Well good morning everyone. Thank you for being up early on a Sunday and then listening in on this. It's great to have you here as Fiona mentioned, I'm a research associate at Bristol, and I'm gonna be talking you through some areas around our research and medicines use and how that integrates with our ideas on communication and and theory from psychology with the aim of giving an overview of a communication tool that we're at the moment.

So we're hoping to kind of freely release to those in practise to just really support better conversations around veterinary medicines use as well as other aspects of welfare. And health. So this morning I'm, I'm going to be briefly going through, you know, well, why develop this tool, what's the the impetus behind being interested in AMR, and I'll be covering just a very brief bit of background before leaning on Gwen's presentation next.

He's also speaking from Bristol, who's talking in a bit more depth about things and use on farm. I'm going to be talking about, you know, how we decide to take theory and practise from psychology and different methodology. To underpin how we can perhaps better engage farmers and conversations around medicines and what that might look like and really getting a detailed understanding of, you know, what is motivation?

What does it look like in in it's all variety and how can we engage with it better, just by the way that we speak to someone and choose to to practise and give advice. And finally, I'll be giving a brief overview of the the communication tools sheets and how we try to broadly integrate some of these ideas into quite an accessible and practical format that ideally in the future people will be able to download and just use in practise. So I'm maybe, you know, repeating information that people are becoming to be very aware of at this moment in time.

But just to kind of bring it back to the real basics of why we're talking about AMR today this morning. AMR antimicrobial resistance, as the World Health organisation state in this this quote from 2014, is an increasingly serious threat to global public health and a post-antibiotic area in which common infections and minor injuries can kill is a very real possibility for the 21st century. So the magnitude of the problem really is very much accepted now.

And if we don't find proactive solutions to slow down the rise of drug resistance, we could be looking at quite an uncertain future. And Perhaps everyone is also familiar with the O'Neill report that came out, and this was really looking at, you know, once we accept that fundamental change is required in the way that antibiotics are consumed and prescribed. To preserve their usefulness of existing products and also to reduce the urgency of discovering new ones, the new report recommended, you know, very specific steps to reduce demand, and you can see quite a few of them here, you know, from enhanced surveillance capacities, increasing public awareness, promoting new rapid diagnostics to cut unnecessary use, a broad remit of of possibilities that that we can think about tackling AMR on 10 fronts.

And what the work that I'm heavily interested in and involved in Bristol and Gwen's next presentation will be delving into a little bit as well, is perhaps the profoundly social elements of of that are integrated across all of these fronts. And I, you'll see in my presentation, I might be a bit of a quote person, but this, this quote from Dame Sally McIntyre really highlights it and that while we accept that the mechanisms which lead to AMR are biological, the conditions promoting or mitigating against these biological mechanisms are profoundly social. The social science really has a key role to play in measuring, modelling, understanding and, where appropriate, changing and challenging the social environment in relation to antimicrobial resistance.

And that's really how our our research is integrated within the wider work at Bristol. And both Gwen and I are part of something called AMR4 here, and this is an interdisciplinary collaborative and vibrant group working in a range of critical AMR topics, both across faculties within university, across the universities within the UK and internationally, in fact. And this covers a whole range of areas where, you know, considerations of AMR are integrated.

But what my work is particularly focused on. Is in the area of motivating change and understanding this kind of social science element. So we have a broad range of projects here, just as a couple of examples, you know, we look at things like stewardship and how that's enacted on farm through exploring whether participatory approaches to policy with retailers are appropriate or whether we can integrate farmer action groups to allow farmers to become more self-directed in how they manage their own policies and procedures on farm.

I'm very particularly interested in motivations and drivers around AM use as well as the broad aspects of herd health, as Fiona mentioned, my PhD was looking at vet and farmer behaviours, that farmer interactions, the veterinary advisory paradigm around herd health and how that plays out and what impact it has on behaviour change. But there's a whole host of research going on here. For example, the project I'm now involved in is also looking at attitudes and awareness and social cultural practises around diagnostic practise and how that in fact influences AMR.

So the real broad brushstrokes of, of, you know, different areas of AM youth. So on the next talk when we'll be talking in a little bit more detail about, you know, the broad overview of AM and AM use on farm and how this is realised in prescribing decisions, how farmers use that med, herd health planning, how you integrate responsible use and practical tips on change, whereas today I'm really focusing much more on the nuts and bolts of these elements of psychology and communication and how perhaps you could integrate this into practise. And the reason I'm fascinated by this is that, you know, motivating change and it's really at the heart of the farmer engagement to to to bring in new practise around medicines used to perhaps adapt to the changing landscape in terms of policy that's coming around, focusing on relationships, communication advisory services will really allow us to to get to that real, you know, personal interaction where vets have a lot of opportunity and motivation to influence behaviour change.

The problem is we know that there's there are big challenges in influencing behaviour on farm and recent research by Rustin and colleagues said, you know, this actually has the potential to undermine the preventative advisory role itself if we don't really get a handle and make use of the wide amount of research and literature on there on motivation and behaviour change, without this understanding, that will be struggling a little bit. And it's well surmised by this comment by a vet in in this paper from Boston in 2016. I said, you know, I think the battleground is probably not on the science.

The battleground is on behaviour change and all this type of thing. So it's not knowing more stuff we need. It's, you know, we basically need to be able to implement it better.

