Nordic veterinarians' threshold for medical treatment of dairy cows, influence on disease recording and medicine use: mild clinical mastitis as an example.

National databases for dairy cows in the four Nordic countries, Denmark, Finland, Norway and Sweden, have been found to capture varying proportions of disease events on farm. A variation in the thresholds of veterinarians to initiate medical treatment may be a reason for this. Studying these thresholds may increase the understanding of prudent use of antibiotics. The primary objective of this study was to investigate whether Nordic veterinarians, on a between country-level, vary in their intention to start medical treatment of a dairy cow with mild clinical mastitis, on the same day as making the diagnosis. The threshold for initiating treatment was quantified as an intention score. Secondary, underlying behavioural components of the intention score was studied within each country. A social psychology model, the Theory of Planned Behaviour (TPB), was used to design a questionnaire that was distributed to 1047 veterinarians in cattle practice in the four countries during autumn 2010. The response rate was around 50% in all the countries, and 543 observations were retained for analysis. The between-country differences in intention were tested with one-way analysis of variance. Multivariable linear regression was used to estimate the proportion of variability in intention explained by the three behavioural components, attitude, subjective norm and perceived behavioural control. The Spearman rank correlations between specific beliefs about the behaviour and intention scores were estimated to find beliefs of high influence on the decision to treat or not. Intention scores differed between all countries (p<0.05) except between NO and SE (p=0.06). The mean intention scores were 0.71, 0.42, 0.58 and 0.50 in DK, FI, NO and SE, respectively. As measured by the adjusted R(2) in linear regression models, the underlying behavioural components of the TPB explained 0.37, 0.41, 0.40 and 0.48 of the variation in intention scores in DK, FI, NO and SE, respectively. Attitude was the most important predictor in DK, NO and SE, but perceived behavioural control was most important in FI. In all countries the specific attitude belief of highest influence was that starting treatment the same day as diagnosing a case of mild clinical mastitis gives the best result, compared to delaying treatment. The varying intentions of veterinarians to initiate medical treatment are likely to influence centrally registered mastitis incidence. This study has given an improved understanding of this behaviour, which may be useful in intervention studies or campaigns aiming at prudent use of antibiotics on dairy farms.

Nordic dairy farmers' threshold for contacting a veterinarian and consequences for disease recording: mild clinical mastitis as an example.

Previous studies have addressed the differences in registered disease incidence between the Nordic dairy disease recording systems. The main objective of this study was to investigate whether Nordic dairy farmers have varying intention to contact a veterinarian the same day as detecting signs of mild clinical mastitis (MCM) in a lactating dairy cow. This is the first, and necessary, step in the process leading to a disease event being recorded. The second objective was to study underlying behavioural components influencing this threshold for action. A questionnaire-based survey was carried out in Denmark, Finland, Norway and Sweden. The questionnaire was based on the Theory of Planned Behaviour from the field of social psychology. After performing qualitative face-to-face elicitation interviews a set of statements about treatment of MCM was identified. These were grouped into behavioural, normative and control beliefs. The most frequently mentioned beliefs were rephrased as questions. Behavioural intention, a proxy for the behaviour of interest, was assessed using case scenarios. The target and eligible herds were in milk recording and had an average herd size of at least 15 cows. The questionnaire was distributed to 400 randomly sampled dairy producers per included country. The response rate was around 50% in all four countries. The hypothesis of differences in behavioural intention between the countries was tested using Wilcoxon's rank-sum tests. Multivariable linear regression was used to estimate the country-specific variability in behavioural intention as explained by attitude, subjective norm or perceived behavioural control alone, or in combination. The Spearman rank correlations between behavioural intention and each belief, weighted by its outcome evaluation or the motivation to comply, were estimated to find the most important drivers, constraints and social referents for the behaviour of interest. There were significant (p<0.01) differences in behavioural intention between all countries except Denmark and Norway. Swedish farmers had the weakest behavioural intention and Finnish farmers the strongest. Attitude explained most of the variability in behavioural intention in all four countries. The most important driver in all countries was to achieve a quick recovery for the cow. The varying behavioural intention partly explain the differences in completeness of disease data in the Nordic countries: if farmers have different thresholds for contacting a veterinarian the registered incidence of clinical mastitis will be affected. Knowledge about the importance of attitudes and specific drivers may be useful in any communication about mastitis management in the Nordic countries.

Increases in the completeness of disease records in dairy databases following changes in the criteria determining whether a record counts as correct.

