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Report: AI.COMM Report: KAP study Laos, Cambodia and VietnamJune 2008

Avian Influenza Behaviour ChangeBaseline Study: Vietnam and Cambodia

June 2008

Prepared for

AED

Kay Engelhardt, TNS Vietnam

Daniel Lindgren, TNS Regional

Page 2Report: AI.COMM Report: KAP study Laos, Cambodia and VietnamJune 2008 2

IntroductionBackground & method

The Mind-set Barometer

KAP indicators Vietnam

KAP indicators Cambodia

USAID KAP indicators

Program Effectiveness Index Benchmarking

Barriers to preventative behavior

Media usage

Recommendations

Annex

In response to the need for Avian Influenza (AI) prevention, AED is planning to conduct behavioural change communication activities in Vietnam, Cambodia and Laos mainly targeted to backyard poultry farmers and small commercial poultry farmers.

Research was needed to gain insight and information for developing communication strategy. AED also needed to establish baseline measures for a number of predetermined KAP indicators. These will later be monitored over time.

This report represent the baseline result for Sector 3 & 4 farmers across 10 provinces and 20 districts in the three countries. The focus is on KAP indicators, the overall mindset of beneficiaries, barriers to AI prevention behavior and media behavior.

Page 3Report: AI.COMM Report: KAP study Laos, Cambodia and VietnamJune 2008

Background &Method


BackgroundThe study design includes both a qualitative and quantitative assessment to allow for a detailed assessment of attitudes and behaviour in relation to AI prevention as well as change barriers. The qualitative assessment is presented in a separate report focusing on to what extent AI is a concern to poultry farmers and other stakeholders. The quantitative report is more focused on KAP indicators and setting a baseline to which future communication efforts can be assessed.

As a direct measure of knowledge and behavioural change, the framework is linked to a “Mind-set Barometer”. The Mind-set Barometer is developed around the predetermined KAP (Knowledge, Attitude, Practice) indicators established by USAID. It is simply a weighted one number measure made up from all the key indicators.

Because communication will be carried out in several countries, it is important that measurements and evaluations are aligned for better consistency. The study was therefore designed to have a framework that will allow AED to benchmark its activities across countries as well as over time. Benchmarking is achieved through the incorporation of a Program Effectiveness Index (PEI) which is independently measured.


Research Objectives

Specific objectives include:

Baseline Stage

To highlight main concerns about AI as well as knowledge gaps (mainly through qualitative assessment)

To map results in terms of behavioral change process (Knowledge, Attitude, Practice) across countries and segments through a “Mind-set Barometer”

To determine extent of behavior compliance in relation to specific KAP indicators

To determine main barriers to AI prevention

To gain an insight into effectiveness of current AI initiatives and establish a benchmark to which future programs can be assessed

To determine how people best can gain access to information about AI


Research Design

Country Vietnam Cambodia* Laos

Locations

4 provinces: − Nam Dinh− Thai Binh− Nghe An− Hau Giang

3 provinces: − Kandal− Pursat− Kampot

3 provinces− Champasack− Savannakhet− Vientiane

Sample size

Backyard poultry farmers (Sector 4) N=800 N=600 N=600

Small commercial poultry farmers (Sector 3)

N=400

SamplingRandom sampling of households selecting dwelling with an interval of 3. Data collection methodFace to face, door to door interviewing using a structured questionnaire

•* Fieldwork conducted by MSD, TNS’ field partner in Cambodia.


Field Procedure

In each country a central briefing was conducted with the participation of:All supervisorsThe project manager and executive

All interviewers were thus personally briefed and instructed.

The instructions included:Sampling proceduresQuestion by question training on the questionnaireHow to avoid refusals to important questionsQuality control procedures

Role-play and pilot interviews were conducted to familiarize the interviewers with the questionnaire.

The pilot tests in both countries were successful and minor adjustments in the wording of a few items were implemented.

In the main field phase no major occurrences were reported.

According to TNS standard 30% of all questionnaires for each interviewer are validated.


Final Sample: Vietnam

Province District Commune Sector 3 – Small commercial

poultry farmers

Sector 4 – Backyard poultry farmers

Total

Nam Dinh Nam Truc Nam Giang, Nam Hung, Nam Thai

50 100 300

Truc Ninh Truc Chinh, Truc Thanh, Trung Dong

50 100

Thai Binh Dong Hung Dong Kinh, Thang Long, Trong Quan

50 100 301

Thai Thuy Thai Hung, Thuy Thanh 50 101Nghe An Dien Chau Dien Hong, Dien Lien 50 100 304

Hung Nguyen

Hung Nguyen town, Hung Tan

54 100

Hau Giang

Phung Hiep Tan Long, Hoa My, Cay Duong town

50 101 301

Chau Thanh Dong Phuoc A, Dong Thanh, Phu An, Phu Huu, Dong Phuoc

50 100

Total 404 802 1,206


Final Sample: Cambodia

Province District Commune Sector 4 – Backyard

poultry farmers

Total

•Kandal Kien Svay Banteay Daek, Kokir, Kokir Thum

105 210

Kaoh Thum Chheu Khmau, Preaek Chrey, Sampov Lun

105

•Pursat Kandieng Anlong Vil, Kandieng, Svay Luong

105 210

Bakan Ou Ta Paong, Svay Doun Kaev, Trapeang Chong

105

•Kampot Kampot Chum Kriel, Trapeang Pring, Trapeang Sangkee

105 209

Bantheay Meas Bantheay Meas Khang Kaeut, Samraong Kraom, Samraong Leu

104

Total interviews 629


Main decision maker for poultry in the family

Females overall and children in Cambodia are facing a greater risk of contracting AI as they are mainly responsible for handling the poultry.