So this is why today I'm going to talk through a couple of core theories and methods that really led into our perception of how to integrate. Motivational ideas into a communication tool and then discuss how maybe that could be realised on farm in your interactions. So the aim of these fact sheets was I I just kind of overview there, you know, what theories of motivation can inform us in the veterinary context, what practical and evidence methodologies can enact this theory in the veterinary context, and how can you make these ideas accessible and practical to use for those working in this area.

So for the next section, I'm just going to talk through the background theory and methodology that led into building the farm animal communication tool and hopefully some of the ideas might resonate and and might lead you thinking a little bit differently about when you next talk to a farm client. So there's two main aspects to this which we drew on, and the first was self-determination theory, and this is really a theory that looks at motivation as a primary construct because motivation itself is, you know, that critical factor that involves mobilising, involves changing your behaviour, involves being passionate and interested and. It's very much valued because of its consequences.

If you're an advisor, this is the the real target to allow someone to engage in the advisory message you're given. And we know that in terms of human behaviour, that the best representations, we are all curious and vital and self-motivated. We have this potential.

We have the capacity to strive to learn, to extend ourselves and master new skills. And actually this effort and agency across cultures and social environments is quite normative. And there's some very positive and persistent features of human nature out there.

And we only maybe perhaps need to think about something like the Olympics when we consider how far that the human mind is able to push itself. These are the people that trained for 4 years with the intention of perhaps training half a second if that off of the world record, and that is enough of a focal drive to kind of pattern their entire behaviour and the world around those goals. But not just that in our own lives, we have, you know, our own interests, our own.

Passions that move us and these can be from the big, you know, career and processes to even the kind of behaviours that we carry out in our home environment. I mean, you need to reflect on perhaps you have a crafting skill that you do, not because, you know, it's not something that you're paid for, maybe you're not even acknowledged for it or compensated, but you still do it, you know, we play games on computers because they give us a sense of intrinsic achievement. We do things like puzzles, we maybe collect things like stamps.

There is a real embedded part of human nature, and it's something that is important to maybe understand. And this is really what self-determination theory wanted to explore, you know, explore the construct of motivation and understand how it moves people to do different types of things and what factors are implicit in it, and maybe by understanding those we can learn to target message a little bit better. We also know through this theory and through, you know, living in our environments, the human spirit can be diminished and crushed regardless of the social stray and your cultural origin, we can become apathetic and alienated, reject growth and responsibility, and so these proactive persistent elements of human nature aren't always present.

And I'm sure everyone listening has had those days, whether it's that particular task, we just can't quite seem to manage to bring ourselves to the fore to engage with. Maybe it's a particular role that we're in. Maybe it's a big element of life, but there are sometimes where you'll get up and go just kind of gets up and leaves you.

And you know, Brian and Decky in the kind of paper in 200, which is really looking at self-determination theory and the facilitation of intrinsic motivation said, OK, well. How can we understand this? If there's functional experiential differences between these kinds of motivation, what are they and how can we perhaps think about them?

And it might be obvious actually, when you start thinking about it that well sometimes we talk about farmers as being well motivated or unmotivated on a topic or interested or not interested or maybe they like this part of, you know, maybe they're really keen on controlling lameness, but other things are not so much at the forefront. It's not a singular construct in any way. So perhaps I told you I was going to watch you dehorn a group of 20 calves, and I told you at the end that you'd be doing it to get a certificate.

Or if I told you I was filming it and 150 of your peers would be watching your practise if I told you you'd win a million pounds if you did it above a threshold that I'd set, or perhaps the dehorning carves is just your favourite activity and something you've chosen to really specialise and promote and doing in a positive way, the way you enacted that behaviour would be subtly different. And so these, these functional differences between how we feel about behaviour does actually change how we engage with them and whether we become more creative or apathetic. The self-determination the breaks this down really into the levels of different motivation across this this kind of construct and to really understand and target, you know, if, if we know that behaviours can be motivated at different levels, how can we promote more positive motivation?

And so there's a kind of scale of different motivational experiences that I'm going to talk you through that try and summarise where they've got to with theorising the different areas here. But essentially the overview here is that the theory proposes that although we perhaps recognise extrinsic and intrinsic motivation is common in how we might talk about people being motivated or unmotivated. What we see is that these extrinsically motivated behaviours vary greatly in relative autonomy, and this is the thing that actually makes a difference in how we carry them out.

I, you know, just talked on that slide, winning a million pounds for doing your role versus getting a certificate at the end might give you slightly different behaviour and how you express it and how much attentiveness to it. So at the bottom of the kind of extrinsically motivated scale is something called a motivation, and this is where we act. Would even don't act, you know, we're not very attentive and that we were lacking this kind of intentionality.

And this is often because we just don't value an activity. We don't feel competent to do it. We're not expecting it to yield the desired outcome.

So maybe you can think about, you know, a board farmer who's mindlessly entering mobility scoring data and maybe making mistakes just because they feel that their peers don't score honestly, so the value in that activity is not coming to the forefront. The next stage up in this this kind of scale as people become more autonomous, there's something called external regulation. So this is where you know you are, you know, becoming more autonomous because you're satisfying some kind of external demand or reward or avoiding punishment in your behaviour.

There still experience is very controlled and alienated and not really self-determined. So maybe that farmer's mobility is growing because it's a condition of their milk buyer contracts and they're feeling very pressured to do it. But again, it's not really, you know, becoming part of the self or something that they're fully accepting as their own behaviour.

