Thank you for listening to my webinar. My name's Andrea Turner, and I'll be discussing this evening my presentation entitled More Planning, Less Using, engaging farmers to use herd health planning to drive responsible antibiotic use. And as I, before I start, I just want to introduce myself.

So I'm I'm a first opinion practise vet working at Langford Vets, which is associated with the University of Bristol. I started working here in 2014 when I was joined the University of Bristol to do a residency. I'm working towards a European College diploma in bovine Health Management, which I finished in 2018.

And through working towards that diploma, I And developed own awareness of evidence-based medicine, and I also did research projects, and specifically one looking at reduction of high priority, critically important antibiotics on dairy farms. And in working here at the University of Bristol, I've had the pleasure of working with a really great team. Of researchers, some of whom are really on the forefront of this realm of thinking about antibiotic use in livestock systems.

And so in working alongside them, I've been able to talk to them and learn from them and learn from their work, particularly the PhDs have been going along, going on alongside my residency. And so there's been quite a lot of work in that time at Bristol that school in The ever expanding realm of social sciences and how these overlap with veterinary medicine and in particular in the area of farmer engagement and communication. And this area is something that I found increasingly interesting because I've realised how important it is to be able to engage farmers and communicate your thoughts effectively to them and And converse, it's also important for us to be able to get farmers communicating with us effectively so that as vets, we can understand the challenges and difficulties that they face and that are going to be standing in the way of them changing their behaviours around herd health and engaging with herd health and antibiotic use.

And so what I'd like to do today in this webinar is really just kind of distil some of the ideas, basically of other people's work of colleagues of mine that I've been working with. That I have taken from their research, and I've started to apply to my own everyday farm animal practise, and hopefully it's kind of be a bit of a user's guide to, farmer engagement, farmer communication from a kind of practising that perspective. So the learning objectives that I'd like to, you to get out of this webinar is to understand the link between herd health planning and antibiotic use, to appreciate what farmers actually want from their vets regarding antibiotic use.

To consider the benefits of farmer peer to peer learning in relation to antibiotic use. And then just to be aware of the principles of something called motivational interviewing, which is a kind of communication technique, that I've, I'm interested in and I'm, I'm starting to try to learn and use myself. So with regards to herd health and antibiotic use, we need to think what is the link between them.

What are the desired outcomes from their link? So for example, are we aiming for not using critically important antibiotics at all, a reduced overall antibiotic use or thinking just about things like a better understanding of medicines use within our client base, or we're looking for more responsible or appropriate antibiotic use for some of those farmers. And then, of course, we need to think about how to actually engage the farmers in, in this process with us.

So for those of you unconvinced, it's worth convincing how that considering how health planning is linked with and can help to reduce antibiotic use on a farm. And of course, this is completely tied up to the idea that prevention is better than cure. And as long as we can get farmers to engage with herd health planning to prevent disease, we're going to be reducing the amount of antibiotics we're going to need to go out there and cure the disease on their farms.

Because if you think about medicines use on farm, it's not just antimicrobials, but all medicines, it feeds into every single aspect of her health and her health feeds into all aspects of medicine use on a farm. So, Assessing all of the different aspects of medicine use on a farm can really help to crack open discussion and shed light on certain areas of her health, some of which you really might not even have known about, had you not looked into the medicines use in the first place. And that's certainly something that's happened to me with some of my farms when I've been going through this process with them.

Excuse me. So One really good in that I have found personally that can help start conversations about antibiotic use on a farm and then lead into engaging in her health planning can be the use of medicine audits. And now in the UK at least, these have recently become a mandatory part of the red tractor assurance scheme.

So there'll be lots of vets in the UK who are signing off now that they have performed a medicines review, at least of a farm, particularly for this red tractor assurance standards. And of course, you'll all know that these sorts of things that are mandatory can just become a box ticking, ticking exercise. But I'd suggest that with a little input, they can become a really useful tool to opening conversations about how and why antibiotics have been used on a farm.

And like I said, sometimes you can actually discover things that you wouldn't have otherwise learned about what's going on on a farm without delving into the antibiotics use. So what you really need to be thinking of about is from this exercises, do you learn anything from the process of reviewing their medicine medicines use and to the farmers learn anything? And if the answer is no, then it's definitely worth reviewing what you're doing and and how you're communicating with farmers about this particular subject.

