Ambassador Training Project for the Prevention and Monitoring of Lyme Disease in Quebec

The Institut national de santé publique du Québec (INSPQ) carried out a training project, in partnership with Nature Conservancy Canada (NCC) between January 2019 and December 2019 in areas where Lyme disease (LD) is a growing public health issue. The project’s purpose was to train ambassadors in the prevention of the disease through a cascade training approach (training of trainers). Once trained, members of this new regional network were expected to conduct LD awareness activities with their colleagues and clients, and independently perform tick sampling activities in their respective communities. In total, 18 ambassadors were trained, and 28 awareness activities were organized, reaching at least 1,860 people directly in seven separate socio-sanitary regions (SSR). During this time, 28 tick sampling activities took place, leading to 36 ticks being collected (through active and passive monitoring). Participant feedback on the project was very positive. The project clearly met a need among outdoor workers and the general population, which suggests that this type of program, combining cascade training and community-based science, has some interesting features that public health authorities could leverage to address LD prevention and monitoring in Quebec.

Understanding and Assessing Impacts

Due to climate change, ticks that carry Lyme disease (LD), Ixodes scapularis, have been spreading northward into new territory. As a result, several southern regions of Quebec are now facing a new issue, zoonotic disease, which can cause long-term health concerns, like heart and joint problems, in people affected by the disease. This is why public health authorities in Quebec have implemented an integrated monitoring program for LD based on compiling data gathered from monitoring human cases and monitoring ticks identified through active and passive methods. However, considerable resources are needed to roll out this monitoring program, especially for tick sampling activities in municipalities of regions at risk. Moreover, workers most exposed to LD generally have jobs where it can be more difficult to ensure proper follow-up of awareness and prevention activities for this disease (seasonal work, with unusual hours in rural settings, thus geographically dispersed) or do not have access to materials in a language they can understand (especially immigrant and/or allophone workers).

Identifying Actions

The main goal of this project was to develop bilingual training for those in charge of Canadian parks through a cascade training approach (i.e., training of trainers). The project would offer training for employees or managers in various natural public parks (or any nature conservancy agency that employs outdoor workers) to become ambassadors for prevention in different regions of the province where there is a risk of contracting LD. More specifically, the goals of the training were to 1) enable each ambassador to inform various groups at risk of contracting LD (colleagues, managers, volunteers and clients of public parks) and raise their awareness, and to 2) educate each ambassador on how to independently and safely sample I. scapularis ticks in the environment by following a standardized protocol. The training content was developed to accomplish two learning goals: raise awareness and independent sampling. The theoretical content was produced by simplifying and adjusting some provincial and federal government materials to create an interactive workshop and a training package. The training package included an ambassador training manual (bilingual), awareness materials and a start-up kit for sampling activities. Each workshop ended with a hands-on activity on the tick sampling procedure, adapted from the standardized protocol of the Faculty of Veterinary Medicine of the Université de Montréal.

Implementation

Through the partnership with Nature Conservancy Canada (NCC), potential ambassadors were identified by the project team among NCC employees, managers and collaborators, based on their place of work, past experience with raising awareness, personal interest and availability. This method for choosing ambassadors was used to reach the highest possible number of regions at risk for LD to raise public awareness, and to increase the number of sampling sites in locations that were not necessarily part of the regular integrated monitoring program. These ambassadors took part in three half-day workshops, facilitated by an INSPQ expert at the beginning of tick season, but before the peak of tourist season. The hands-on component (supervised tick sampling) was conducted outside, near the training venue, where sampling conditions were favourable. After the workshop, the newly educated and equipped ambassadors were invited to organize LD awareness and sampling activities in their respective organizations during tick season, from June 2019 to September 2019. These activities occurred on a voluntary basis, and, if needed, ambassadors could reach out to INSPQ experts for remote support.

Outcomes and Monitoring Process

In total, 28 different activities were organized in seven regions of the province affected by LD. Some of these activities, like discussion groups, took place once, while others were recurring (for example, in day camps), or ongoing, like posters in workplaces. In addition, 28 samples were collected, which represents 56 km travelled in wooded areas. Moreover, educating participants on LD also led to the collection of 25 ticks discovered by accident on people or equipment. During follow-up evaluations, ambassadors expressed a high level of interest in the initiative and in maintaining this outreach network long-term.

Next Steps

Two subsequent components of this project are currently in development: first, the possibility of offering the training across Canada and second, the implementation (already in progress) of a similar ambassador training project for mosquito-borne diseases. The latter would namely seek to adapt the training to a virtual format to comply with COVID-19 health measures.

Resources

Link to the Full Case