Moving up from this, there's something called injective regulations. Now this is where we carry out a behaviour and we're not again accepting it fully as we know our own kind of motivation, but it's something that we're doing to avoid guilt or anxiety or or maybe to attain ego enhancements, such as, you know, pride and a focus on others' perception. So there's a kind of characteristic we call roadside farming and social science where decisions on a plot of land are influenced by who might be able to see it.

So, for example, in some of my interviews with farmers. I had this quote from someone who said, you know, I own that piece of land out in the dual carriageway as you turn in. Every farmer goes past that and rises up from the road.

Now I got a maze there and that field gets everything it needs because every farmer looks at that. So that is a motivating factor that is, is causing this kind of interpersonally controlled behaviour. So that farmer is, is, you know, perhaps doing a bit more than they would if it was just being forced upon them.

But again, it's kind of coming from this external locus. Next stage is something that we call identified regulation. So this is where we become more accepting of the behaviour and it becomes more personally important to us.

And so this is, you know, the goal or the recommendation itself is really consciously valued. So perhaps you can think about the farmer who is spending time fixing crush. It's not because they actually enjoy that behaviour itself, but they, they value keeping the farm tasks moving as needed, and they know the knock-on effect will be valued across other aspects of their life.

And this motivates them to to kind of go through those behaviours in a slightly more autonomous fashion and from other people perhaps just perceiving them doing it. And finally, as we get closest to what we might think of more intrinsically motivated behaviours something called integrative regulation. So this is where our behaviour aligns with our own values.

There is a sense of consistency of it becoming kind of part of the self, part of what we think of to be priorities for us. So maybe you see a farmer who scrapes their sheds twice a day. It's a chore for them, but you know, they feel it is necessary for enhancing personal priorities such as cow welfare that they put really high on top of their list.

And it's only after this that we start to think about intrinsic motivation. So you can see, you know, those different gradations there of extrinsically motivated behaviour are quite different in terms of the experience of the individual, and this impacts their behaviour and intrinsic motivation, therefore, is, you know, the top end of this where you perform an activity for the sake of it, you know, for your interest for enjoyment. You know, it's very much the ideal of self-determination.

So maybe that the farmer, you know, who just stays that extra 5 minutes after cleaning out, let's not to watch them frolic, to watch them play because it just makes them feel good about themselves and maybe there's areas in your life where maybe you just stop and kind of smell the roses and just really appreciate something because of that joy that it gives you. So you can see from the scale that actually when we might think of people as motivated or unmotivated, actually the scale is much more complicated and what we tend to talk about then is how to make behaviour more self-determined through this theory. So we know that obviously the gold standard is intrinsic motivation, things that people are doing because they really want to because it.

It aligns with their self-worth, but what we know is that all these areas on the left where people are doing it for impersonal reasons or somewhat external, maybe because of other pressures on top of them, they do vary significantly in terms of what behaviours that creates in the individual. And if we recognise that some activities just aren't intrinsically appealing, you know, if we're talking about bringing in new policies, bringing your stewardship regulations, you know, in any industry, farming, there's a lot going on. There's a lot of pressure on farmers, and there can be this feeling that it's just more pressure from above.

But the salient question is if we're going to engage people in better discussions and advisory services and behaviours around aspects such as medicines use and animal health and welfare. The real question is how we motivate individuals to to value, self regulate and without external pressure, carry out and maintain these. And when we look at this scale, the activities that are more internalised, you know, those that, you know, move more towards this experience of.

Internal value systems or intrinsic motivation. When we look at how people behave in accordance with them, we see that the behaviours put in place, say around farm management or any area of your life where you're considering whether you're, you know, what kind of motivation you have. We have greater initiative.

We're better at coping with failure. We experience less anxiety, we tend to put in more effort and we have more enjoyment and better performance from this. So the scale really is quite important and trying to think about ways to engage with farmers at different levels of the scale then becomes quite critical if we're targeting messages around, you know, really any change for herd health.

And so the question in self-determination theory really became, you know, if we accept that a lot of these extrinsically motivated pages are not typically interesting, and the primary reason people initially perform them can really affect how creative, how committed they are. What are the factors that promote this, you know, more internal autonomous regulation of of the behaviour. And this came down to really 3 core areas, so.

You know, firstly, because extrins between motivated behaviours are not typically that interesting to individuals, the primary reason people might initially perform such actions is because behaviours are prompted, modelled or valued by significant others to who they who they feel or who they want to feel attached or related. So both my work and Gwen's work and a whole host of research in this area is really emphasise the critical nature of trust between vets and their clients. And the fact that these feelings of relatedness of being connected of having respected relationships are really important in how advice is taken up and integrated into that farmer's mindset.

And this really echoes within the theory, you know, if we value the input and the connection we have with our adviser, we're much more likely to feel some kind of connectedness to the advice we're giving because it will come in at a more value-based level than, you know, someone that we perhaps don't respect or don't have that connection with. The second level that really affects how much we kind of internalise and integrate these ideas is perceived confidence. So, you know, people are way more likely to adopt activities that relevant social groups value when they feel, you know, that they have efficacy with respect to those activities.

So, you know, this is a really core aspect that, you know. Developmentally is the case with all intentional action. So supports the competence, so you know, perhaps evoking from farmers their own ideas, their ability to engage with change, what works for them on their farm at the moment, how they might foresee positive activities happening in the future.

That really underpins this element here. So how can we you know engage someone in really believing that they have the capacity and the competence. To attain these challenges and extend the capabilities to meet them.

