Client behaviour change is at the heart of veterinary practice, where promoting animal health and welfare is often synonymous with engaging clients in animal management practices. In the medical realm, extensive research points to the link between practitioner communication and patient behavioural outcomes, suggesting that the veterinary industry could benefit from a deeper understanding of veterinarian communication and its effects on client motivation. Whilst extensive studies have quantified language components typical of the veterinary consultation, the literature is lacking in-depth qualitative analysis in this context. The objective of this study was to address this deficit, and offer new critical insight into veterinary communication strategies in the pursuit of client behaviour change. Role-play interactions (n = 15) between UK cattle veterinarians and an actress experienced in medical and veterinary education were recorded, transcribed and analysed thematically. Analysis revealed that, overall, veterinarians tend to communicate in a directive style (minimal eliciting of client opinion, dominating the consultation agenda, prioritising instrumental support), reflecting a paternalistic role in the consultation interaction. Given this finding, recommendations for progress in the veterinary industry are made; namely, the integration of evidence-based medical communication methodologies into clinical training. Use of these types of methodologies may facilitate the adoption of more mutualistic, relationship-centred communication in veterinary practice, supporting core psychological elements of client motivation and resultant behaviour change.
Achieving herd health and welfare improvement increasingly relies on cattle veterinarians to train and advise farmers, placing veterinary interactions at the heart of knowledge exchange. Cattle veterinarians recognize their influence and the need to be proactive advisors but struggle with acting upon this awareness in daily practice, reporting a need to enhance their advisory approach to inspire farmer behavior change. Understanding how veterinarian-farmer interactions positively or negatively influence the enactment of change on farm is therefore essential to support the cattle veterinary profession. This paper adopts a qualitative approach to conceptualize how and under what circumstances veterinary advice has the potential to support and inspire farmer engagement with behavior change on the UK dairy farm. Fourteen UK dairy farms were recruited to take part in a qualitative study involving research observation of a typical advisory consultation between veterinarian and farmer (n = 14) followed by separate, in-depth interviews with the farmer(s) and their respective veterinarian. Interview data were organized using a template coding method and analyzed thematically. While accuracy of veterinary advisory content was valued, it was a relational context of trust, shared veterinarian-farmer understanding, and meaningful interpretation of advice at a local (farmer) level that was most likely to enact change. Critically, these relational factors were reported to work together synergistically; a trusting relationship was an essential, but not necessarily sufficient, component to create a culture of change. Findings suggest that cattle veterinarians may benefit from tailoring advisory services to the farmer's specific world view, facilitated by a shared understanding of the farmer's immediate and long-term motivational drivers. In consequence, cattle veterinarians seeking to positively engage farmers in advisory interactions could consider a focus on farmer priorities, motivations, and goals as paramount to frame and inform advisory messages. This explicit collaborative communication encourages the selection of appropriate and timely veterinary expertise, leading to better integration and adoption of advice on farm given enhanced advisory relevance for farmers' unique circumstances. This farmer-centered approach, involving active co-creation of plans between individuals, is critical for engagement and commitment when tackling complex problems.
The problem of nonadherence to advice is recognized in several professional relationships, including the veterinarian-client relationship. A better understanding of farmer perspectives may help to improve efficiency in veterinary herd health management. This study aimed to qualitatively and quantitatively describe farmers' reasons for adherence and nonadherence with veterinary recommendations regarding preventive herd health measures. We carried out structured telephone interviews about implementation of preventive measures with owners or staff of 163 dairy farms and 6 beef farms. The farms had received an advisory visit by their veterinarian (n = 36), who had documented the preventive measures they had recommended. The interviewer noted verbatim responses to reasons for implementing preventive measures fully, partially, or not at all, and we analyzed these responses thematically. We also conducted a quantitative analysis, in which we calculated descriptive statistics of the proportions of different categories of reasons stated by the farmers. Altogether, 726 preventive measures (range per farm 1 to 17; median 3; interquartile range 2 to 6) were documented. We identified 3 organizing themes related to adherence or nonadherence with veterinary advice: trust, feasibility, and priorities. Overall, the most commonly stated reasons related to trust (in the veterinarian, in the advisory process, or in individual preventive measures). The most common reasons not to follow the recommended advice were related to feasibility. Based on the results, we recommend that, to improve adherence to their advice, veterinarians pay increased attention to farmers' needs, priorities, goals, and motives, as well as to farmers' perceptions of the effectiveness of individual preventive measures. We also recommend that veterinarians need to increase their focus on recommending preventive measures that are practically feasible to implement on farms.
