Challenges identified in dealing with horse owners over Hendra risk

A coloured transmission electron micrograph of the Hendra, virus. Photo: The Electron Microscopy Unit of the Australian Animal Health Laboratory, part of the CSIRO science agency CC BY 3.0 via Wikimedia Commons
A coloured transmission electron micrograph of the Hendra virus. Photo: The Electron Microscopy Unit of the Australian Animal Health Laboratory, part of the CSIRO science agency CC BY 3.0 via Wikimedia Commons

One in every four owners told that their horse may have contracted the deadly Hendra virus were either initially unreceptive, overwhelmed by fear, or in denial about the associated risk, research has found.

Researchers from James Cook University in Townsville, Queensland, wanted to learn more about the difficulties experienced by veterinarians when communicating with animal owners about the risks of zoonotic infections − those capable of crossing the species barrier.

Diana Mendez and her colleagues did so by examining the veterinary issues around Hendra, a virus carried by Australia’s native fruit bats which is capable of infecting horses. People can contract the disease through contact with infected bodily fluids from horses. Of the seven known human cases, four have proved fatal.

The researchers, writing in BMC Veterinary Research, said communication skills were essential for veterinarians who needed to discuss animal health-related matters with their clients.

“When dealing with an emerging zoonosis, such as Hendra virus, veterinarians also have a legal responsibility to inform their clients about the associated risks to human health.”

The study team carried out a mixed-methods study that examined the preparedness of, and difficulties experienced by, veterinarians communicating about Hendra risks with their clients.

Face-to-face semi-structured interviews were carried out with veterinary personnel in Queensland in 2009–10 to identify the barriers to Hendra management in equine practices. Then, in 2011, veterinarians from the same region were surveyed on their preparedness and willingness to communicate about Hendra risks, and the reactions of their clients.

All of the veterinary personnel interviewed were aware of their legal responsibilities over Hendra risks to human health and had some level of management plan in place.

The researchers found in the later survey, which drew 200 responses, that 83.1 percent of the vets had access to a Hendra management plan and 58.6% had ready-to-use Hendra information available for clients within their practice.

Most (87%) reported “always or sometimes” informed clients about Hendra risks when a horse appeared sick. However, fewer than half the participants (46.6%) always or sometimes provided Hendra-related education to owners when a horse appeared healthy.

When Hendra virus infection was suspected, 58.1% of participants reported their clients were receptive to their safety directives. However, 24.9% of clients were either initially unreceptive, overwhelmed by fear, or in denial of the risks.

Hendra-related risk communication to clients was perceived overall as a significant issue by interfering with veterinarians’ compliance with their animal welfare and occupational health and safety responsibilities.

One vet commented: “I find great difficulty in dealing with owners because it is a power play, and ultimately we are responsible of the safety of all involved. But some owners don’t believe that, which compromises the legal situation. We usually end up taking the risk out of concern for the welfare and wellbeing of the horse.”

However, another vet did not find this aspect of Hendra management a major challenge: “I have not had problems with owners complying … You just need to make them aware of the situation and the risks involved.”

Some owners considered the use of personal protective equipment to be redundant. Horse owners who had already been in prolonged close contact with their sick animal believed they had already been significantly exposed to the potential risks and did not require the safety gear.

One vet commented: “The owner had already spent half a day with the sick horse, so he declined the mask because [he] thought exposure had already happened.”

Another observed: “Most clients refuse personal protective equipment as they have already been handling the horse, so they don’t feel it necessary to use [it].”

The study team continued: “Veterinarians identified this as a major issue because if a client became infected it would be impossible to determine when infective exposure had occurred: before or after the involvement of the veterinarian.”

Some veterinarians reported that horse owners disregarded the information given about Hendra management.

Participants thought this was because horse owners either failed to recognise the expertise of the veterinarian, the seriousness of the risks, or were unable to follow the health and safety instructions provided.

One vet commented: “You have to protect yourself first and foremost, but owners don’t see it that way.”

Another said simply: “People don’t listen.”

Horse owners usually made mistakes despite explicit instructions, another vet observed, while one commented: “They are in denial and think you are overreacting.”

Veterinarians reported feeling pressured by clients into focusing on cost minimisation rather than human health and safety. Any extra cost incurred by the management of a suspected case of Hendra was said to require a justification to the client.

“Emerging zoonoses are unpredictable events that may require a different communication approach,” the researchers wrote.

“Future training programs addressing veterinary communication skills should take into account the particular issues inherent to managing an emerging zoonosis and emphasise the importance of maintaining human safety.

“There needs to be further investigation of the particular skills or personal attributes that are necessary to communicate effectively in these kinds of crisis situations, emerging zoonotic outbreaks, within the veterinary context in order to better train existing and future veterinarians.

“Veterinarians also need to be aware of the ways in which their expertise is perceived and the motivation of their clients, in order to achieve better communication.

“This could be achieved by implementing a client-centred approach to veterinary communication with the aim of not only improving the veterinarian-client relationship but also achieving positive health and safety outcomes for both veterinary staff and their clients when dealing with zoonotic risks.”

The study team comprised Mendez, Petra Büttner, Jenny Kelly, Madeleine Nowak and Rick Speare, who has since died.

Difficulties experienced by veterinarians when communicating about emerging zoonotic risks with animal owners: the case of Hendra virus
Diana H Mendez, Petra Büttner, Jenny Kelly, Madeleine Nowak and Rick Speare (posthumously)
BMC Veterinary Research 2017 13:56 DOI: 10.1186/s12917-017-0970-2

The study, published under a Creative Commons License, can be read here

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