The final element is autonomy, and this is really a critical element of regulation, and it refers to really being the perceived origin or source of one's own behaviour. So it's not related to independence, so it's not necessarily that you know, we know in this environment, for example, say the new red tractor regulations that things will come down in a top down way. And it's not that you can be independent as such from the possibility of being drawn into behaviours that weren't your autonomous choice, but it refers more to an individual's need to feel in control of their environment and their actions.

So maybe you do have to implement a specific policy, but how you put that in place and how that's supported and how what that means for your individual farm, and the choice you receive over that control is what's really critical. So I hope this little overview here is kind of giving you a very brief whistle stop tour of what it perhaps means to To think about motivation as more than a binary construct. Sometimes it's very easy to say farmers are motivated or unmotivated, but actually it's not that simple.

We have this huge kind of variation in terms of our experiential quality and how extrinsic advice comes down to us. And whilst it's lovely to think that there are definitely some farmers that will be intrinsically motivated to carry out these kind of new policies and new ideas, when we recognise that a lot of these activities are perhaps Not the first thing someone thinks about and springs up with joy after bed in the morning. If you can think about these characteristics of relatedness, autonomy of competence and how these affect that value system and how internally regulated the motivational behaviour is, that can really help support promoting the best practise in our environment.

So how could we realise this in a in an interaction and what are the skills that bring this to the fore because the thing with the it can be very easy to come across with these broad concepts, but putting them into practise can be a little bit more difficult. So this is where we look to motivational interviewing. And this is really a communication methodology that developed and was modelled out of real interactions.

It wasn't drawn from theory, but as it's evolved over the decades, actually what we've seen is that it's described almost as a kissing cousin of self-determination theory by the authors of both, because the enactment of the ideas seems to really, you know, harmonise it and be in synergy with these, these concepts of relatedness, competence and autonomy. So I'm just going to give you a very brief whistle stop tour of motivational interviewing to give you a sense of of where these crossovers lie. So the method itself is a person centred goal orientated towards change method of communication, and the idea is to elicit and strengthen these more intrinsically motivated qualities to allow someone to move towards positive behaviour change.

Now it developed in the medical and psychological sciences actually in the field of addiction treatment by these professors Bill Miller and Stephen Rolnick, and it lists behaviour change by helping clients specifically explore and resolve ambivalence or feelings for and against the behaviour. It does so by emphasising choice, self-determination. Relational understanding, all these critical aspects that we've been talking about that make the difference between the quality of motivation and therefore the kind of creativity and engagement that we see with people from receiving advisory recommendations.

So the core areas of motivation to begin to split into something we call the MI spirits or the MI ethos. And the first of these is compassion, and this means that as an advisor, as a helper, we're really trying to work with clients in a very non-judgmental, non-blaming, non-shaming way and striving to be, you know, really quite as empathic as possible that we can. And striving to understand what the problem is like for the clients, you know, when we're coming on and talking about medicines use, what does that mean to that individual?

By doing this, we're attempting to help them find some form of acceptance of what's going on and move on to a different place regarding that issue. So building on this sense of relatedness and trust and really trying to be genuine and engage with that kind in that immediate moment. The second element is something called acceptance, and this is kind of a four-pronged area, which is about kind of accurate empathy, so really focusing on understanding and the client and communicating that to them and really getting a sense of who they are and and what they feel and making them aware that you're interested and actively involved in in pursuing this understanding.

We're thinking about, you know, valuing the absolute worth of someone. So knowing that whatever the problem, however complicated it is with the individual in front of you, everyone's kind of dignity is the same, and knowing how to get there and no matter what the situation is, if we give people due respect, then far more likely to be open and honest regarding their issues. So again, that relatedness quality.

It's about affirmation of of client effort, so really pointing out positive specific things about the individual. It's not about unwarranted praise, but reinforcing things that the client does or says that may assist in making a change and support of autonomy and choice really is the fundamental underpinning here. So means that the responsibility for the change is really with the clients.

So they're the key person that that can enact and integrate and. Understand your advisory processes in a way that only will be realised if they choose to make that change actually themselves. The next stage is something we call partnership, and within motivational interviewing, this means, you know, obviously the work is much more supportive rather than persuasive.

It's very guiding style where we think about working alongside a client as opposed to kind of in front of a post to them. So a confrontational approach is really the antithesis of motivation interviewing. And finally, you know, evocation.

So this is a method that's really about thinking that all clients have much of the strength and the motivation to allow and engage with a with an advisory session. It's just finding their own individual strengths and and bringing that out of them that really matters and acknowledging that if people are the expert of their own lives and their own farms, if we can evoke this and link it to our advice, that's the best approach. It also recognises that, you know, ambivalence, which is basically simultaneous emotions for and against the behaviour is completely normal in terms of considering behaviour change.

So our function is to really evoke and strengthen someone's own arguments. If you think of someone that you know on the one hand on their farm, perhaps your client is really proud of their cows and they want to have good welfare. On the other hand, you know, one of their problems is lameness increase in foot trimming means less time spent with their kids.

So it's not, you know, being judgmental, it's guiding someone to maybe try to evoke the both sides of our own business and work with them to focus on the pro change arguments because we all feel this way about change. If you've ever made a New Year's resolution, tried to diet, tried to quit smoking, if you've ever made a pros and cons list, you basically materialise this in reality because we don't really go through change without considering the pros and cons. And I guess the the problem with directive advisory style as is if we go in and try and give someone the pros, well, these are all the positives of, you know, if we change your medicines use practise, and let's think about AMR with this global problem.