2

24

45

29

3

8

58

31

3

9

50

37

0 10 20 30 40 50 60 70

Other person

Child

Female household head

Male household head

Vietnam sector 3

Vietnam sector 4

Cambodia

Laos


Awareness of AI and AI programs

Awareness of AI and related programs is overwhelming with nearly 100%.

AI Awareness

100100100 1009898

0

20

40

60

80

100

VietnamSector 3

VietnamSector 4

CambodiaSector 4

Laos Sector4

Aware of AISeen AI initiative


The Mind-set Barometer

Quick overview of KAP results


KAP Questions

In line with previous research and building upon indicators set by USAID, a total of 6 key questions were used as a basis for the Mind-set Barometer. Each question addresses a specific knowledge and behavioral change issue and has been weighted:

Weight Key Questions Correct Answer

10 Identifying a possible outbreak of AI

Sudden and massive death in poultry

10 AI sign in humans Fever, Difficulty breathing, Cough, Muscle ache, Head ache, Sore throat

10 To whom an AI outbreak should be reported

Animal health worker , Village head, Agricultural extension worker, Local authority,

Cluster head, District office, Unit head, Animal raising authorities,

Person of authority non-political, People’s committee (Vietnam only),

Head of Hamlet (Vietnam only), Village policeman (Vietnam only)

10 Action to take with AI victims Bring to them to a health facility

30Knowledge about and Practice of ways to decrease risk of AI in poultry

Vaccinate poultry against AI, Keep in fenced area or pen, Separate chickens and ducks, Keep new poultry separate for 2 weeks, Wash hands with soap before and after handling poultry, Change clothes when coming from other farm or market, Keep visitors away from your poultry, Store manure/ fertilizer from other farm for 3 weeks

30Knowledge about and Practice of ways to decrease risk of AI in humans

Wash hands with soap before and after handling poultry, Wash hand with soap before cooking, Change and wash clothes after handling poultry, Do not let children handle poultry or eggs, Do not eat duck or geese blood pudding, Do not eat under cooked poultry or eggs, Don’t eat poultry that has fallen dead, Burn and bury dead poultry


Mind-set Barometer

Behavioral change without the right mind-set may be short lived without a sustainable outcome. In accordance with the KAP concept, behavioral change must be supported by knowledge as well as the desired attitude.

•Positive•Achieved Goal

•Neutral•Developing Positive

•Negative•High Risk Attention

Knowledge

Attitude

Behavior

Naive

Denial

Developed

Engaged

PreventativeHigh Risk

Result from the KAP are converted into a weighted 0-200 barometer score

The “Mind-set Barometer” provides a quick overview of peoples’ mental state and adopted behavior. It pin- points where critical situations exist as well as monitoring development over time.

KAP weight

25%

25%

50%


Mind-set Distribution

Thrivers Strivers Survivors

Identify success

Develop & improve

Push

Educate

Follow up

Reinforce behavior

Improve program reach

Identify and overcome barriers

Educate

Have the required knowledge and are

building towards behavioral change

Desired behavior is present but it is not

supported by knowledge and / or

attitude

Neither the desired knowledge nor behavior

is in place.

STR

ATE

GY

SIT

UA

TIO

N

Beneficiaries can be divided into three groups based on their developmental stage: Thrivers, Strivers and Survivors. Because of their different situation, variation to event strategy is required. For thrivers we can push forward whereas strivers and survivors require more education to build knowledge.


Overall Behavioral Change

Mind-set Barometer

109

93

117

80

90

100

110

120

130

Vietnam Cambodia Laos

Sector 4 Sector 3

Mind-set Distribution

38 289

2124

11

41 48

80

0%

20%

40%

60%

80%

100%

VietnamSector 3

VietnamSector 4

CambodiaSector 4

Laos Sector4

SurvivorsStriversThrivers

Situation:Given that there have been AI initiatives taking place in Vietnam and most people are aware of them, it is not surprising to see Sector 3 Farmers with a higher barometer score (117) compared to backyard poultry (Sector 4) farmers (109). However, the scores are relatively low and both groups have significant proportion of people who are at risk with poorly developed awareness and not engaging in preventative behavior.

Strong educational focus is needed, especially on preventative methods for how to protect poultry and ones family from potentially contracting AI. Effective use of messages should be considered.