So this is just an example, of course, you can do medicines reviews in lots of different ways, and in its most simplest of form, you can just do a comparison of drugs sold to the farm in the last 12 months and the 12 months prior to that and just look at what's changed. This is just one example of a small Beef, very small beef suckler unit of pedigree cows. And in this instance, you can see that the farmer hasn't particularly changed his antibiotic use drastically year on year, or non-steroidal use.

And so just literally making a tally and having a conversation about the totals of each, antibiotics, non-steroidal, etc. That are going to be being used, you might be able to dig deeper into things that have changed, little disease outbreaks that have happened in that last year. And this is one thing that came out of the PhD, like when Res a colleague of mine, I'm going to talk about a little bit more later in this webinar.

And she looked about the best methods for collecting data to be doing these antibiotic reviews. And basically, the bottom line is that farm records are pretty useless and the closest that we have, at least in countries where farmers can only buy anti microbials from vets on prescription, excuse me, as medicine sales records. So again Excuse me, if you can get that from your practise, you can get someone to pull that data out for you.

That is something that you can do, you know, the information is reasonably readily available for you there. And this is something that you can do just by again, pulling out some graphs and some charts from that kind of data, and it can be pretty simple stuff like this here, just to make a point and just open a conversation. About what's going on on that farm.

So here you can see both the antimicrobials and the non nonsteroidals reduced on a farm year on year. And again, you can just, you know, ask more questions about why that was the case and what can be done to sustain that kind of pattern that you're seeing on a farm. So of course, there's Lots of different ways of measuring and monitoring antibiotic use on a farm on farms, and there's lots of different benefits and drawbacks of each.

And I'm not going to discuss each and every one here, but I will direct you to this paper, which discusses a lot of those different ways of assessing antibiotic use on farms. If you haven't thought about this, and it's something that you might want to go and do on some farms, then it's definitely worth a read just to point you in the directions of different ways that this can be done. So I already mentioned that basically distilling the work of others into my own kind of user's guide to farmer engagement and communication.

And these are really the people that I need to credit for all of the hard work. And between these ladies, they've put 9 years of collective effort researching. Methods of engagement and communication with and between farmers and vets.

And I'm just going to be taking tiny snippets of what they've done, that I have now applied to my practise to give you a taste of all that work that they've done. So I'll first be talking to you about the work of Gwen Reese, whose PhD focused on understanding antibiotic use on UK dairies. Then I'll be telling you a bit about this Morgan's PhD, which looked at how farmer peer to peer learning can help knowledge transfer, particularly about antibiotic use.

And finally, I'll give you a tiny taster in the work of Alison Bard, who looked at how vets can use a communication technique called motivational interviewing to engage farmers in changing their behaviours in relation to herd health. So you might be thinking that you're expected to hear about what kind of herd health programmes you can put in place to reduce antibiotic use on farms, and why am I going to be telling you all about communication? Well, Dame Sally McIntyre captured this sentiment pretty well, and she was the chair of a working group for the ESRC, the Economic and Social Research Council, and they were investigating the role of social science in antimicrobial resistance.

And within that report, or this report, she was quoted to say that the mechanisms which lead to antimicrobial resistance are biological. However, the conditions promoting or mitigating against these biological mechanisms are profoundly social. And of course, as vets, we know this is true.

The decision to give an antibiotic or certain antibiotic isn't just made based on culture and sensitivity results every time. In fact, that is rarely the case, particularly in farm animal medicine. And those decisions are made on our decision making or the decision making of the farmer, that is there reaching for a bottle of antibiotic on the farm.

And we are all fallible humans and in turn, we're influenced by a whole range of things like previous experience of disease and certain situations. If this is our favourite cow or the farmer's favourite cow, how much the animal's worth, how much does the treatment cost? Is this the only time you're going to get near this animal?

And, you know, that's true of so much more than the use of antibiotics in farm animal medicine and social context and social influence. Won't just affect what antibiotic we choose to give. It will affect whether a farmer decides to invest in new cow mattresses or invest in a vaccination protocol for pneumonia and young stock, or basically any management decision on a farm.

And this is kind of realisation I've had in recent years, probably much later than most have this realisation. And that's that it really doesn't matter how much I know about lameness or how many CPDs, CPD hours I do about mastitis or fertility. If I can't communicate that information to my clients in a way that engages them and taps into something that really motivates them, then they're not even going to listen to the man management changes or herd health plans that I suggest that they implement.