These are all the reasons why supporting this would be good and, you know, what we tend to do is actually evoke from someone the reasons, you know, it's not that easy for me. It's not obvious that the work would pay off immediately. I and when we'll talk through the concerns that farmers have, you know, the, you know, it's.

Using a using antibiotic is a lot cheaper than a dead cow, you know, there's a lot of reasons for people not to engage. And if we go in with the kind of prose focused arguments, we evoke the cons. So the, the idea of a mind is to have more of a guiding star and lead them towards a positive conversation about change through a very much more evocative engagement process.

And so we do this with a suite of kind of core skills, so these would be things like open questions, but we just invite people to, to tell their story in their own words and try and emphasise using more of these enclosed in any interaction. As I mentioned, we use a lot of affirmations, so recognising strengths. Acknowledging evoking the kind of behaviours that lead towards positive change and try and be genuine and congruent in that discussion that these affirmations are meaningful for the client.

We also use reflective listening. This is a very primary skill on a pathway for engaging others in relationships, building trust and fostering that motivation to change again, coming down to that relational quality and really, you know, the nuts and bolts of them are about kind of repeating or rephrasing what the client says, paraphrasing or reflecting their feelings, trying to add and summarise the meaning and content of what someone has said to you. And we also do summaries.

Which are special applications of reflective listening in a way, because they're particularly helpful to summarise what someone said on a particular topic or you know, to to help someone move forward and and provide a stepping stone in communication. And we integrate all these skills into an MI conversation, which has 4 really fundamental processes that make it a little bit different from a typical directive style. So when we think about having a communication interaction with someone in motivation to do we start off.

Basically bringing our agenda and kind of parking it at the back of our mind. So maybe we know that we've gone on to talk about, you know, adjusting medicines use and practise, and that's really where we want to take this conversation, but actually the idea here is that before we do anything in it, whatever our agenda is, whatever we think is the best practise for that client, first, we need to understand them and their world and how that makes sense to them on their farm on that day with all the things going on in their world and how we might integrate that advisory service. So perhaps.

Now this process involves listening, accurate empathy, striving to understand fully from your client's perspective, without an agenda, and using those core skills of open questions, reflections, and summaries to understand both sides of someone's ambivalence or dilemma, you know, avoiding telling them all the good reasons why you've come with this advice on that day, that may be evoking how they really feel about it, what have they heard that's good, what have they heard that's bad. Would they be willing to even talk about it, you know, and really allowing someone to vocalise all those positives and negatives, because then we're not getting into this kind of push and pull where we're kind of voicing the good sides of the argument about voicing the bad. And once we feel like we've really understood and got to the the the nuts and bolts of what that person feels about that topic on that day.

Then we think about setting a focus with them, you know, why are we here guiding guiding the client to a target behaviour that's important to them and important for us is really the idea of focus setting. And, you know, this is really just identifying that target area using things like agenda agenda setting. And asking the client what's important to them, what area of present behaviour might get in the way of the goal that you're talking about, being transparent really about if you have come with a specific idea in mind, that you want to talk about offering it to the client with permission and giving them a chance to say whether or not they agree with talking about that today or what other things were on their mind and making a collaborative kind of pathway to move forward with that.

The next stage you might think about is evoking, and this is where we try to draw out the client's own arguments for change, what's change, whether to change and why. And this is where we try and harness some of that more intrinsically motivated ideas. So that by bringing out someone's own ideas and reasons for change, listening for and recognising these arguments as they arrive and perhaps selectively reinforcing them and avoiding this kind of expert trap where we try to give our own arguments really avoids what we call psychological resistance, where as I mentioned.

When someone's ambivalent, you come in with a good side, it's very easy for them to come in with the opposite. So here we're just trying to get someone to talk positively and as I was mentioning earlier with self-determination. The more we vocalise our own arguments with change, the more they're aligned with our values, the more they're about us as individuals, the more powerful those reasons become and the more likely we'll be to engage in this process.

And finally, we think, you know, once we've gone through this and we feel that that person is, is really ready to change by saying, you know, once they start talking about the importance of it, or we can ask them, you know, what makes you confident you can do it and bring the conversation to a natural point where we can go, OK, but maybe we can start consolidating commitment. Maybe we can start bridging to change by Asking key questions determine the readiness for planning action or assisting them with change plans or, you know, revisiting plans that have been put on the farm before and looking at former changes that have worked or additions to the plan and those kind of things, the how and when we're really putting this in place. And you can kind of see how this is very much a collaborative and farmer centred way of guiding the conversation towards the planning stage rather than going in and saying, OK, well this is something that needs to happen and we're just going to have to work way through it together.

This is more about saying, OK, your world is complex, and I really want to understand it and you have a choice about whether you're in how this is implemented on your farm and let's talk about how that, what that could look like and what that means for you. And this is how the mechanism of MI action works really, so this is building up of relational components that are resonated in things like self-determination theory of giving autonomous choice, accepting the client, building trust and relational components and using technical language to strengthen their own ideas for change that builds that self-confidence, that competency, that self-directedness. So perhaps you can see just even in this rather whistle stop approach, the synergy between these two ideas and and why really this is underpinning our idea of, OK, if we want to move towards an interaction between the vet and farmer that does its very best to look at this quality of motivation, this thing that mobilises this thing that builds engagement and trust and all of these particular qualities that Pets and farmers themselves relate as critical to an advisory interaction.

