Danish cattle veterinarians' perspectives on antimicrobial use: Contextual and individual influencing factors.

The global risk for antimicrobial resistance (AMR) can be reduced by reducing antimicrobial use (AMU). Veterinarians are one of the key actors in relation to AMU in livestock, and understanding the dynamics of veterinary treatment and prescription is central to achieving AMU reduction. Veterinary AMU decisions are influenced by a complex pattern of both individual and contextual factors. In this study, we conducted semi-structured interviews with 16 Danish cattle veterinarians to investigate their perspectives on AMU and current practices in a national context with low use and extensive legal control. We found that personal experiences and emotions, rather than scientific evidence, guided some veterinarians when making AMU choices. Furthermore, less-experienced veterinarians felt pressure to prescribe according to colleagues' and farmers' preferences for certain antimicrobials. We found that changes in Danish legislation seemed to have introduced hesitancy and a lack of motivation within the veterinary profession, and that AMR was perceived as an abstract threat not applicable to the veterinarians' daily professional decision making. We concluded that the lack of field-generated research of local relevance nourished a culture in which AMU choices are built on personal experience rather than scientific evidence, which also diminished newly educated veterinarians' self-confidence in relation to their AMU choices. Future research should focus on developing locally relevant research on optimal AMU choices and AMR, and the implications of extensive legal control of AMU in livestock farming should be further investigated to find a balance on the path to reducing AMU.

The antimicrobial landscape as outlined by Danish dairy farmers.

Limiting antimicrobial use (AMU) in dairy farming is an important step toward reducing antimicrobial resistance (AMR). Therefore, it is relevant to understand dairy farmers' choices and the potential for change in relation to AMU, even in countries with low usage. Furthermore, there is an increasing recognition of the need to focus on both the individual farmer's behavior as well as the context surrounding and influencing the farmer's decisions in relation to AMU if the goal is further reduction. To date, no studies have taken into account both the individual farmer and their context in both conventional and organic dairy farms under Danish conditions. For this study, 15 Danish dairy farmers were interviewed using qualitative semi-structured research interviews, and the notion of landscape was used to describe the context of their AMU. We found that AMR was considered a distant element of the farmers' antimicrobial landscape. Daily challenges such as acutely diseased animals and poor housing conditions seemed more urgent and overruled the threat of AMR. We also found that interviewed farmers had differing opinions on farm management, partly shaped by changes in legislation and ways of farming over time. At one end of the scale, some organic farmers had rethought the current way of farming; keeping robust animals in a natural setting was expected to prevent disease. They were positive about legislation, and the numerous restrictions on AMU over time were thought to contribute to ensuring quality for consumers. At the other end of the scale, some conventional farmers perceived disease as something that should be controlled through treatment, and the currently eased legislation and intensification of farming have legitimatized AMU for this purpose, leading to an expectation among these farmers of certain rights to handle medicines themselves. These contrasting views might lead to inspiration and competition in terms of reducing AMU, as the farmers appeared to value the opinions of other farmers, and they were found to continuously assess each other. Through such ongoing assessment, pioneers of AMU reduction-whether organic or conventional-might motivate their colleagues to change their AMU. Future research should address the potential of experience- and attitude-sharing among farmers as motivation to reduce AMU.

Veterinary Herd Health Consultancy and Antimicrobial Use in Dairy Herds.

The globally increasing level of antimicrobial resistance affects both human and animal health, why it is necessary to identify ways to change our current use of antimicrobials. The veterinary herd health collaboration between veterinarians and dairy farmers provides a useful setting for changing antimicrobial use in livestock. However, farmers and veterinarians work in a complex agricultural setting influenced by socio-economic factors, which complicates their choices regarding antimicrobial usage. It is therefore necessary to be aware of the range of potential influencing factors and to integrate this knowledge in the relevant local settings. This manuscript presents a literature review of relevant factors relating to antimicrobial use within the veterinary herd health consultancy setting, including knowledge gaps of relevance for changing the use of antimicrobials. An enriched version of the framework of the Theory of Planned Behaviour was used to organise the literature review. We identified diverging attitudes on correct treatment practices and perceptions of antimicrobial resistance among veterinarians and farmers, influenced by individual risk perception as well as social norms. Furthermore, disagreements in terms of goal setting and in the frequency of herd visits in relation to herd health consultancy can negatively influence the collaboration and the intention to change antimicrobial use. Farmers and veterinarians emphasise the importance of legislation and the role of the dairy industry in changing antimicrobial use, but the relevance of specific factors depends on the country-specific context. Overall, farmers and veterinarians must communicate better to understand each other's perspectives and establish common goals within the collaboration if they are to work efficiently to reduce antimicrobial use. Farmers and veterinarians both requested changes in individual behaviour; however, they also called for national and structural solutions in terms of balanced legislation and the availability of better diagnostics to facilitate a change in antimicrobial use practices. These various paths to achieving the desired changes in antimicrobial use illustrate the need to bridge methodological research approaches of veterinary science and social sciences for a better understanding of our potential to change antimicrobial use within the dairy farm animal sector.