Date of Conferral

8-4-2026

Date of Award

August 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Berthline Isma

Abstract

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided by the health belief model with a social constructivist stance, this study used a phenomenological approach to conduct semistructured interviews of N =14 adult participants from the West, Middle, and East Tennessee. Thematic analysis of data revealed the following themes: Low perceived awareness and risk perception, changed perception of susceptibility following illness, impact on work and daily functioning, psychosocial impact of illness, barriers to diagnosis and validation of illness, financial burden seeking care, internal triggers prompting care seeking, and external triggers prompting care seeking. Results demonstrated a disconnect between official surveillance narratives and lived experiences of individuals in Tennessee. Findings of this study highlight the need for public health policies that will strengthen the surveillance of LD. This study has the capacity to contribute to positive social change by informing more equitable surveillance strategies, improving provider awareness, addressing diagnostic barriers, and strengthening public health communication in low-incidence states.

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