Taking components from these elements might be a really positive way to do this. And the great thing about MI is that it is evidence-based. There's over 500 controlled trials looking at its use, systematic review and meta analysis support the use of MI and the pursuit of positive behaviour outcomes, and it established, you know, internationally with 3000 trainers in the MI network of trainers that I'm a part of.

And the tech accessible in over 27 languages. So it's really one of these worldwide disseminated empirically validated therapy approaches. So while self-determination theory alone is actually maybe quite difficult to to enact in terms of knowing how to bring this into a conversation with a farmer, motivational interviewing actually helps us do this and realise how this might work in an interaction process.

And my PhD research was, you know, really looking at what happens when vets speak to farmers about herd health using MI techniques and practises. And we were really excited to find that the same kind of positive results came through here is that when vets learned and applied the MI methodology, and this was. You brief MI learning perhaps 4 or 5 hours of the core ideas to see how this works when talking to clients about real change on farm, you know, in between all the usual jobs that are going on, what happened?

And they found that, you know, as we saw an increase in MI skills, we saw an increase in farmers responding more positively using. More positive arguments for change of their own about her health practises under discussion, and these were you know broad from anything from say mastitis to lameness to yoni calf health, but the nuts and bolts of the conversation were what mattered. And when we looked at the specific skills we've been talking about, you know, emphasising the client's autonomy and seeking collaboration with them and affirming their existing positive behaviours, these are the skills that were most likely to lead to farmers responding positively in response and giving arguments like, well, I guess I could do that, or that sounds interesting to me.

These arguments for change that would naturally be evoked from a client. And the inconsistent skills is being more confrontational or perhaps trying to use persuasive arguments and say, well, this just has to happen or you know, this is kind of coming down from above and we have to put this in place and you're just going to have to kind of, you know, there's more directive approaches are most likely to lead to arguments against change. So this is really interesting to see that this isn't again some abstract ideas that are just developed in medical sciences and there's something real that's experienced on farm when vets use it.

So a bit of a whistle stop tour there across the background theory of methodology that has influenced how we want to think about this this environment, but our ideas were, you know, if we're trying to bring in new policy and new stewardship, new ideas around medicines use, but also in the broad remit of her health, my original impetus of my PhD project was looking at lameness and the sits control in any of these aspects we need to really start thinking about. Deeply about motivation and the characteristics are very important in evoking it and strengthening it, allowing people to become more creative and committed over time rather than just trying to get the minimum behaviour through, perhaps putting in a much more top down regulatory approach that might get what we want done, but it won't lead people to become engaged positively and be more creative and empowered in what they do, and that's really what leads to long term engagement. So with the farm animal communication tool sheet, we wanted to bring ideas from self-determination theory and practise from MI together.

This was really the goal, but somehow keep them simple, but both of them are huge, huge concepts with so many features and you know we wanted to see, OK, could we try and boil this down to a task that the farmer has to complete. And maybe allows them to evoke from themselves something they want to change, perhaps, you know, some support sheets for the vet. We were trying to go for less than 5 just so people know it doesn't end up in the back of the van, never being looked at, and we wanted them to be quite accessible and free to use if we can keep it that way.

So trialling these with volunteers or giving them the projects that we're just looking for this kind of material and then ultimately hosting them through an accessible platform. So this is in the spirit of, I guess, MI and being collaborative and partnership based, the whole point of this is to bring it out into practise, so more people are using and benefiting from it. So I'm just gonna talk you through very briefly the components of the fact sheets as they currently stand.

And because our discussions on herd health are ongoing and we're still in consultancy with vets in practise and understanding how to integrate herd health, I'll be talking through some of these on a more poultry component, but they will still give you the overview of these essential components which are for the farmer a questionnaire and an evocative topic choice sheet and the vet, some instructions, some rules of some, and a conversational flow sheet to kind of go through and understand the interaction. So the projects that we have currently released these sheets to is through the lang Hen Welfare Forum. That's an organisation that takes expertise from, you know, a broad range of industry, farm, research, government areas with a primary motive of trying to improve flock management and reduce injurious pecking among laying hens.

And as a recently funded. Programmes being run by Paula Baker at Bristol and Jessica Stokes at RAU primarily they're using bespoke action plans on further cover to engage farmers and fact sheets are just one element of this. And initially they're trying to integrate ideas from self-determination theory and MI just in the very act of going out on farm, the kind of conversations they're having, you know, so instead of going along and saying, well, this is the kind of Management systems that we know work to reduce feather packing, they're going on farm and saying, well, walk me around your farm, tell me what works for you.

What have you put in place yourself? What, you know, how did that feel and what are the benefits of doing it. I'm very much trying to have an autonomously led conversation that's about engaging this kind of self-confidence, this competence in existing behaviours and promoting like positive relatedness by just embedding real respect.

And acknowledgement of the existing, you know, farmer actions and and how we are leading to positive activity in and of themselves. As we said earlier, this idea that, you know, any individual, whether in a farm or any other context is the expert of their own life, and if we can activate this and respect it, we'll build this kind of relational quality that is in and of itself quite functional and promoting good practise. So the fact sheets are really something that they're looking to give to vets over the next couple of months after some initial trialling by Paula and Jessica, looking at how farmers interact when you talk to in this way and the kind of ideas they come up with and they're feeling very confident and very positive about the ability to have farmers self identify change and and use that as a means in to promote positive veterinary interactions on areas that might be, you know, linked to.

