Getting the Message Out: How You Can Recruit Clients for Biosecurity Defenses
by Maureen Blaney Flietner
With the publication of the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines, hospitals are working hard to up their game to detect and limit any pathogen’s entry into or transmission within their domains. But how can they recruit their clients into the effort?
It can be a challenge, because it may seem at times that some pet owners are unaware of or not concerned about potential problems affecting themselves or others.
You can also download the booklet, Keep It Clean: Infection Control and Biosecurity in Veterinary Medicine by the Numbers.
When They Just Don’t Get It
At AAHA-accredited Oromocto Veterinary Hospital in Oromocto, New Brunswick, Canada, some clients have failed to mention any health issues when booking or confirming appointments for their routine checkups and vaccinations, said Alyson Howard, RVT.
“They allow their pets to interact with other pets in the lobby while waiting for their appointment time. Once in the exam room, they mention issues that can be contagious—diarrhea, fleas, ear mites. But sometimes, even when our veterinary assistants and RVTs ask them questions, information doesn’t come out until the veterinarian gets into the room,” said Howard. “Unfortunately, not all clients understand the seriousness of each situation.”
“We just had a couple of dogs come in with kennel cough from a couple of kennels that do not recommend the Bordetella vaccination. So pet owners are being torn between us, who recommend it but usually have limited contact with the owner, and the internet, pet stores, and kennels that tell them vaccinations are not necessary or bad and sometimes have more contact with them than we do.”
Alyson Howard, RVT
Howard, who also develops Facebook posts for the hospital to create awareness, said that after treatment of a pet, team members will recap information and provide educational handouts. In follow-up phone calls to clients, they will remind them about good hygiene with advice such as “Wash your hands really well” and “wash all of the bedding in hot water. This is a time when you don’t want to save energy.”
“We try our best to educate clients in many ways,” Howard said. “I have volunteered my time doing public talks on contagious or potentially zoonotic diseases and disorders for the Society for the Prevention of Cruelty to Animals and local cat clubs, but sometimes people think it can’t happen to their pet.”
At AAHA-accredited Oradell Animal Hospital in Paramus, New Jersey, Heather Troyer, DVM, DABVP (C/F), CVA, CVPP, said she has found that “the hardest thing for people to understand is literally the concept of a germ,” so she focuses on “things you can’t see” and tries to emphasize hygiene with clients.
Many people, she said, do not understand the difference between cleaning and disinfecting or how to properly wash hands.
Yet hospitals can provide informational brochures, posters, reminder emails, web posts, postcards, and flyers about biosecurity and infection control. Team members can do the following repeatedly:
- Tell clients about the importance of regular veterinary visits
- Tell clients to schedule their pets’ vaccinations
- Tell clients about endo- and ectoparasite control
- Tell clients to keep litter boxes regularly cleaned
- Tell clients to properly clean up and dispose of pet messes and to disinfect surfaces
- Tell clients not to let their pets eat table scraps
- Tell clients not to let their pets drink from the toilet or from standing water
- And much more.
But these efforts don’t seem to get through to all clients. What’s going on?
Jason Stull, VMD, MPVM, PhD, DACVPM
Why They Might Do Versus What They Do
One possibility is that people don’t like to be told what to do, especially when the reasoning for the recommended change may not be clear. And medical professionals “have a tendency to preach,” said Jason Stull, VMD, MPVM, PhD, DACVPM, assistant professor at both The Ohio State University’s College of Veterinary Medicine and the Atlantic Veterinary College at the University of Prince Edward Island, Canada. He chaired the 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines task force.
“If we want people to change behaviors, we have to engage them in a discussion about the behavior and then check back to see how they are doing,” he said. “We need to understand why people do what they do.”
Take a client who feeds their pet uncooked meat-based food, he said. While the veterinarian may feel strongly that a pet owner should not do that, if she talks with that client, she may discover the motivators for that client’s actions and be able to educate from there.
Even what might seem to be the simple issue of handwashing can be a sticking point.
“To us, things like proper handwashing may seem very basic, but the vast majority of pet owners may not be aware such a simple behavior can have a huge impact on disease risk,” said Stull.
Indeed, to be effective, handwashing has specific steps that need to be taken over 15–30 seconds, according to the Centers for Disease Control and Prevention’s guidelines for handwashing.
Glenda Dvorak, DVM,
“Handwashing after handling pets, pet food, and pet treats—especially before touching or eating food, touching the eyes or mouth—is one of the easiest and best ways to prevent disease transmission,” said Glenda Dvorak, DVM, MPH, DACVPM, assistant director and veterinary specialist at the Center for Food Security and Public Health, Iowa State University.
Then why might some clients not be big on handwashing? Could it be that they have not yet experienced any consequences?
“Most people do not do good handwashing, and oftentimes nothing occurs,” Dvorak explained. “Just like [with] human germs, we are exposed to a lot of them [germs from animals] all the time. Most of the time we can fight them off. But many times when bad situations do occur, it’s often found that people had contaminated hands or wounds, and that handwashing or wound cleansing could have prevented or at least minimized the result.”
Changing behaviors in the human-animal bond is difficult, said Stull, noting that “we are asking pet owners to change the way they interact with a family member.” In working with focus groups to learn how immunocompromised individuals think about their interaction with their pets, Stull found some insights.
“If the change suggested was to benefit the person’s health, it was unlikely to be a motivating factor to influence change,” Stull said. “But anything focused on the pet’s health was motivating.”
With that understanding, Stull said it might help a client to accept their role if they think of biosecurity and infection control as a two-way street: Animals can affect humans and humans can affect animals.