Vietnam Sector 3 Mind-set Barometer Score

Situation:Looking across subgroup it can be seen that smaller Sector 3 farmers face higher risks together with those who involve children in looking after the poultry business. Not surprisingly perhaps, those with lower education are at higher risk. On the positive side it can be seen that media has a positive effect on those watching TV and listening to radio regularly.

Segment Sample size % Sector 3

Barometer scoreOverall 405 100 117

Number of poultryLess than 50 174 43 105

50-99 poultry 125 31 125

100+ poultry 105 26 126

MediaTV watchers 352 75 121

Radio listeners 72 15 129

No media consumption 46 10 87

EducationNo formal education / primary school 70 17 87

Secondary school 204 50 123

High school or higher 130 32 122

Mainly responsible for poultryMale household head 151 38 120

Female household head 203 50 118

Children in the household 38 9 103

Other person 13 3 na


Mind-set Barometer Score by Segment

Situation:Sector 4 farmers also face higher risks amongst those who involve children in looking after poultry, although this is a relatively small group. Those with lower education face higher risk. Again, media has a positive effect and those listening regularly to radio and watching TV have a much more developed mind-set.

Segment Sample size % Sector 4

Barometer scoreOverall 802 100 109

Number of poultry5-19 poultry 799 100 109

20-50 poultry 2 0 na

50-99 poultry 1 0 na




EducationNo formal education / primary school 149 19 88

Secondary school 464 58 113

High school or higher 189 24 116

Mainly responsible for poultryMale household head 252 31 109

Female household head 464 58 112

Children in the household 66 8 96

Other person 20 2 na


Mind-set Barometer Score by Segment

Situation:Cambodia has a very uniform result. Unlike Vietnam, TV and Radio media does not appear to have played a major role in contributing to behavioral change. More children are responsible for handling the poultry.

Segment Sample size % Cambodia

Sector 4Sample

size % Laos Sector 4

Overall 629 100 93Number of poultry5-19 poultry 479 76 93

20-50 poultry 150 24 95

50-99 poultry 0 0




EducationNo formal education / primary school 345 55 90Secondary school 192 31 96High school or higher 92 15 102Mainly responsible for poultryMale household head 183 29 92Female household head 283 45 91Children in the household 153 24 99Other person 10 2 na

Page 20Report: AI.COMM Report: KAP study Laos, Cambodia and VietnamJune 2008Base: All

Sector 4 80 Chau Thanh 82 Phung Hiep 79

Sector 3 86 Chau Thanh 88 Phung Hiep 84

Hau Giang

Mind-set Barometer Vietnam by Region

Sector 4 125 Nam Truc 127 Truc Ninh 123

Sector 3 143 Nam Truc 149 Truc Ninh 137

Nam Dinh

Sector 4 119 Dong Hung 119 Thai Thuy 118

Sector 3 124 Dong Hung 122 Thai Thuy 126

Thai Binh

Sector 4 114 Dien Chau 107 Hung Nguyen 121

Sector 3 115 Dien Chau 107 Hung Nguyen 122

Nghe An

Situation:There are clear regional differences. Hau Giang in particular has a significantly lower barometer score for both sectors. Sector 3 is also somewhat weaker than average in Nghe An. Nam Dihh on the other hand is doing much better, especially Sector 3 Farmers.


Mind-set Barometer Cambodia (Sector 4)

KrongKep

OtdarMean Chey

BanteayMean Chey

Battambang

PursatKg. Chhnang

Paillin

Siem Reap

Kg. Thom

Preah Vihear

Kg. Cham

Kratie

SvayRieng

Prey VengKohKong

KampotTakeo

Kg. Spue

Kandal

StoeungTreng Rattanak Kiri

MondulKiri

KrongKep

OtdarMean Chey

BanteayMean Chey

Battambang

PursatKg. Chhnang

Paillin

Siem Reap

Kg. Thom

Preah Vihear

Kg. Cham

Kratie

SvayRieng

Prey VengKohKong

KampotTakeo

Kg. Spue

Kandal

StoeungTreng

Rattanak Kiri

MondulKiri

Sector 4 92 Kandieng 92 Bakan 91

Pursat

Sector 4 94 Kampot 95 Banteay Meas 93

Kampot

Sector 4 94 Kaoh Thom 93 Kien Svay 96

Kandal


KAP Indicators Vietnam:

Sector 3 & 4 farmers


Overview of KAP Measurement Questions

Unprompted questions about AI knowledge- Yes- No

To what extent do you yourself believe this is true?- Extremely serious / Very necessary / Definitively- Serious / Necessary / Probably- Not so serious / not really / probably not or not sure

Unprompted questions about preventative action taken- Have done- Could do- Not done

Knowledge

Attitude

Practice


Vietnam: Knowledge , I significantly lower knowledge in Sector 4 farmers and need to build knowledge on symptoms in humans beyond fever

72

41

25

11

9

49

67

31

33

21

8

6

38

58

0 20 40 60 80

Sudden, massive death of poultry

Fever

Difficulty breathing

Cough

Head ache

Muscle ache

Sore throat

Sector 3(n=404)