Promoting better risk management strategies within block block health plans. So this is why we've got these pictures with with poultry on. So I thought I mentioned it as I thought there might be a little bit of a herd health bias this morning, but again, the documents are all the same.

It's merely the content and the type of things that will be will be slightly different when we're thinking about aspects of herd health relating to medicines use. But the first element of this is the farmer questionnaire. So this is ideally, you know, a document that wouldn't take more than 10 minutes for someone to fill in, but it's something that really the farmer is given perhaps before the visit and can fill in a loan and it's even encouraged to, that's their choice whether to share the content of it with the vet.

Because what we're trying to get here is not, the actual whole document to read through to understand every component part. What we're really trying to get at is farmers self-identifying a topic area that they're happy to talk about with the vet. So we have kind of a list of questions within that, you know, are not value laden, not judgmental, but involve the farmers' kind of active assessment of flock health or herd health through their eyes.

So for example, this question, you know, saying something like, what do the birds see when they look outside of the potholes just to get a sense of how the birds are ranging and each question is given kind of a letter grader. From A to E. And at the end of the questionnaire, what we're trying to get people to do is to say, OK, we'll look through this questionnaire.

Look for areas where you've got more C's or more D's and E's, and these are really where if you mention these to your vet, you could, you might be able to help reduce the the topic issue that we're talking about with these and these, you know, you will be able to help reduce and influence the topic area, you know, we're talking about. So we get the farmers to go through themselves to identify these these questions where the these kind of other letters came up and we use this as a guide to get them to discuss with their vet and self-identify the kind of topic areas that might be worth communicating with the vet about. And as you know, maybe having just gone through the MI approach, you can see this is really just trying to facilitate that focus setting before the vet gets on farm so that it's about the the farmer reviewing.

I honestly going through themselves and identifying a topic area that that makes sense. And this is kind of inspired by another project that I worked on actually in diabetes management where we had individuals fill out questionnaires on diet and having done one myself. And realised that, you know, having been asked by my GP on many occasions, you know, the healthiness of my diet, how much chocolate I eat, you know, the, the alcohol that we all drink, all these kind of things, when you're told that no one's going to look at it and you fill in a questionnaire yourself, you're much more readily to to admit and identify areas where maybe you could change rather than someone directively telling you exactly where your your health problems might be.

And I was rather surprised by the amount of cake I was able to consume on a weekly basis. So the next area that we, we get people to move forward is to a topic choice sheet, and this is again, very simple, very simplistic. But the areas that the, the farmers identify within their questionnaire is a topic area of discussion.

They just have kind of a print out like this on the right. And they just right underneath. I would like to discuss.

You know, for example, bird inspection, and they're encouraged to think through the behaviour steps that are currently in place. So what happens in this process that you could discuss, you know, how it's played out on your farm, one of the main components of it, and this is really to facilitate the conversation with the vet. So you have this.

This is what the farmer will give you when you arrive on farm or perhaps if you go through it together, this is this is the document that you talk through. And again, here the key is the self direction element. If farmers have a choice what to put in this.

They have a chance to give their perspective and really run through without interference exactly what their current approach is and their reasons and and, you know, encouraged to put down, you know, what, what do they think is working, what do they think might be better, and what would they like advice on. And again, this is really keying into those core elements we've been talking about. The vet instruction sheets then we have kind of 3 of these at the moment where there's a simple 1 page instruction on the interaction for the vet.

So you know we talk through how to get the producers to fill in the questionnaire, how to ask them to fill in the discussion sheets with you, how to use the flow sheets, just a very broad overview on how to have this kind of helpful conversation and and you know, links to to wider. Information and advice if desired to learn a little bit more about the skills, but the idea is really that this could be a standalone intervention. You also receive rules of thumb.

So, you know, what if we took ideas from self-determination theory and really try to boil these down to two of the most important things to build this engagement and to ensure that we get someone to internalise and value and self regulate in terms of the advice that we're giving them. So we really look to more empathy and active listening and working with clients with ambivalent responses because we know that these are just a common part of change. And really, you know, the core of both SDT approaches and and these ideas we've been talking about in motivation interviewing.

And again, they'll be signposting some more information of time and interest, but the idea is if you try and implement these two core elements into your practise, that we might see some really big gains and how that conversation plays out and how that person feels when they're, you know, being having their identified change area being discussed with them. And finally there's a very simple flow sheet, which is really trying to bring together the core process of this MI led interaction, thinking a bit about those processes I talked to earlier of engage, focus, evoke and plan and having some step by step goals for the discussion and examples of questions to ask at each stage. Now we know this is incredibly, you know, reducing it to a very small component, and conversations are hugely dynamic and complex.

But even the main overarching process of MI is only 4 stages, and having these kind of goals in a conversational process helps us to focus. So the idea is to maybe give some, you know, an additional pace to this kind of highlighting some of that theory and methodology we've been talking about that would back up this this process and this conversational flow, but to really think, OK, these are really the core areas that we're going to go through with the client, and this is what really matters in that interaction. And I hope you know through all of these sheets, the main intention is to really link to this idea that people feel most able to change when they feel free not to.

Now it's kind of counterintuitive, but if we can give the person that we're choosing to advise the autonomous choice over which part of their farm area they wish to engage with us about it, what that might look like, and then, you know, give skills if that process doesn't entirely bring up all the areas we want to talk about. Basically engage collaborative and autonomous conversation and build this relatedness through active empathy and and resisting the need to persuade. We're hoping to get to a point in just a very simple suite of behaviours that we build better client engagement.

