Knowledge, attitudes and behaviours related to tick awareness and prevention among users of urban green spaces: insights from stakeholder focus groups

Abstract Background: Ticks in the UK can transmit pathogens that lead to diseases in humans, including Lyme disease and tick-borne encephalitis. Expanding tick populations and increasing human use of urban green spaces may elevate exposure risk. Public health advice exists, but little is known about how this guidance is understood and applied by users of urban environments. Methods: Four stakeholder focus groups were conducted with professionals involved in tick fieldwork in urban green spaces. Discussions explored interactions with the public, perceived awareness, behaviours, and views on communication. Data were analysed thematically using an approach informed by the Framework Method. Results: Stakeholders reported substantial variation in public awareness of ticks, influenced by prior exposure to rural environments and local knowledge. Misinformation, particularly around tick removal, was common. Signage was rarely observed in urban green spaces, and views on its effectiveness were mixed. Participants emphasised the need to balance risk communication with reassurance and highlighted the importance of age-appropriate education. Conclusions: Insights from stakeholders underline the importance of targeted, context specific public health messaging in urban settings. Priorities include identifying groups with lower awareness, addressing misinformation, designing balanced communication materials, evaluating the effectiveness of signage, and integrating education for children and families.