Sector 4(n=802)

Vietnam (total), Sector 4: n=802, sampling error: +/- 3.5% (max), unprompted

Sector 3: n=404, sampling error: +/- 4.9% (max), unprompted

K1. Events to report as AI outbreak

K2. AI symptoms in humans

%


Vietnam: Knowledge, II Good level of knowledge in these areas

83

84

73

14

86

17

0 20 40 60 80 100

Animal health worker

Village head

Bring to a healthfacility

Sector 3(n=404)

Sector 4(n=802)

Vietnam (total), Sector 4: n=802, sampling error: +/- 3.5% (max),

Sector 3: n=404, sampling error: +/- 4.9% (max)

K3. Persons to report to

K4. Actions when someone has AI

%


Vietnam: Knowledge (risk prevention poultry), III vaccinations may create a false sense of security as it is the only action considered by most

85

28

25

13

12

10

6

4

28

24

11

10

11

8

5

76

0 20 40 60 80 100

Vaccinate poultry

Wash hands when handling poultry

Keep in fenced area/pen

Change clothes

Separate chickens & ducks

Seperate new poultry

Keep visitors away

Store manure/fertilizer

Sector 3(n=404)

Sector 4(n=802)

K5. Actions to reduce AI risks in poultry

%




Vietnam: Knowledge (risk prevention: humans), IV need for further awareness building across all areas

53

52

33

33

33

17

14

11

48

27

31

31

18

14

14

54

0 10 20 30 40 50 60

Don’t eat dead poultry


Burn and bury dead poultry

Don’t eat poultry blood

Don’t eat under cooked poultry

Wash hand before cooking

Don’t let children handle poultry

Change and wash clothes

Sector 3(n=404)

Sector 4(n=802)

K6. Actions to reduce AI risks in humans

%




Vietnam: Attitude (Top Box), I no attitude barriers in these areas

89

83

89

81

80

92

88

96

0 20 40 60 80 100

Sudden and massivedeath of poultry

A family member hasAI symptoms

Reportsudden/massivedeath of poultry

Take someone to ahealth facility if theyhave AI symptoms

Sector 3 Sector 4Vietnam (total), Sector 4: n=802, sampling error: +/- 3.5% (max),


Top rating = Extremely serious/ Definitely

A1. Seriousness of events (“extremely serious”)

A2. Likelihood to take actions (“definitely”)

%


Vietnam: Attitude (Top Box), II the emphasis on vaccination means other, simple, actions are almost ignored and may have long term ramifications

91

66

53

52

48

48

45

65

50

43

43

40

42

3937

84

0 20 40 60 80 100

Vaccinate poultry


Keep poultry in fenced areas

Separate new poultry

Keep visitors away


Change clothes

Store manure/ fertilizer

Sector 3 Sector 4

A3. Belief in preventive actions for poultry (“very necessary”)

%



Top rating = Very necessary


Vietnam: Attitude (Top Box), III relatively low levels of attitudes are to some extent a reflection of low awareness levels, strong need to emphasize protection of children

82

77

77

71

70

51

84

78

73

70

56

42

60

61

70

60

0 20 40 60 80 100


Don’t eat sick/dead poultry







Sector 3 Sector 4

A4. Belief in preventive actions for humans (“very necessary”)

%





Vietnam: Behavior to protect poultry (unprompted) besides vaccination only few actions top of mind in both Sector 3+4

92

38

35

17

17

11

10

7

82

39

32

11

11

9

11

6

0 20 40 60 80 100

Vaccinate poultry


Keep poultry in fenced areas/pen



Keep visitors away

Change clothes


Sector 3(n=404)

Sector 4(n=802)

B1a. Activities performed to protect poultry (unprompted)

%




Vietnam: Behavior to protect humans (unprompted) strong need to create behavioral change for human protection

68

57

40

38

34

30

17

15

64

55

39

34

32

27

16

12

0 20 40 60 80 100









Sector 3(n=404)

Sector 4(n=802)

B2a. Activities performed to protect humans (unprompted)

%




Vietnam: Behavior to protect poultry (prompted) even when asked prompted it is clear that many preventative actions are not done

96

68

58

41

40

33

32

20

88

73

52

34

28

31

31

17

0 20 40 60 80 100

Vaccinate poultry


Keep poultry in fenced areas/pen



Change clothes

Keep visitors away


Sector 3(n=402)

Sector 4(n=789)

B1d. Activities performed to protect poultry (prompted)

%




Vietnam: Behavior to protect humans (prompted) Again, prompted behavior still show large gaps in behavior

87

84

74

70

66

56

44

37

86

83

75

71

62

60

45

36

0 20 40 60 80 100









Sector 3(n=403)

Sector 4(n=801)

B2d. Activities performed to protect humans (prompted)

%




Vietnam Sector 4: Other preventative measures In terms of other preventative methods most have been focused around protecting poultry (26% overall) as opposed to humans (18%).