Veterinary communication has evolved in the context of traditional veterinary tasks, such as diagnosing and treating sick animals, and this may encourage a directive communication style, in which the veterinarian acts as an expert, directing the client in what to do and how to do it. This type of communication style has been shown to evoke resistance to change in clients who are experiencing psychological ambivalence, a well-known aspect of farmers' herd health decisions. Veterinary herd health management (VHHM) constitutes an increasing proportion of the work of cattle veterinarians and often focuses on behavior change. The present study aimed to characterize communication styles of Swedish dairy cattle veterinarians involved in VHHM in relation to their skills in facilitating behavior change. A secondary aim was to investigate whether these skills differed among veterinarians depending on their experience in the veterinary profession or in VHHM. Audio-recorded role-play conversations (n = 123; reflecting VHHM telephone consultations) with 42 veterinarians involved in VHHM in Swedish dairy herds and audio-recorded on-farm consultations (n = 86) with 18 of those veterinarians were coded using a system developed to evaluate motivational interviewing (MI) skills. Motivational interviewing is a communication methodology aimed at facilitating clients' internal motivation to change. The MI Treatment Integrity (MITI) code identifies frequency counts of 10 verbal behaviors, and assesses 4 global variables on a Likert scale, based on 20 min of conversation. It also suggests 6 summary measurements of MI competency based on these 14 original variables. Of the 42 veterinarians, 39 also responded to a web questionnaire about their age, continuing education, and experience in the profession, in dairy herds and in VHHM. We analyzed associations between the 6 summary MITI variables from the role-play conversations and characteristics of the 39 veterinarians using logistic and linear multivariable regression models. Veterinarians in the role-play and on-farm conversations relied predominantly on giving information, questions, and persuasion in their consultation approaches. They generally did not explore the client's expectations or wishes regarding the agenda for the consultation, or acknowledge the client's right to make decisions about actions. Veterinarians gave advice without exploring the client's need for the advice or how the information was perceived. We found a significant reduction in so-called relational scores (Empathy plus Partnership) and an increase in MI-nonadherent behaviors (Persuasion plus Confront) as years of veterinary experience increased. Results showed that there is room for improvement in the communication style of veterinarians involved in VHHM. Wider literature suggests that training veterinarians in a client-centered communication methodology such as MI may increase the demand for and success of VHHM.
Current veterinary communication skills training often focuses on the strategies necessary to successfully transfer information and promote shared decision making rather than inspiring client motivation to engage in behaviour change(s). One evidence-based communication methodology with a specific focus on enhancing conversations about change is Motivational Interviewing (MI), which is perceived by veterinarians to be highly relevant to their profession. We examined whether veterinarians who experienced brief (4–5 hours) MI training (BMIT) were able to change their communication behaviours to be more MI consistent. Fourteen veterinarians recorded 31 veterinary herd health consultations before (n = 15) and after (n = 16) BMIT to allow pre-post intervention analysis of veterinarian and farmer verbal behaviour. Additionally, using a sequential linguistic analysis of 3885 veterinarian-farmer communication events within these consultations, the influence of veterinarians’ verbal behaviours on farmers’ response language was explored. Analysis of veterinary consultations undertaken before and after BMIT revealed that veterinarians changed their communication style to be more consistent with the MI methodology, including more use of reflection statements, a more empathic and partnership-oriented consultation style and greater emphasis on clients’ own language in favour of change goals. In response, farmers contributed more to the conversation and discussed more herd health-related changes. Sequential linguistic analysis suggested that following a veterinarian emphasising something positive about the farmer (e.g. efforts, strengths), seeking collaboration or emphasising farmer choice, farmers were subsequently more likely to express arguments in favour of change (‘Change Talk’), especially phrases indicative of commitment. This study offers the first evidence of the potential value of a BMIT experience to enhance veterinary communication skills, although conscious and disciplined use of MI principles, strategies and Spirit–an ethos of compassion, acceptance, partnership and evocation—requires longer and more complex training. Further studies examining the longevity and consistency of these verbal behaviour changes following BMIT are required.
Antimicrobial use in agriculture has been identified as an area of focus for reducing overall antimicrobial use and improving stewardship. In this paper, we outline the design of a complex antimicrobial stewardship (AMS) intervention aimed at developing a national Veterinary Prescribing Champion programme for Welsh farm animal veterinary practices. We describe the process by which participants were encouraged to design and deliver bespoke individualised AMS activities at practice level by forging participant “champion” identities and communities of practice through participatory and educational online activities. We describe the key phases identified as important when designing this complex intervention, namely (i) involving key collaborators in government and industry to stimulate project engagement; (ii) grounding the design in the literature, the results of stakeholder engagement, expert panel input, and veterinary clinician feedback to promote contextual relevance and appropriateness; and (iii) taking a theoretical approach to implementing intervention design to foster critical psychological needs for participant motivation and scheme involvement. With recruitment of over 80% of all farm animal practices in Wales to the programme, we also describe demographic data of the participating Welsh Veterinary Prescribing Champions in order to inform recruitment and design of future AMS programmes.