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Health Promoting Behaviors of Young Adults with Chronic Lyme Disease Patricia D Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Health Promoting Behaviors of Young Adults with Chronic Lyme Disease Patricia D. Bolivar Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Patricia Bolivar has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Harold Griffin, Committee Chairperson, Public Health Faculty Dr. Lee Bewley, Committee Member, Public Health Faculty Dr. Vincent Agboto, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Health Promoting Behaviors of Young Adults with Chronic Lyme Disease by Patricia D. Bolivar MS, California State University Los Angeles, 2001 BS, California State University Los Angeles, 1984 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2018 Abstract Lyme disease is the most prevalent arthropod-borne (tick) disease in North America. The disease is more prevalent in some Eastern and Central states than in Western states. The general problem is that, in southern California especially in Los Angeles County, both patients and practitioners fail to recognize the disease, resulting in misdiagnosis and delayed treatment. Consequently, the patient may develop the long-term, chronic Lyme disease (CLD). The purpose of this phenomenological study was to explore the impact of CLD on the health-promoting behaviors of ethnically diverse young adults from similar educational and socioeconomic backgrounds based on their lived experiences. The geographical focus of this study was restricted to Los Angeles County, California, because researchers have demonstrated a general lack of awareness of CLD as well as a gap when it comes to representing CLD clients from diverse ethical and socio-economic groupings. Data were collected from face-to-face semistructured interviews of 9 participants, based on the health belief model constructs on an ethnically diverse group of young adults clinically diagnosed with CLD. Data were coded and explored for themes. Key results of the study include the existence of excellent health prior to CLD, marked declined in health status because of the disease not being recognized or properly treated, and the use of various modalities of treatment including conventional antibiotic treatment and complementary and alternative treatments to combat the disease. Social implications of this study include increased awareness of physicians and the community in the Los Angeles County of Lyme Disease as an emerging epidemic, development of preventive measures against this disease, and generation of rich data and propositions regarding CLD for further research. Health Promoting Behaviors of Young Adults with Chronic Lyme Disease by Patricia D. Bolivar MS, California State University Los Angeles, 2001 BS, California State University Los Angeles, 1984 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2018 Dedication This work is dedicated to my children Janelle Sophia and Alexander Daniel Del Rosario. Thank you for your unconditional love and support. You have encouraged, motivated, and waited patiently for me to culminate this academic endeavor. I also dedicate this work to all those young adults in Southern California whose doctors told them it was all in their head, and to my Abba in heaven who watches over me and granted me this dream to become a reality. Acknowledgements My dissertation process was a journey of extreme dedication, patience, and sacrifice yet tremendously gratifying. I express my gratitude first to my committee chair, Dr. Harold Griffin, for his encouragement, motivation, and guidance on qualitative research. I would also like to thank the other two members of my committee, Dr. Lee Bewley and Dr. Vincent Agboto, for their evaluations and guidance. When I embarked in this long and arduous journey, many friends, coworkers, and family members believed in me achieving this dream and I thank every one of them for their support, faith, and prayers; especially at a moment in the journey when I did not know if I was going to make it. I am grateful for my parents and siblings abroad who regularly checked on my progress and helped me keep focused. I also want to thank my colleagues who participated in my validation and verification panels, and my interrater who provided invaluable assistance and feedback in data coding and interpretation. Lastly, my deep appreciation goes to the research participants and amazing group of nine young adults who, despite their busy schedule of medical appointments and major health issues, committed their time to this research and provided candid and transparent description of their lived experiences with chronic Lyme disease. Table of Contents List of Tables................................................................................................................. vii List of Figures ............................................................................................................. viii Chapter 1: Introduction to the Study ............................................................................... 1 Introduction ............................................................................................................... 1 Background ............................................................................................................... 2 Problem Statement ..................................................................................................... 6 Purpose of the Study .................................................................................................. 8 Research Questions .................................................................................................... 9 Theoretical Framework for the Study ....................................................................... 10 Nature of the Study .................................................................................................. 12 Definitions ............................................................................................................... 13 Assumptions ............................................................................................................ 15 Scope and Delimitations .......................................................................................... 16 Limitations .............................................................................................................. 18 Significance ............................................................................................................. 20 Summary ................................................................................................................. 21 Chapter 2: Literature Review ......................................................................................... 22 Introduction ............................................................................................................. 22 Literature Search Strategy ........................................................................................ 23 Theoretical Foundation ............................................................................................ 26 The Health Belief Model .................................................................................... 26 The Health Belief Model Brief Description ........................................................ 27 i Dimensions of the Health Belief Model .............................................................. 28 Limitations of the Health Belief Model .............................................................. 30 Applications of the Health Belief Model ............................................................ 31 Rationale for Using the Health Belief Model for the Current Study .................... 32 Literature Review Related to Key Variables and/or Concepts ........................................ 33 A Brief History of Lyme Disease ....................................................................... 33 Ecology, Epidemiology and Transmission of Lyme Disease ............................... 40 Lyme Disease in California ................................................................................ 50 Symptoms and Disease Presentation................................................................... 51 Unique Biological Characteristics of the Organism ............................................ 61 Laboratory Diagnosis of Lyme Borreliosis ......................................................... 65 Treatment of Lyme Disease............................................................................... 70 Prevention .......................................................................................................... 74 The Chronic
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