So this is why the work that when and Lisa and Alison have done, which has a lot of social science methodology behind it, is really important and particularly Gwen's work, which I think is really the starting point, which is to try to understand the decisions that farmers are making about using antibiotics. So part of Gwen's PhD was a cross sectional study of 27 dairies looking at Medicine storage, medicine use, medicine recording, and farmer decision making regarding antibiotic use. And Gwen looked in depth at farmer decision making by spending a lot of time on 5 particular farms to find out and try to Follow the process of decision making about their antibiotic use.

And I just wanted to share a few things from that I've taken away really from Gwen's PhD is that this is one idea that Gwen identified and there's lots of evidence that this happens in human medicine as well, and that is the idea of defensive prescribing. And that's the concept of covering with an antibiotic or giving them just in case. And it's understandable and simply a product of human nature that we would do this.

And when there's uncertainty, which in farming practise, particularly that is a lot of the time. And when the stakes are high, it's human nature to just hedge your bets. And this is the reason why a lot of vets will still give a bottle of calcium under the skin as well as one in the vein or put a boon of suture in after a prolapse, even though there's not a huge amount of evidence to say that those things are warranted, we do it just in case, and we think that the potential benefits will outweigh the potential risks.

And farmers have a similar approach to giving antibiotics to cover the alternative or a sick animal or or a dead cow. And recognising that we're doing this, or recognising that farmers may be doing this is kind of the first step to try and reduce this behaviour, really. Gwen also found that farmers use medicines in lots of ways other than that that's advised or and some sometimes, sorry, in ways that we would describe even as not really being responsible.

And sometimes that's because the vet has advised it to be used in that way, but sometimes the vet will have no idea that that's happening on a farm. So farmers will exceed data sheet guidelines. That's a common thing that they do.

They also use expired medicines. So double tubing mastitis case happens using medicines of licence, particularly things like poultry, antimicrobials in foot baths. And when it came to vaccine storage, when study also backed up another one done by MSD that showed that vaccines are commonly incorrectly stored.

And so, You know, is of questionable efficacy by the time they get into the animal. So, as I said, I was gonna try to glean some top tips from each of the work of my colleagues, and suggest what, how I've, what I've taken away from them. And one really important thing I think I've taken from Gwen's work is to understand what farmers really want from vets.

And farmers have explicitly stated their preference for simple set protocols for treatment, particularly on farms with large numbers of staff. And so things like laminated posters are popular, but they really have to be tailored specifically to that farm and not just be generic protocols. Farmers agree that lots of these protocols might be in the herd health plan, but if it's just collecting dust on the shelf, it really isn't helping anyone.

So they like the idea of active and usable protocols, which can minimise ambiguity and increase certainty and trust. So if a farmer or farm worker follows a certain protocol, and the animal is still sick or even it dies, it kind of takes responsibility off that person as an individual, and it might even feed into reducing the temptation to perform defensive prescribing like we've discussed earlier. So, this is something I actively try to offer and offer to my farmers.

And That I do, that offered to farmers that I do and her health planning with and try to give them usable protocols that everyone's aware of. The other thing that farmers like is consistency between vets. And actually, again, if a practise can have practise protocols, and it reduces the inconsistency between vets who visit the farm and can just increase trust from the farmer into those, Protocols and treatment plans.

And ultimately, all of the farmers want healthier cows and smaller bills. So there is a huge motivation into, you know, engaging in herd health planning and reducing antimicrobial use. We just have to engage them in the right way to harness that.

That kind of motivation at the right time. And that leads me quite well on to the work of Lisa Morgans, and she looked at a participatory farmer-led approach to changing practise around antimicrobial use on dairy farms. So the main aim of Lisa's work was to assess the influence of peer to peer learning on antimicrobial use.

And also to assess the usefulness of using medicine audits to review antimicrobial use changes. And this idea of peer to peer farmer learning is based on a similar Danish model and where they used, they called these stable schools. And what Lisa did was she looked at the effectiveness of farmer action groups, which are groups of farmers who met on a regular basis to share ideas about how they and others in the group could reduce their reliance on antimicrobial use on their farms.