•B4a. Things done to protect poultry (unlisted actions), n=209

•B4b. Things done to protect humans (unlisted actions), n=142

5944

2129

24

1767

4130

204

2314

918

98

525

125

23

0 10 20 30 40 50 60 70 80 90 100

Nett PenKeep pen/breeding facilities clean

Spread lime powder or disinfectant around penNett Treatment/ remedies

Give medicine to the poultry/ Disinfect with medicineNett Feeding

Mixed food and medicine for poultryFeed poultry with clean food

Nett Other

Nett WearingWear mask when dealing with poultryWear gloves when contacting poultry

Put on bootsNett Stay away

Keep people away from the poultryStay away from sick poultry

Nett PenKeep pen away from house

Keep pen/breeding facilities cleanSpread lime powder or disinfectant around pen

Nett OtherEat hygienic food

Dont eat poultry that have diseases

Vietnam (total), Sector 4

%

26%

18%


Summary: KAP Vietnam

Overall there is significantly lower knowledge about Avian Influenza for Sector 4 farmers.

Knowledge and attitude towards reporting of AI and taking a AI victim to a health facility is relatively high and well established.

Knowledge about AI symptoms in humans is limited to fever with little awareness about other symptoms.

The provision of vaccinations may create a false sense of security as it is the only preventative action considered by most. The focus onvaccination leads to the neglect of other preventative actions and a certain carelessness.

Generally, sector 4 farmers take more action to protect themselves rather than the poultry itself but compliance is generally low across all actions.


KAP Indicators Cambodia

Sector 4 farmers


Cambodia: Knowledge , I Critical gaps in knowledge about symptoms in humans including fever.

42

19

15

15

5

2

83

36

63

38

0 20 40 60 80 100

Sudden and massive death of poultry

Fever

Cough

Difficulty breathing

Head ache

Muscle ache

Sore throat

Village head

Animal health worker

Bring to them to a health facility

K1. Events to report as AI outbreak

K2. AI symptoms in humans

K3. Persons to report to

K4. Actions when someone has AI

Cambodia (total), Sector 4: n=629, sampling error: +/- 3.9% (max)

%


3530

25

91

057

2020

1917

11

18

22

3

0 10 20 30 40 50 60 70 80 90 100

Keep in fenced area/penSeparate chickens & ducks

Wash hands when handling poultrySeperate new poultry

Vaccinate poultryKeep visitors away

Change clothes Wash hands when handling poultry

Burn and bury dead poultryWash hand before cooking

Don’t eat dead poultryDon’t eat under cooked poultry

Don’t let children handle poultryChange and wash clothes

Store manure/fertilizer Don’t eat poultry blood

K5. Actions to reduce AI risk in poultry

K6. Actions to reduce AI risk in humans


%

Cambodia: Knowledge, II Knowledge about preventative behaviors relatively low


Cambodia: Attitudes (Top Box), I Preventative behaviors for poultry are not supported by attitude and could be a warning sign

85

69

83

83

83

67

61

60

56

39

36

30

0 20 40 60 80 100

A family member has AI symptomsSudden and massive death of poultry

Report sudden/massive death of poultryTake someone with AI symptoms to hospital

Wash hands when handling poultryVaccinate poultry

Separate chickens & ducksSeparate new poultry

Keep poultry in fenced areas Keep visitors away

Change clothesStore manure/ fertilizer

A1. Seriousness of events

A3. Belief in preventive actions for poultry

A2. Likelihood to take actions


Top rating = Extremely serious/ Definitely/ Very necessary

%


92

84

83

82

79

74

66

48

0 20 40 60 80 100




Don’t eat sick/dead poultry





A4. Belief in preventive actions for humans



%

Cambodia: Attitudes (Top Box), II Attitudes towards preventative behaviors regarding AI in humans are relatively higher.


35

28

25

15

3

1

0

59

24

19

18

18

16

5

2

0 10 20 30 40 50 60 70 80 90 100

Keep poultry in fenced areas/penSeparate chickens & ducks

Wash hands when handling poultrySeparate new poultry

Keep visitors awayChange clothes

Store manure/ fertilizerWash hands when handling poultry

Wash hand before cookingDon’t eat under cooked poultry

Burn and bury dead poultryDon’t let children handle poultry

Don’t eat dead poultryChange and wash clothes


B1a. Things currently done to protect poultry (unprompted)

B2a. Things currently done to protect humans (unprompted)


%

Cambodia: protective behavior (unprompted) preventative behaviors are not top of mind and therefore also not reflected in behavior


93

62

60

46

45

42

30

91

86

85

84

81

81

70

44

0 20 40 60 80 100

Wash hands when handling poultrySeparate chickens & ducks

Keep poultry in fenced areas/penSeparate new poultry

Change clothesKeep visitors away

Store manure/ fertilizerWash hands when handling poultry

Don’t eat under cooked poultryBurn and bury dead poultry

Don’t eat dead poultryWash hand before cooking

Don’t let children handle poultryDon’t eat poultry blood


B1d. Things currently done to protect poultry (prompted)

B2d. Things currently done to protect humans (prompted)

Cambodia (total), Sector 4: n=629, sampling error: +/- 3.9% (max)%

Cambodia: protective behavior (prompted) If farmers really are doing some of this, the behavior is not supported by knowledge and means consistency in behavior may not be there.