So, you know, the ones I've talked through there obviously, you know, linked to a poultry product. So how are we thinking about adopting these medicines conversations? Well, obviously at the moment the the questionnaire is the thing that's really going to be different.

So this is something that will focus on broad elements of her health, but also having consideration of critical components and medicines. So we see particular in the UK thinking about the guidance that has come down on responsible use of antibiotics and how we can integrate and fully assess aspects of this within the farm through this questionnaire style if that's possible. But the veterinary support sheets are functionally going to be very similar between the poultry context and the herd health, because what we're looking at those for is really how to crystallise these ideas from self-determination and how to crystallise ideas from motivation interviewing.

So not so much the advisory content, but how something is interactive with the farmer. So that's really the broad goal with the next stages of bringing this into the herd health paradigm. So if you know anyone is listening to this this morning and thinking, well, you know, some of these ideas seem to make sense, they resonate with me.

As I said, you know, this isn't about, you know, the farmer behaviour as such, this is the broad psychology and really applies to every element of life in terms of our own motivation as well and our interactions. And if maybe some of it is resonated with you, we are looking for voluntary engagement and involvement on these these fact sheets because we would like to give them out freely, but obviously we want to do so knowing. Exactly how they work and the kind of benefits and drawbacks and how we could best give, you know, the right support and advice and the right supporting sheets to allow this process to try and materialise without the need for intensive training and the need for for going and pursuing and understanding all these complex methodologies.

So if this is something that you might be interested in contributing to, but you might want some of the support, you might want these as the ready for release. There's an email address here. Which is [email protected].

And what we'll be doing is monitoring this and if you send in your name and your address, and we'll add you to the list of participants who would like to be contacted and I myself will be working with Fiona, who is also chairing this session, who is a fellow MI enthusiast and we'll be closely working and promoting other projects around MI as well in the future. And together we're hoping to promote this in industry and really push this through. So the take home message really, you know, engaging clients, it's really about having effective conversations that engage this motivation.

Self-determination theory teaches us that if we can have activities that are more internalised that, you know, this will lead to better initiatives, better coping, less anxiety, all these qualities that we know will allow behaviours to persist on farm. And I consistent communication as a way to help this and to achieve those features of autonomy, relatedness and competence. And that's why we have these fact sheets to try to enact these ideas with simple, easy to follow guidelines.

So I hope this is kind of giving you an overview of the thought process that got us here, why we think it's important, the theory and methodology that has led us to this these outputs. And again, as I mentioned, if you're interested in getting in touch, that's the email there that I'll leave up on the screen. There's also free information on motivation interviewing through either this website here with resources or free modules online through BMG based on health sciences do feel free to explore more and thank you ever so much for listening.

I hope it's been of interest and maybe giving you something to reflect on and take away for your clients coming up. Thanks very much, Alison, that was fantastic, really enjoyed that, and I hope you did too. So.

As such, thank you very much, Alison, for giving the email address for people to get in touch. There's no questions come through at the moment, but I'd certainly like to reinforce what Alison's been saying. It's certainly always helpful to understand more deeply what motivates ourselves and obviously then farmers, as we're all humans, to make changes and what, you know, what, what factors are behind that, so we can lead.

So everyone can get to better and more effective relationships, and behaviour changes. So thank you, Alison. One quick question actually, how did the farm, any sort of farmer feedback on the approach that the vets were starting to use after the training?

Were they, intrigued or any sort of particular bits of feedback that you could share with us? Well, I actually spoke, because of Paula Baker and Jessica Stokes have been doing this quite recently in the poultry sector, and I was asking, you know, how, how have they found people engaging because I think It's a bit of a vulnerable thing to start saying, you know, oh well, I'm not going to give you the advice, so I'm just want to evoke it from you and that makes us kind of go, well, that's not really my role on farm. People must notice that quite quickly and and get a bit uncomfortable and wonder what I'm doing.

But they said that the feedback has actually been really positive. Again, if you think, you know, we all. All the experts of our environment and once we kind of give people an opportunity to say look what works for you and what applies on this farm and, and how does this make sense for you moving forward and what are your ideas for change?

It's, you know, although it's stylistically very different from a normal advisory conversation, we might think that that could. Create a bit of tension. Actually, people tend to be so engaged from finally having someone go, oh, you know, your opinion really matters and And we can only integrate this expertise in science, understanding your perception, your farm, your motivations.

They've responded in their projects very positively to this. And there's been some really good engagement on integrating these skills and the kind of answers and and competencies they've had put forward as a result. So in their project, it's all going very well.

In my PhD research, obviously I was mainly looking more. Specific communication variables and what we could draw from that to to assume engagement. But as I said, you know, when these skills are used more, we see in response, farmers change talk, the arguments for change there and the verbal behaviours of engagement really do increase.

So across the board, although obviously there's, it's, you know, it's one of those things that perhaps isn't for everyone and it's part of integrating. With your natural style, we see in response people are, you know, farmers tend to be very positive as our clients across a range of disciplines and environments that this is used in. So yeah, I guess that's why maybe things like motivation to viewing across international and language boundaries because they they target something really fundamentally human about what to be listened to and heard and valued.

Yeah, very good point. Excellent. Well, hopefully, I'm and I'm sure we're both looking forward to having being contacted and people want to get engaged because I think it's a fantastic project.

And thank you very much, Alison, look forward to hearing more in the near future.