And so Lisa would facilitate these meetings to encourage peer to peer learning. And the key to this was that she'd really tried to steer away from the idea of didactic teach teaching from a vet to a group of farmers. And so, in the study, Lisa had 5 farmer action groups, across the southwest of England, and she followed these for 2 years.

And they would work together to discuss how to reduce antimicrobial use on their farms, and she had 30 farms in these groups in total. And so this is just an idea of what she did with them. So she would start by setting up a pre-visit with the farm, one farm, and do a farm walk, discuss areas that they wanted to showcase areas of improvement that they were interested in.

She'd co-create an agenda with that farmer. To focus on areas of strength and also to include looking at the high versus low antibiotic use on that farm. She'd also do a medicine review, again, using veterinary sales data, supplemented with them from medicine records.

And then that will be presented back to the farmer in a personalised report. And they would then have a meeting about 3 hours. On the host farm, where they do a farm walk and then she at least would do facilitate discussion on the herd health and antibiotic use on that farm.

And then they'd organised for the next post to go, and go to that farm and do the same process again. And so, as you can see, There was good engagement with this. She had lots of farmers working in the process.

They would walk around the farm. They would then do this, these various facilitated techniques. And at the end, they'd come up with a practical action plan, co-produced by those farmers.

For the farming quest host farm to work on to reduce their reliance on antibiotic use. And I've discussed this with Lisa, and I've tried a couple of these things myself. I'll tell you about all of the different ones that she used.

So she used lots of different methods and tools to kind of try and stimulate discussion within the farmer groups. Some of those, for example, here, like sticky notes on posters thinking about the positives and areas to improve on a farm. Mapping of the farms are getting a non-host farmer to draw a map of the farm.

They've just been walking around and use stickers to, indicate areas where different farmers thought that there was good, Good areas and maybe areas for improvement and discussion. You can see this can be done in fairly informal settings. She also did score chart exercises, listing areas of different herd health and getting farmers to score them out of 10 and then just really focusing on those areas and the just further discussion, just focusing particularly on areas, Which had lower scores.

And then things like the ping pong ball ranking exercise. And again, you can just at the end of this process, just look at the bowls that have the largest amount of pink or red balls and just use those as as a focus for discussion rather than trying to talk through every aspect of herd health and antibiotic use. So there, there was some quantitative results from her studies, and that's these are the, all farms implemented at least one recommendation from their action plan within a year, with an average implementation of 54.3%.

And most of those, many of those recommendations are still ongoing at the end of the study. And that the majority of participating farmers reduced the use of highest priority critically important antimicrobials over those two years. Remember, this was a study particularly looking at influencing antimicrobial use on these farms.

But as well as the quantitative benefits, there was actually a huge amount of qualitative benefits that Lisa found the farmers are reporting, including benefiting from sharing of knowledge. Farmers felt more empowered. To change their practises because they've gained confidence from the group learning experience, a sense of solidarity from going through the process of change together and also I mean that knowledge gaps are identified, particularly on high priority critics important antimicrobials that then could be filled either between the farmers or even potentially with Lisa's help as well.

There was also some outcomes looking at the vet farmer communication process, and And the knowledge gaps surrounding antibiotic use really highlighted issues between like about and antimicrobial knowledge and the transfer of knowledge between vets and farmers. And these have found that a key component of these action groups was that the facilitators and who supported the knowledge mobilisation and really helped to build a sense of solidarity with the, with the farmer groups. So in talking to Lisa about her study, and from my own experience, subsequently of trying to kind of set these little groups up even on, on ad hoc basis, is that farmers do have a lot of knowledge and are very commonly willing to share it.

So it is worth considering just trying to get farmers together for a farm walk, even, if you aren't doing this on a whole herd health scale. I've done this, just on a small scale with regards to if a farm is interested in calf housing, just get a group of a small group of 3 or 4 farmers together and just do a farm walk, even if you end up only doing this on 2 farms. One, farm that's willing to host and and show around that maybe might give some ideas and then on the farm that is, you know, the host farm on the farm that is maybe struggling with calf pneumonia or calf housing, thinking of changing their calf housing, even just having a couple of these farm walks with a small group of farmers just looking at one area of herd health can really kind of mobilise ideas and try to, you know, stimulate some discussion.

