criteria decision analysis, MCDA, Quebec, Switzerland,  "One health"

Keyphrases: Lyme disease, Prevention, Risk communication, Social factors, Risk perception, Acceptability, Prioritization of interventions, Multi-criteria decision analysis, One health, Preventive behaviors