“People often don’t recognize that there are different parts of an infectious process,” he said. “It needs to be pointed out that, depending on the disease, pets can shed the disease-causing organism before signs show and continue to shed after signs have disappeared.”
That means there are risks not only for the pet but for any children, elderly or immunosuppressed people, or other pets at home as well as risks for other pets and owners in community settings such as the dog park, daycare, or boarding facilities.
How else might the messages be put across?
Gregg Sparkman, PhD
How They Want to Go with the Flow
Ways to Recruit Clients for Biosecurity Roles
- Start engaging clients with self-assessments, intake forms, and checklists to help them recognize that what they do makes a difference and to direct conversations about topics, said Stull. One interactive site (idrc.vet.ohio-state.edu/) is a dog infectious disease risk calculator offered by The Ohio State University College of Veterinary Medicine. Its assembled overarching information about zoonotic diseases, dog-to-dog transmission, and protective measures can provide basic guidance for dog owners across the country regarding risks to their pets at such places as dog parks or boarding facilities.
- “Besides discussing topics like handwashing, show clients and ask them to show you how they do it,” said Jason Stull, VMD, MPVM, PhD, DACVPM. “I will be honest: It may be easier to teach the youngest in the family rather than looking to adults. There can be different champions in each household.”
- Educate clients about the difference between cleaning and disinfecting. According to Todd Hepburn, director of corporate partnerships at Virox Animal Health, “Cleaning is the physical removal of soils (including pathogens) from a surface. Those pathogens can survive this process, but it’s important to have a clean surface before you disinfect. Disinfection, on the other hand, is a chemical process to kill (or inactivate) the germs (pathogens) on a surface or object. Disinfection is very important because although cleaning may remove most of the pathogens on a surface, it only takes a small amount to make a person or animal sick.”
- Realize that the content of dynamic messaging needs to be changed over time to ensure that the information is still perceived as relevant.
Gregg Sparkman, PhD, a postdoctoral research associate at the Andlinger Center for Energy and Environment and Department of Psychology at Princeton University, offered insights from his research and from his chapter—“Designing Dynamic Norm Interventions: How to Dislodge Problematic Norms and Accelerate Positive Change”—written for the forthcoming book edited by G. Walton and A. Crum, Handbook of Wise Interventions: How Social-Psychological Insights Can Help Solve Problems.
Sparkman has been a part of several research projects that have revealed that when people learn that others are changing, it can motivate them to follow suit. How? Through dynamic norm messaging instead of static norm messaging.
What is static messaging? It provides information about the behaviors and attitudes of others in the present—for example, “Many people text while driving.” On the other hand, said Sparkman, dynamic messaging provides information about the changes in others’ behavior or attitudes over time—for example, “More people are starting to avoid texting while driving.”
Research is finding that people conclude that something is the norm for a good reason, that widespread changes are happening for a good reason, and that acting against the group will lead to social rejection or being left behind, he said.
So how can veterinary hospitals use that information for better health behaviors?
“I imagine you would first want to know which motivations are already present or available in carrying out the behaviors of interest,” said Sparkman. “For instance, are people already motivated by the prospect of helping out their community regarding biosecurity? Are they interested in helping their own health or the health of their family? Are they motivated by helping out their pets? Would they feel guilty thinking their pet was a ‘vector’?”
Next, he said, hospitals would want to “get a sense of how norms influence this range of motivations. For example, does seeing most people not take action lead people to assume that biosecurity is not a credible threat and these actions are superfluous?”
He suggested that hospitals speculate about how messaging about other people changing could start to add motivation. Perhaps if clients learned that more and more pet owners are starting to follow a biosecurity plan—of three or fewer steps, so it is not difficult to recall—it would lead them to think this actually was fairly important.
How might those messages read? Let’s look at one example from a 2017 randomized controlled trial in which Sparkman was involved. In it, university residents were encouraged to use full loads of laundry because of a drought. Signs posted in laundry facilities gave either a static message—“Most residents use full loads/Help conserve water”—or dynamic messages—“Residents are changing/Most now use full loads/Help conserve water.” At the end of the three-week trial, there was a 10% reduction among those exposed to the static message and nearly a 30% reduction for those exposed to the dynamic message.
For biosecurity at veterinary hospitals, then, a basic message to clients could be, “More and more clients are following our three-step biosecurity plan: A, B, and C.”
“The message could be delivered alongside a pamphlet with a simple checklist that clarified important details. These last details pertain to getting people the last mile,” said Sparkman. “Dynamic norms might have created motivation, but you’ll need to do more to make sure taking action is easy and clear so that the newfound motivation actually gets translated into action.”
You may have to work around specific beliefs that stymie change, said Sparkman. For example, if a pet owner thinks that they couldn’t possibly have time because they are busy, the message could be tailored to remedy that specific psychological barrier, such as, “More pet owners are adopting a ‘quick clean pet routine,’ which only takes 10 minutes.”
“The idea,” said Sparkman, “is to acknowledge the concerns people might have and to leverage information about others changing in a way that gives evidence that their concern can be resolved—social proof via social change.”
“Clients need to know they have a role,” explained Stull. “Frame infection control and biosecurity as something clients need to do for their pet and their community. It may open up a dialogue. Educating people comes down to the relationship between the client, the pet, and the clinic. At the end of the day, the client plays a huge role in practice and community infection control.”
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Maureen Blaney Flietner is an award-winning freelance writer living in Wisconsin.
Photo credits: ©iStock.com/gpointstudio