Evidence-based communication on climate change and health: Testing videos, text, and maps on climate change and Lyme disease in Manitoba, Canada

blacklegged ticks has been attributed in part to climate change and land use changes [26,27], and future warming is expected to increase growth and reproductive rates of blacklegged ticks, as well as facilitate further range expansion [28,29]. In this way climate change is expected to increase the risk of Lyme disease in endemic areas, as well as well as bring the risk to new areas. Illness representation of Lyme disease can vary widely between individuals; common symptoms may include a circular “bulls-eye” rash around the bite area and flu-like symptoms, such as fatigue, fever, headache, and hot and cold sweats, while in the minority of cases the dis- ease can cause serious neurological effects. In addition to the provincial and federal Lyme dis- ease surveillance efforts to track the disease spread [30,31], there is a need to understand how best to communicate with the public about the evolving risk. Research design A qualitative design based on the focus group method [32] was used to explore responses to visual and written communication materials about Lyme disease and climate change. These focus groups were divided in two parts, with the first exploring baseline public perceptions of climate change and Lyme disease, and the second exploring responses to communication materials. The present article focuses on findings from the second part of the focus groups (i.e. materials testing); results from the first part as well as a detailed description of the method are shared elsewhere [33]. To inform the creation of communication materials related to Lyme disease and climate

change, interviews with six experts from the areas of Lyme disease, public health, and climate change research were conducted alongside a review of academic and grey literature. Three communication materials were developed: a short video (five and a half minutes); a plain lan- guage article (approximately 1200 words); and two series of maps illustrating the temperature suitable for the spread of the blacklegged tick (Ixodes scapularis) under future climate change in Manitoba and Canada (Fig 1). Materials were developed by a Canadian CIW research team in a participatory and iterative way, ensuring that experts were able to verify the accuracy of the data and information, and that they were properly represented in the video. Participants and procedure This research received ethics approval from the University of Winnipeg Human Research Eth- ics Board. Two focus groups were held in each of the three communities over November and December 2019, for a total of six focus groups with 61 participants. The research team collabo- rated with Probe Research, an independent third-party research firm who assisted with recruitment and discussion moderation. Because the focus groups were specifically testing materials developed by the research team, it was preferable to have an independent moderator to avoid any potential bias. Participants of a range of demographics and concern about climate change were recruited at random from Probe Research’s panel of over 6,000 people in Mani- toba. During recruitment, a short screening questionnaire was conducted by phone which

asked: age, climate concern, gender, city or town of residence, ethnicity, education, occupa- tion, and time spent working outdoors. People who had participated in a focus group at any point in the past year, or who worked for media, advertising, in the field of climate science, or at the University of the researchers, were excluded. Participants were divided into focus groups according to level of concern about climate change as indicated in the pre-screening questionnaire, with one “high” climate concern and one “low” climate concern group per community (Table 1). The focus groups discussions were guided by a moderator, following a moderator’s guide developed by the researchers (the full guide can be found in the Supporting Information (S1 File)). Discussions were structured in PLOS ONE Evidence-based communication on climate change and health PLOS ONE | https://doi.org/10.1371/journal.pone.0252952 June 10, 2021 3 / 17