And think about change in these in these farmers. So, again, it made me aware of trying to avoid this idea of the expert trap, which is that we tried to, I try to facilitate the farmers to share information and try to avoid lecturing to them, my knowledge. And, and one way that I found that is effective to do that is just to ask questions back to the group and commonly someone in the group will come up with the answer rather than, you know, as the vet, you standing there and didactically telling and teaching them.

What you know. So that's just that, that's just a little summary of my takeaways from, from Lisa's work. And now I'm just going to tell you a little bit about Allison Bard's work.

And Alison's PhD, created a tool kit for vets to implement emotional interviewing techniques, which they could then use with farmers. She did motivational interviewing training for farm vets specifically. And then what she did was assess the effects on farmer behaviour change when they interacted with a motivational interviewing trained or not trained vet.

And while I'm going to give you a very brief overview, just of my experience of doing these techniques or trying to learn about and do these techniques. It's worth saying that there is a webinar available through the webinar that that Alison did, which is entitled The Farm Advisor communication tool, practical support for effective conversations on veterinary medicines use. And so if you haven't already and would think that this is something that you'd like to look into, I would direct you towards that webinar, which then in turn directs you towards even more learning materials in this area.

So just to give you an idea of what is motivational interviewing, so it's a person centred goal oriented method of communication for eliciting and strengthening intrinsic motivation for positive change. So it was originally set up by these two guys, so Professor Bill Miller and Professor Stephen Ronick, and these are, American doctors in the US and they work in the realm of working with people with drug and alcohol misuse problems. And they quickly realised that just telling someone that drug and alcohol use is bad for them.

Doesn't elicit change to move away from those behaviours. Otherwise, you know, particularly in the sense of drugs, they're illegal anyway, though, those people know this, and that's not enough to motivate the change. And so they developed this way of communicating, with people to elicit change and to elicit motivation for change.

And that's what this is all really based on. And so this is The idea that giving, giving more information to a farmer about a topic or a disease will, and that will just engage them to change their behaviour. It's kind of based on, on, on that premise, but actually that usually just overwhelms a farm or turns them off to your ideas.

And I realised this maybe only in the last few years, whereas earlier in my career, I was convinced that if I knew more about a disease or husbandry, then I could give farmers better ideas. I could persuade them more often to change or educate them better with more information, and then they'd be more motivated to change. And I realised that having better knowledge did help me with my confidence in giving information and having confidence in my own ideas, but it didn't drastically change how the farmers I was working with behaved.

And I realised that to get behaviour change, then what I really needed to think was about the way I was communicating, and that was far more important. And this really plays out in what we've seen. In herd health over recent years and despite huge scientific industry advances in the understanding of mastitis, the understanding of lameness, we still see farms that struggle with those herd health problems, and it's not necessarily because farmers like having lame cows on their farms, or that the vet they're working with doesn't understand how that situation could be improved.

But maybe it's just a little bit of a breakdown in communication there or, you know, there's just not been the kind of motivational, they've not been, found that motivational point for the farmer to get him to engage in actually changing behaviours and, and planning, doing herd health planning in a way that, elicits real change on a farm. So I'm just going to talk you through some key concepts of motivational interviewing, and tell you about some aspects that I've then used in conversation with farmers as an in motivational interviewing. Of course, like I said before, I'm not an expert in this, and you're not learn how to do motivational interviewing from me.

I'm just hoping that I can give you some kind of tips and tricks. Just to get you started and ignite some interest and then hopefully convince some of you who haven't already looked into this to go and look into it a bit further and even discuss this concept with your colleagues as to what kind of, you know, things you can potentially put in place in your practises. Motivational interviewing has some key concepts and one.

Is that There are different ways in which we are kind of Made to make behaviour change. And some of those are extrinsic factors and that may be that we're being forced to do something, paid to do it, or even that we just know that. And others will judge us if we don't do those things.

And there are other internal factors. For example, it might, doing something might make another task easier. You might appreciate that it will help something else that you yourself value, or even that you enjoy doing it in its own right.

And so the idea of motivational interviewing is trying to identify areas that are of more value to the farmer and focus conversations on these things to try and help enable them to change their behaviours, because ultimately, those behaviours that are influenced by internal factors are much more sustainable and much more likely to be implemented in the long term. So in order to change your interactions with farmers, so you can make kind of people more likely to change their behaviour, it's helpful to understand the concept of what influences someone to listen to the opinion of someone else. And this is kind of based on these three things.