•B4a. Things done to protect poultry (unlisted actions), n=269

•B4b. Things done to protect humans (unlisted actions), n=345

7068

256

95

37

53

8985

3511

53

25

333

1618

11

0 20 40 60 80 100


Nett Treatment/ remediesGive medicine to the poultry/ Disinfect

Vaccinate poultryNett Bury/ burn/Destroy

Burn or bury poultry faecesBury or Burn feathers

Bury/ burn dead poultryNett Feeding

Mixed food and medicine for poultryNett Other

Nett WearingWear mask when dealing with poultryWear gloves when contacting poultry

Nett Cleansing/ WashingClean the tools with soap/detergent


Keep pen away from houseNett Bury/ burn/Destroy

Bury or Burn feathersNett Stay away

Stay away from sick poultry

Cambodia (total), Sector 4

%

Cambodia: additional protective behaviors Keeping cage clean and wearing protection when slaughtering are the most common additional protective actions.

42%

55%


Summary: KAP Cambodia

Knowledge about Avian Influenza in general is significantly lower compared to Vietnam.

When prompted, farmers have a belief in the necessity of preventative measures, especially for humans. However, most of these behaviors are not performed, at least not knowingly.

The only area with relatively high awareness, knowledge and practices is the area of washing hands after handling poultry.

Preventative behaviour in Cambodia is focused on human health, while preventions to protect poultry is very low.


USAID KAP Indicators


Summary USAID Indicators 1 - 4

The indicators are set out according to the USAID standard and are summarized in the tables following. Note that indicator 5 and 6 are represented on both Knowledge and Practice. All questions were asked in an unprompted format.

Key Questions

(unprompted)

Vietnam Sector 3

%

Vietnam Sector 4

%

Cambodia Sector 4

%

Laos Sector 4

%

K1 Identifying a possible outbreak of AI (massive and rapid death of poultry) 58 49 42

K2 AI sign in humans (at least 3 correct answers) 48 34 15

K3 To whom an AI outbreak should be reported (only correct answers counted) 86 77 89

K4 Action to take with AI victims (take to health facility) 84 86 63

K5 Knowledge about ways to decrease AI in poultry (at least one activity) 88 86 65

K6 Knowledge about ways to decrease AI in humans (at least one activity) 82 82 75

K5 Action taken to decrease AI in poultry (at least one activity) 94 90 57

K6 Action taken to decrease AI in humans (at least one activity) 86 87 79


Summary USAID Indicators 5 – 6 (Knowledge)

K5Knowledge about ways to decrease AI in

poultry

(unprompted)

Vietnam Sector 3

%

Vietnam Sector 4

%

Cambodia Sector 4

%

Laos Sector 4

%1 Vaccinate poultry against AI 85 76 92 Keep in fenced area or pen 25 24 353 Separate chickens and ducks 12 10 304 Keep new poultry separate for 2 weeks 10 11 185 Wash hands with soap before handling poultry 28 28 256 Change clothes when coming from other farm 13 11 <17 Keep visitors away from your poultry 6 8 18 Store manure from other farm for 3 weeks 4 5 1

K6 Knowledge about ways to decrease AI in humans % % % %

1 Wash hands with soap after handling poultry 52 48 572 Wash hand with soap before cooking 17 18 203 Change and wash clothes after handling poultry 11 14 34 Do not let children handle poultry or eggs 14 14 175 Do not eat duck or geese blood pudding 33 31 16 Do not eat under cooked poultry or eggs 33 31 197 Don’t eat poultry that has fallen dead 53 54 208 Burn and bury dead poultry 33 27 22


Summary USAID Indicators 5 – 6 (Practice)

K5Action taken to decrease AI in poultry

(unprompted)

Vietnam Sector 3

%

Vietnam Sector 4

%

Cambodia Sector 4

%

Laos Sector 4

%1 Vaccinate poultry against AI 92 82 na2 Keep in fenced area or pen 35 32 353 Separate chickens and ducks 17 11 284 Keep new poultry separate for 2 weeks 17 11 155 Wash hands with soap before handling poultry 38 39 256 Change clothes when coming from other farm 10 11 17 Keep visitors away from your poultry 11 9 38 Store manure from other farm for 3 weeks 7 6 <1

K6 Action taken to decrease AI in humans % % % %

1 Wash hands with soap after handling poultry 68 64 592 Wash hand with soap before cooking 30 27 243 Change and wash clothes after handling poultry 15 12 54 Do not let children handle poultry or eggs 17 16 185 Do not eat duck or geese blood pudding 34 32 26 Do not eat under cooked poultry or eggs 40 39 197 Don’t eat poultry that has fallen dead 57 55 168 Burn and bury dead poultry 38 34 18


Program Effectiveness Index

Benchmarking program performance


Program Effectiveness Index (PEI)A 5-dimension indicator for perceived performance of past and current programs and initiatives as rated by the receiving communities.

