Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Connecticut Primary Care Physicians and Chronic Lyme Disease Yvette P. Ghannam Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion 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 Yvette P. Ghannam 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. Vasileios Margaritis, Committee Chairperson, Public Health Faculty Dr. Steven Seifried, Committee Member, Public Health Faculty Dr. Scott McDoniel, University Reviewer, Public Health Faculty The Office of the Provost Walden University 2019 Abstract Connecticut Primary Care Physicians and Chronic Lyme Disease by Yvette P. Ghannam MS, University of Florida, 2009 MA, Central Connecticut State University, 2006 BA, Central Connecticut State University, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2019 Abstract The prevalence of chronic Lyme disease (CLD) remains relatively unknown in Connecticut because there is not an agreement on what CLD is and how it should be diagnosed in addition to which pathological agent causes CLD. The aim of this quantitative study was to assess whether there were significant differences between two groups of primary care physicians (PCP) working in Connecticut from two different points in time regarding their knowledge in the diagnosis, treatment, and management of CLD. A knowledge, attitude, and practice model was used as the underlying theoretical framework for this study. A random cross-sectional survey was mailed out to the 1,726 PCPs found in the list of certified medical doctors in Connecticut of 2015. One hundred and forty-five PCPs responses (11.9% response rate) were received and compared to responses from previous data (a 2010 study) of 285 PCPs (39.1% response rate) from the list of certified medical doctors in 2006. The PCP estimated mean number of patients diagnosed and treated for CLD was not significantly different between 2006 and 2015. However, a significantly higher number of PCPs in 2015 reported knowing Lyme disease (LD) symptoms but not feeling comfortable diagnosing LD (χ² = 536.83, p < 0.001), and significantly more PCPs in 2015 reported knowing LD symptoms and feeling comfortable diagnosing CLD ( χ² = 265.41, p < 0.001). This study can promote social change by encouraging Connecticut PCPs to recognize CLD as a diagnosis to enable the development of registries and case-control assessments. The findings of this study may also inspire future studies. Connecticut Primary Care Physicians and Chronic Lyme Disease by Yvette P. Ghannam MS, University of Florida, 2009 MA, Central Connecticut State University, 2006 BA, Central Connecticut State University, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2019 Dedication I dedicate my dissertation work to FBI Agent Samuel Hicks, an exceptional young man whose life was cut short. Tragically, Special Agent Hicks died when he was 33 years old. He was memorialized by former FBI Director Robert S. Mueller, III, who stated, “Though our hearts ache, we trust that Sam awaits us in a better place. And until we meet again, may we all find joy in the example of a life lived to the fullest.” Although I never had the opportunity to meet Special Agent Hicks in person, I became a great admirer of him after reading his biography. Special Agent Hicks and I have shared interests, such as science, connections with people from Jordan, and love for our nation. Sometimes, people think about how their lives may have been changed if they had made different choices. If I had the opportunity to live a second life, I would like to live a humble and meaningful life like FBI Special Agent Hicks. He was a science teacher, police officer, forensic scientist, and FBI agent. There are few people so committed to bravery, fidelity, and integrity as those citizens who choose to serve others by keeping the nation safe. His biography has inspired me to become a forensic microbial scientist. It is an honor for me to finish my doctoral degree and to continue the work of FBI Special Agent Samuel Hicks. I think that his primary goals were to love and serve the United States of America where anyone—especially the young—can dream about pursuing any career they want under the Constitution. Acknowledgments I would like to acknowledge my committee members as well as all the professors I had at Walden University for getting me to this point in my path of higher education. I must give special recognition to Dr. Nancy Rea, Dr. Root, and Jen Rothamel for their continuous support during difficult times I had while working on the completion of this dissertation. At the same time, I want to thank other educators (from CCSU, UFL, and COSC) who believed in me to come to Walden University. Your faith in me will never be forgotten because you all inspired me to put higher education to benefit our society and this great nation above all things. Additionally, I want give thanks with the bottom of my heart to my family members and friends for their strong support during good and challenging times in this path of learning. During these nine years of educating myself at Walden, I had to say goodbye to two special people in my life who were pillars of hope and humility for me: my mother, and with all respects to Dr. Jack Miller, former president of Central Connecticut State University. Also, I want to give thanks the CT Law enforcement agencies (Greenwich Police Department, New Britain Police Department, and the New Haven FBI) for wishing me all the time the best of luck during my journey here at Walden University. I also have to give many thanks to Dr. Johnson, Dr. Cartter, Dr. Grady, and Dr. Stafford for helping me when I requested information from them to advance my research. Lastly and above all, I want to give special recognition to the Lord, who taught to stand firm and to believe all things can be possible. “Success is not final, failure is not fatal: it is the courage to continue that counts.” —Winston Churchill . Table of Contents List of Tables ..................................................................................................................... vi Table D1. Frequency of Primary Care Physicians……………………………...……………………………….224 Table E1. Data on Primary Care Physicians Based on Category………………………………………………………………225 Table E2. Frequency Results Based on Category………………………………………………………………225 List of Figures .................................................................................................................. viii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................2 Defining and Diagnosing Chronic Lyme Disease .................................................. 7 Problem Statement .......................................................................................................14 Purpose of the Study ....................................................................................................14 Research Questions and Hypotheses ...........................................................................16 Theoretical Framework ................................................................................................19 Nature of the Study ......................................................................................................21 Assumptions .................................................................................................................26 Scope and Delimitations ..............................................................................................28 Limitations ...................................................................................................................31 Significance..................................................................................................................33 i Summary ......................................................................................................................36 Chapter 2: Literature Review .............................................................................................38 Introduction ..................................................................................................................38 Literature Search Strategy............................................................................................40 Theoretical Foundation ................................................................................................41