So relatedness, competence and autonomy. Now, relatedness, so it is to do with trust between two people. So what can you do to enhance that relationship between you and your farmer?

Well, obviously, you can be nice and do your best and be friendly, and maybe in some instances having extra qualifications in certain areas might, elicit more trust in you from that farmer. And sometimes that just comes from previous good experience between you and that farmer over a particular case, for example, or a conversation. And then the competence, that isn't actually the competence of the vet, but that's the competence of the farmer.

So farmers having confidence in their own skills. And knowledge means that they're more likely to have the confidence to change their behaviour in the realm of that particular aspect. So what can we do to try and increase that?

Well, we could do farmer training evening. So if we are talking about using antibiotics more responsibly, then the farmers having a better understanding of how antibiotics work, what critically important antibiotics are, etc. Might help with this.

And the other aspect is to give confidence. So when we do talk to farmers about herd health planning and doing herd health planning, I'm thinking about antibiotic use, giving compliments, giving compliments and being genuine in those compliments will help to give the farmers confidence in what they're doing. So try to find something that they're doing well and tell them about that before then, going on to discuss around the area, and that can sometimes help and then engage with that.

Another thing is autonomy. So this is the idea that farmers have autonomy over their own decisions, on, on their farms. So it's good to identify what areas are important to the farmers, and it's simple to do that.

You just ask them. So it's also good to work in partnership with farmers and make it very explicit that it's your plan to do so. So ask to work with a farmer on something and try to avoid leading from the front.

Also trying to allow the farmer to have their own ownership over your the herd health plan or the discussion about antibiotic use. Let them come up with their own ideas and formulate their own plans, working out their own solutions is kind of key to all this, because ultimately they know what is going to work on their farm and kind of tell you what they're willing to do and can do. So This is just an idea about, to give you an idea about the main kind of ethics of motivational interviewing.

And the first of these ethics is compassion. So It's really a good idea to ask the farmer's opinion on the subject. So we're looking for both the good and the bad of their opinion.

And this is because we need to know what the challenges are for our clients, with regards to antibiotic use on her health so that we can help them overcome those specific challenges. And I might often ask something like, tell me about your thoughts and feelings about this subject. And I might kind of do that in a bit of a tongue in cheek way, because it's a slightly awkward thing to say in communication.

But then if you stay silent and actually listen, they'll often just start talking about the good and the bad sides of certain aspects of herd health that they're interested in working on. And like I said, it's good to know that, you know, the challenges that they feel that surround a certain area because kind of being forewarned is being forearmed with that situation. And the second ethic is acceptance.

So that for us is accepting that the responsibility of change really lies with the client, and only they can initiate a change that's going to be meaningful. And so, We need to, kind of empathise with them at this stage. So empathy is important and understanding the specific challenges that surround a particular issue.

I got some bubbles here that I've not been putting up. So, this idea of empathy and, and actually explicitly saying, I appreciate that it's really hard, hard to find time to do X, Y or Z, just to let them know that you are understanding the, the kind of problems of these kind of processes. And another thing to think about is partnership.

So definitely trying to work alongside as opposed to ahead of the farmer with this, is really important. So try to ask to discuss something with a farmer as opposed to just launching into it, off the cuff. And also, To try to again, avoid the idea of the expert trap.

So try to engage them and get them to start talking about their ideas as well as just trying to, you know, lead from the front and, and Point them in the right direction every time, as it were. So in order to kind of foster an idea of partnership, the client should be doing about twice as much talking as you. So it just highlights the importance of asking them questions, particularly open questions.

And this is something that I've really taken away with me, actually. It is slightly awkward to do in sometimes in a, in a kind of social, in a conversational flow, but it's the concept of asking permission to give information. So again, not just launching into a feet first approach to didactically lecturing a farmer about a certain aspect of her health or antibiotic reduction.

But if a farmer, you know, you feel like a farmer is kind of exhausted in a certain area and with their own ideas, if you feel like you need to relay some information or teach the farmer something in a certain area, just asking permission to tell them, really opens their ears to you, as it were, and that someone's much more likely to listen to the information you're telling them if you've asked permission to tell them in the first place. So just saying something like, would you mind if I tell you about X, Y or Z or OK, I've got some thoughts about this particular aspect of antibiotic use. Can I share them with you?