It should be noted that whilst AED has not launched its program yet other initiatives have taken place and so the current measure is really a benchmark of the situation at hand and not an evaluation of AED per se.

• •Overall program success

• •Overall quality of •communication

•Program•Effectiveness

•Index• •Favorable opinion

•towards the program

• •Trust in what is being •communicated

•“•weak•“ •“•strong"•Perception development

•Overall effort behind the •program

•Effective Engagement •Emotional Engagement

• •Overall program success

• •Overall quality of •communication

ProgramEffectiveness

Index• •Favorable opinion

•towards the program

• •Trust in what is being •communicated

•“•weak•“ •“•strong"•Perception development

Overall effort behind the program

Effective Engagement Emotional Engagement

Being practical and using the right channels

Building trust, credibility and relevance

Creating awareness and being visible


Performance Effectiveness Index Questions

1. How do you rate the overall effort behind AI?Excellent – very good – good – fair - poor

2. How favourable is your opinion about AI prevention?Extremely favourable - very favourable - fairly favourable - not very favourable - not favourable at all

3. How much do you believe you can trust what is being communicated in relation to AI? Definitely - probably - fairly likely - probably not - definitely not

4. How do you rate overall success achieved by AI initiatives ?Excellent – very good – good – fair - poor

5. How do you rate the quality of what is being communicated about AI? Excellent – very good – good – fair - poor


Effective Engagement

Emotional Engagement

Program Effectiveness Index Component by Country

3

3.5

4

4.5

5

Effort Favorability Trust Success Quality

Ave

rage

rat

ing

scor

e

Vietnam S3Vietnam S4CambodiaLaos

Comment:Emotional engagement is high especially on the trust dimension and may result from many people having experienced or seen first hand the effects of AI. Hence they are also favorable to the program and trust the communication. However, in Vietnam poultry farmers don’t see enough effort behind the program and hence, overall quality of the program is rated lower. It is possible that some farmers may doubt the vaccination program. Both Vietnam and Cambodia score low on success.

Effort


Program Effectiveness Index (PEI)

Comment:Cambodia has achieved a significantly higher PEI compared to Vietnam. In Vietnam the AI initiative has been very focused on poultry vaccinations but this has not been the case in Cambodia. It is interesting to note that whilst Cambodia has a higher PEI the Barometer score is lower. It may be that Sector 4 farmers started from a lower base in which case an increase in the index should be seen over time. Alternatively, the program is not covering all the essential components that make up the barometer score.

Program Effectiveness Index (PEI)Program Effectiveness Index by Country

40

60

80

100

120

140

VietnamSector 3

VietnamSector 4

CambodiaSector 4

Laos Sector 4

PEI and Mind-set Barometer by Country

40

60

80

100

120

140

VietnamSector 3

VietnamSector 4

CambodiaSector 4

Laos Sector 4

40

60

80

100

120

140

PEI Mind-set Barometer

93 89

10993 89

10993

109117


PEI by Province

Situation:Overall the PEI is fairly consistent across provinces except for Hau Giang in Vietnam where program effectiveness is significantly lower.

Segment

Vietnam Sector 3 Total Nam Dinh Nghe An Thai Binh Hau Giang

Awareness of AI (%) 100 100 100 100 100

Program Effectiveness B-Mark 93 99 102 101 84

Vietnam Sector 4 Total Nam Dinh Nghe An Thai Binh Hau Giang

Awareness of AI (%) 100 100 100 100 100

Program Effectiveness B-Mark 89 95 90 89 85

Cambodia Sector 4 Total Kandal Pursat Kampot

Awareness of AI (%) 100 100 100 100

Program Effectiveness B-Mark 109 108 106 111

Laos Sector 4 Total Champasack Savannakhet Vientiane

Awareness of AI (%)

Program Effectiveness B-Mark


Barriers to preventative behavior

Based on those who don’t practice preventative behavior


Action Barriers (protecting poultry): Sector 3 Vietnam High levels of unawareness and disbelief in protective behaviours

12

6

4

4

3

3

8

8

24

23

24

28

25

26

38

39

18

29

36

32

40

41

32

32

46

42

37

37

32

30

22

21

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Vaccinate my poultry against AI,n=33

Change clothes when comingfrom other farm or market, n=365

Store manure/ fertilizer from otherfarm for 3 weeks, n=374

Wash hands with soap before andafter handling poultry, n=251

Keep new poultry separate for 2weeks, n=334

Keep visitors away from yourpoultry, n=359

Separate chickens and ducks,n=262

Keep poultry in a fenced area orpen, n=262

Cannot afford to do it Too much trouble They were not aware of this action They don't believe it will help to prevent bird flu

Vietnam (total), Sector 3: FILTER: only farmers, not practicing these behaviors


Action Barriers (protecting humans): Sector 3, Vietnam Money is not a major issue but attitude and awareness

