"You Pinch It With the Nail Clipper, and You Kill It": A Reflexive Thematic Analysis of How Maya Families Prevent and Manage Tick Bites in Yucatan, Mexico.

In peasant livelihoods, families are regularly exposed to ectoparasites such as ticks, and thus to the diseases they carry. Little is known about how rural families' knowledge influences health in domestic and community environments. We applied reflexive thematic analysis (RTA) to family preventative and curative strategies for tick exposure and bites in a Maya community in Yucatan, Mexico. Data were collected over six months via participant observation and 26 semi-structured interviews with fifteen women homemakers, five peasant farmers, three traditional healers, and three biomedical professionals. Three themes became apparent via RTA: "Socialization and normalization of tick management," "Pragmatism and observation," and "Women Caregivers." A principal finding is that local participants only associated tick bites with skin ailments, which they treated at home using mostly homemade remedies, as well as some biomedical products. Based on their knowledge of and experience with ticks, their preventive strategies in the domestic sphere focused on minimizing tick contact with the skin, preventing ticks from entering the house, and protecting children. All family members contributed to implementing anti-tick strategies, using knowledge created through communal processes influenced by economic factors and experiences with similar illnesses. One biomedical professional commented that the study population's lack of awareness about the magnitude of the disease risk from ticks is alarming, referring to tick-borne Rickettsia as a "sleeping giant." Our findings underscore that acknowledging and understanding domestic knowledge and strategies is vital to developing programs to assist rural populations in better controlling this and other disease vectors.