And if they say yes, they're much more likely to actually engage in the process. I guess on that line, I should just warn you that you have to be ready to, to have them say no, and that has also happened to me when I offered tell a farmer about the benefits of giving non-steroidals at the same time as finding hoof lesions, claw horn lesions in cow's feet. And I offered to explain, asked if I could explain the benefits of giving nonsteroidals to him, and he told me no and walked off.

So I had to be prepared for that as well. But at least I wasn't, wasting my time and I'm wasting his time as well. And the other thing is that this idea of evocation.

So you've got to think about both the pros and the cons of behaviour change, but you really need to try and get the farmer to list both the pros and the cons. And this concept really relies on the fact that we basically listen to our own voices much better than that of other people. And so if you hear yourself say something, you're more likely to listen to it.

And if the farmer has conflicting feelings on a subject, like he knows he needs to foot from his cows, but he doesn't have the time to do so, and then you just listing all the good, you know, the positive reasons why they should be doing something can kind of automatically make them in their heads start listing or even out loud to you, listing all the reasons why actually they can't do that, and that's going to be hard for them. And you end up actually in, you know, going backwards because what then they're doing is externalising all the negative reasons and all the reasons against change to you. And they're going to be listening to their own voice more than they're listening to your voice.

So we need them to start engaging, and telling me, telling you about, the pros of doing something. So it's fine to, to ask them about the challenges of doing something in the first instance. But then it's also good to specifically probe into what good things might come from the behaviour change that maybe you're trying to elicit.

And obviously, sometimes farmers are quite negative about certain situations and I found one really, good tip that I learned from Ali was this idea of a scale of 10 to 10. So for example, you might say, OK, so on a scale of 0 to 10, how likely are you to start vaccinating your cards for pneumonia? And if they might only say, for example, oh, well, a 1 or 2, then you can say, OK, well, tell me why you are a 1 or 2.

And not a zero, and automatically that gets them externally saying out loud, the positives behind that behaviour change. And this isn't going to, you know, happen overnight. They're not next day you're going to be buying a whole load of pneumonia vaccine, but it starts the process of getting them thinking about the positives of these of these behaviour changes.

So this is just like a little plan that I use for kind of trying to do motivational interviewing conversations with my farmers. So, first of all is to engage. So the crucial part idea behind this is that it's not just about more information.

You need to engage the farmer first. So really open conver open questions are crucial, actually engaging them in what they're concerned about if they turn up to this to a meeting. With you worried about their cell count and you start talking about a number of lame cows on their farm, they're just going to disengage straight away.

So really find out what is important to them on the day. You might want to just use more open questions, try, try and expand that understanding. So explain to me your thoughts about X, Y, or Z.

The next thing then is to really focus in on what's important to them. So you, again, this is the idea of trying to think about the pros and the cons of that particular aspect of her health or, or antibiotic use, and drilling down more into what the challenges are that is already stopping them, making those behaviour changes and then thinking about evoking. So like I said before, what we got here?

Yeah, so again, I just wanted that to to highlight that when you're focusing or even invoking, if you do have more information to give, remember to try and ask permission to share that information, they're more likely to be listening to you when you do. So with regards to evoking, you're then thinking about what could be changed. So then at this point, it's about trying to get the farmers to externally say what they think those changes can be.

So again, remembering that you need them to have ownership of this, these changes and these plans that you want to implement, because they need to be realistic for the farmer. And so again, asking open question, asking the farmer to come up with the plan themselves, can be a lot more, beneficial than just telling them what you think they should be doing. Again, trying to elicit from them the challenges that they see in a certain situation, as well as the benefits of making those changes and then going on to try and kind of reinforce this kind of change talk with them.

So examples that would be thinking of saying, is there anything you can think of that you could do to get the cows others cleaner in the parlour and see what they come up with, or again, what be the benefits or even the drawbacks of washing the dirty others and trying to get them to externalise those thoughts. To you. And again, If you're trying to think about evoking change talk as as it's, as it's described, thinking about this tip of getting them to say on a scale of 1 to 10 or 0 to 10, where would you be and go from there, use it as a springboard to, to, to work into some change talk into the conversation.

Then you need to make a plan, of course. And really getting down to the nitty gritty of that I think is important and this. So how can you, they physically make those changes on a day?

