Living Among Ticks: Behavioral Patterns and Risk Consideration in the Stockholm Archipelago : Exploring Human Exposure and Protective Strategies Against Tick-Borne Diseases

Tick-borne infections are an increasing concern in Northern Europe, particularly in regions with high levels of outdoor activity. This research examines the behavioral factors that influence an individual's exposure to ticks in the Stockholm Archipelago, with a focus on the gap between awareness and protective action. Using a survey conducted with 141 respondents, including permanent residents, seasonal visitors, and occasional guests, the research explores outdoor habits, use of protective measures, and knowledge of tick-borne infections. Findings show a high degree of engagement in tick-prone environments like forests and meadows, with common activities including hiking, gardening, and dog walking. Despite a strong general awareness of tick-related risks and high TBE vaccination coverage, nearly half of the participants reported having contracted a tick-borne infection, most commonly Lyme borreliosis. Protective behaviors were inconsistently applied, where many participants wore shorts or slippers in the forest and rarely used repellents, often citing comfort or habit as barriers. The Health Belief Model was used to frame the analysis, revealing that while most respondents recognized the risk, this did not always translate into consistent protective actions. Factors such as perceived discomfort, cultural norms, and lifestyle habits emerged as key barriers to behavior change. Dog ownership, frequency of visits to nature, and prior tick exposure were stronger predictors of risk than gender or age. This study underscores the importance of complementing public health education with interventions that address practical and cultural barriers to behavior change. Tailored strategies that consider local traditions and promote feasible protective behaviors are essential to reducing incidences of tick-borne infections in endemic regions.