BACKGROUND: The four Nordic countries: Denmark (DK), Finland (FIN), Norway (NO) and Sweden (SE), all have national databases in which mainly records of treated animals are maintained. Recently, the completeness of locomotor disorder records in these databases has been evaluated using farmers' recordings as a reference level. The objective of the present study was to see how previous estimates of completeness figures are affected by the criteria determining whether a recording in the database is to be judged correct. These demands included date of diagnosis and disease classification. In contrast with the previous study, a period of time between the date of disease recording in the database and by the farmer was allowed. Further, the calculations were brought to bear on individual locomotor diagnoses instead of a common locomotor disease complex code. METHODS: Randomly selected dairy herds (≥15 cows) were invited to participate. During two 2-month periods in 2008 the farmers recorded the diseases they observed on the farm and their recordings constituted a farmer database (FD). These recordings were compared to disease recordings in the National Databases (ND). Earlier calculations of completeness for locomotor complex cases assuming an exact match on date were compared with ±7 day and ±30 day discrepancies calculated in this study. RESULTS: The farmers in DK, FIN, NO and SE recorded 426, 147, 97 and 193 locomotor disorders, respectively. When a window of ±7 days was allowed there was a relative increase in completeness figures lying in the range of 24-100%. Further increases were minor, or non-existent, when the window was expanded to ±30 days. The same trend was seen for individual diagnoses. CONCLUSION: In all four of the Nordic countries a common pattern can be observed: a further increase in completeness occurs when individual locomotor diagnoses recorded by the farmer are permitted to match any locomotor diagnosis recorded in the ND. Completeness increased when both time span and different diagnoses within the locomotor complex were allowed.

The association between farmers' participation in herd health programmes and their behaviour concerning treatment of mild clinical mastitis.

BACKGROUND: In Denmark, it has recently become mandatory for all dairy farmers with more than 100 cows to sign up for a herd health programme. Three herd health programmes are available. These differ in a number of aspects, including the frequency of veterinary visits and the farmer's access to prescription drugs. The objective of this study was to investigate whether dairy farmers' behavioural intentions, i.e. to call a veterinarian or start medical treatment on the day that they detect a cow with mild clinical mastitis (MCM), are different depending on the type of herd health programme. METHODS: A questionnaire survey based on the Theory of Planned Behaviour (TPB) was conducted. TPB proposes that a person's behavioural intention is strongly correlated with his or her actual behaviour. Three behavioural factors determine the behavioural intention: attitude, subjective norm and perceived behavioural control. Each of these factors is decided by a set of beliefs, each of which in turn is weighted by an evaluation: 1) the expected outcomes of performing the behaviour, 2) what a person believes that others think of the behaviour, and 3) the person's perceived power to influence the behaviour.A set of statements about the treatment of MCM based on interviews with 38 dairy farmers were identified initially. The statements were rephrased as questions and the resulting questionnaire was distributed to 400 randomly selected Danish dairy farmers who use the two most restrictive herd health programmes, either Core or Module1, and to all 669 farmers with the least restrictive herd health programme, Module2. The association between intention and the herd health programme was modelled using logistic regression. RESULTS: The farmers with the Module2 herd health programme had a significantly higher behavioural intention to perform the behaviour, when compared to farmers with a more restrictive herd health programme (OR = 2.1, p < 0.0001). CONCLUSION: Danish dairy farmers who participate in Module2 herd health programme had a higher intention to treat cases of MCM, compared to farmers who participate in a more restrictive herd health programme in which the veterinarian initiates treatments.

Completeness of the disease recording systems for dairy cows in Denmark, Finland, Norway and Sweden with special reference to clinical mastitis.

BACKGROUND: In the Nordic countries Denmark, Finland, Norway and Sweden, the majority of dairy herds are covered by disease recording systems, in general based on veterinary registration of diagnoses and treatments. Disease data are submitted to the national cattle databases where they are combined with, e.g., production data at cow level, and used for breeding programmes, advisory work and herd health management. Previous studies have raised questions about the quality of the disease data. The main aim of this study was to examine the country-specific completeness of the disease data, regarding clinical mastitis (CM) diagnosis, in each of the national cattle databases. A second aim was to estimate country-specific CM incidence rates (IRs). RESULTS: Over 4 months in 2008, farmers in the four Nordic countries recorded clinical diseases in their dairy cows. Their registrations were matched to registrations in the central cattle databases. The country-specific completeness of disease registrations was calculated as the proportion of farmer-recorded cases that could be found in the central database. The completeness (95% confidence interval) for veterinary-supervised cases of CM was 0.94 (0.92, 0.97), 0.56 (0.48, 0.64), 0.82 (0.75, 0.90) and 0.78 (0.70, 0.85) in Denmark, Finland, Norway and Sweden, respectively. The completeness of registration of all CM cases, which includes all cases noted by farmers, regardless of whether the cows were seen or treated by a veterinarian or not, was 0.90 (0.87, 0.93), 0.51 (0.43, 0.59), 0.75 (0.67, 0.83) and 0.67 (0.60, 0.75), respectively, in the same countries. The IRs, estimated by Poisson regression in cases per 100 cow-years, based on the farmers' recordings, were 46.9 (41.7, 52.7), 38.6 (34.2, 43.5), 31.3 (27.2, 35.9) and 26.2 (23.2, 26.9), respectively, which was between 20% (DK) and 100% (FI) higher than the IRs based on recordings in the central cattle databases. CONCLUSIONS: The completeness for veterinary-supervised cases of CM was considerably less than 100% in all four Nordic countries and differed between countries. Hence, the number of CM cases in dairy cows is underestimated. This has an impact on all areas where the disease data are used.