How can they fit into everyday routines? And again, getting the farmer to take ownership of this is really important. So what challenges could that be and how could you overcome them and how could you make that into a daily routine?

And then You know, taking this with a farmer with a group with a farm and the farm workers at this point there, going back to the work I was talking about at the beginning, you can then feed that into protocols that you can make with the farmer, and again, then those protocols can be laminated, put up about the place, and maybe then potentially would steer them away from defensive prescribing or kind of defensive practises on the farm with regards to antibiotic use. So There's my, there was a lot of information there about motivation and interviewing. Like I said, it's just really some top tips from me and not, not a full training session, as it were.

So the main tips from me would be that remember that more information is not always needed. You need to really engage the farmers first before you just launch into telling them how to reduce their antibiotic use in a certain area. To do that, open questions are really useful.

You'll get a lot more information than asking yes or no questions. Ascertaining what is a concern, or maybe not to the farmer, find out about the challenges from them actively before you then try to suggest changes that they could make with regards to antibiotic use. The idea of affirmation.

So again, finding things that they're already doing well and telling them that they're doing that well will help build their confidence in this area. And when they're more confident in an area, they're more likely to be able to implement changes in that area. I like the idea now.

I try to do it as much as possible is to ask permission to give information. Just don't assume that the farmers are wanting your knowledge in all areas. So ask lots of open questions and then if you get to the point where you feel they need a bit more information, ask permission to give it before just launching into a didactic lecture to them.

And just a real kind of tip about try to promote change talk and a really small thing that I started to do, when I was, you know, the beginning of, of trying to do these motivational interviewing and type techniques was just this 0 to 10 tip when I'm trying to engage a farmer in promoting change talk, I'll try and use this just to get them to externally verbalise the kind of benefits of doing some behaviour change to me. So I just wanted to return now to the learning objectives and, and kind of the summary of everything that I've said. So obviously it was one of the learning objectives was to understand the link between herd health planning and antibiotic use and hopefully you have, I'm sure you already had, have good understanding of why those two are too to kind of closely linked.

Also to appreciate what farmers want from their vets regarding antibiotic use. So that's Gwen Rees's work, when she found that farmers really like the idea of treatment protocols, usable treatment protocols that are visible on the farm. They like consistent that advice.

So if you don't already have them, try to think about treatment protocols within your practise, and also making herd health plans active. So pulling bits out of the health plan that again can be referred back to through the rest of the can be laminated as protocols, protocols and go on the wall. And as part of that, I'm, I also do I make kind of calendars with my farmers so they can actually have that as something a document that they will refer to every month of the year and to see what needs doing or what we're thinking about that month.

Another learning objective was to consider the benefits of farmer peer to peer learning in relation to antibiotic use. So, you know, is it, is that something that you can do? Can you go on to facilitate some farmer groups?

And that's certainly something I'm looking to do more of in the coming year. Hopefully going to be doing this. I've got a plan to do this with some beef farmers to kind of co-produce the herd health plans with them and with a group of beef suckler farmers.

And then remembering that medicine audits, even in the most simple form of just some tallying of different types of drugs that they've used on a farm, is a really helpful way to just spark conversation about what antibiotics they're using, and where areas of high antibiotic use lie on a farm. And then finally, hopefully now you're just aware of basic principles or even just the existence of motivational interviewing, communication, . And with regards to those, just to think about engaging farmers using open questions, then focusing on both the pros and the cons from the farmers' perspective on how they can change, how they can change things on the farm to reduce antibiotic use in certain areas, and evoke reasons for change.

So think about trying to promote change talk, maybe with that 0 to 10 tip. And then making a plan so that again has to be farmer led. They need to have ownership of it and ideally, link that all the way back to then use that plan to make some protocols, make some plans for the year ahead.

So I think that's just about everything from me. So hopefully you've taken away some tips, like I said, primarily thank you to, Gwen, Lisa and Allison for all of the hard work that they did and the inspiration and the information they've given me to help me in my practise. And hopefully, I've given you some inspiration and some ideas to go away and, and try to, you know, think about.

Engaging farmers in more effective ways and how to engage them in herd health planning ultimately so that we can look to reduce antibiotic use further on any of the farms that they're working on. So thank you very much for listening. And any questions, please put them to me.

Thanks.