5

7

4

2

5

3

7

6

17

17

12

14

30

15

36

37

31

31

40

42

29

48

30

34

47

45

44

42

36

34

27

23

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Don't eat sick or deal poultry, n=174

Burn and bury dead poultry, n=251

Do not eat under cooked poultry or eggs, n=244

Do not eat duck or geese blood pudding, n=266

Wash hands with soap before and after handlingpoultry, n=129

Do not let children handle poultry or eggs, n=337

Wash hand with soap before cooking, n=284

Change and wash clothes after handling poultry,n=344

Cost too much money Too much troubleThey were not aware ot this action They don't believe it will help to prevent bird flu

Vietnam (total), Sector 3: FILTER: only farmers, not practicing these behaviors


Action Barriers (protecting poultry): Sector 4 Cambodia Money is a bigger issue in Cambodia

14

14

11

12

22

21

16

23

27

24

24

37

27

26

26

34

27

23

44

38

37

30

27

20

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Store manure/ fertilizerfrom other farm for 3

weeks, n=627

Change clothes whencoming from other farm or

market, n=621

Wash hands with soapbefore and after handling

poultry, n=473

Keep new poultry separatefor 2 weeks, n=538

Keep visitors away fromyour poultry, n=610

Separate chickens andducks, n=412

Cannot afford to do it Too much troubleThey were not aware of this action They don't believe it will help to prevent bird flu

Cambodia (total), Sector 4: FILTER: only farmers, not practicing these behaviors


Action Barriers (protecting humans): Sector 4, Cambodia There is a great need for attitude change

12

5

11

1

1

4

8

17

22

18

19

31

30

34

23

27

24

36

31

32

25

48

47

47

44

37

34

33

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Don't eat sick or dealpoultry, n=531

Do not eat under cookedpoultry or eggs, n=511

Burn and bury dead poultry,n=514

Do not eat duck or geeseblood pudding, n=614

Do not let children handlepoultry or eggs, n=518

Change and wash clothesafter handling poultry, n=597

Wash hand with soap beforecooking, n=479

Cost too much money Too much trouble They were not aware ot this action They don't believe it will help to prevent bird flu

Cambodia (total), Sector 4: FILTER: only farmers, not practicing these behaviors


Summary: Barriers

Overall, money is not a large barrier but awareness and attitude. Money is to some extent a greater barrier in Cambodia for protecting poultry. For Vietnam, vaccinations have a high cost barrier for Sector 4 farmers.

The biggest challenge for human protection is building knowledge and changing beliefs. It is clear that a lot can be achieved simply by raising awareness, especially in Vietnam. Cambodia is in more need of anattitude change.


Media Usage

Penetration, consumption and type of programs


Media penetration in households Television available in most households in Vietnam whereas Cambodia has higher penetration for radio

Sector 3 Vietnam Vietnam Cambodia

Television 98 98 70Radio 32 31 61Newspapers/ magazines 16 11 2Internet 1 1 0None of the above 2 1 12

Sector 4 Unit: %

Vietnam sector 3: n=404, sampling error: +/- 4.9% (max) Vietnam sector 4: n=802, sampling error: +/- 3.5% (max)

Cambodia sector 4: n=629, sampling error: +/- 3.9% (max)


Media Consumption (day before) Television consumption is also much higher in Vietnam whereas in Cambodia Television and Radio are consumed in similar proportions. But 43% in Cambodia cannot be reached.


Television 87 88 43Radio 18 14 35Newspapers/magazine 5 2 1Internet 1 0 0None of the above 11 11 43

Sector 4 Unit: %




Media Consumption TV reaches most households in the evening which is normal


Mon-FriMorning at 5 - 8 15 13 4Morning at 8 - 11 5 7 7Noon at 11 - 14 33 29 19Afternoon at 14 - 19 19 16 26Evening at 19 - 22 95 96 82Night at 22 or later 3 4 27Not watch TV 0 0 1

Sat-SunMorning at 5 - 8 16 14 4Morning at 8 - 11 7 10 10Noon at 11 - 14 33 31 26Afternoon at 14 - 19 22 20 28Evening at 19-22 96 96 77Night at 22 or later 4 4 28Not watch TV 0 0 3

Unit: % Sector 4




Media Consumption Radio usage peaks in the early morning, around noon and early evening


Mon-FriMorning at 5 - 8 38 31 29Morning at 8 - 11 9 11 26Noon at 11 - 14 27 24 44Afternoon at 14 - 19 13 15 29Evening at 19 - 22 31 19 48Night at 22 or later 18 16 16Not listen to radio 3 9 1

Sat-SunMorning at 5 - 8 38 30 28Morning at 8 - 11 6 11 22Noon at 11 - 14 24 26 44Afternoon at 14 - 19 16 15 29Evening at 19-22 33 21 51Night at 22 or later 18 14 19Not listen to radio 3 9 1

Unit: % Sector 4




Media Consumption: TV News is watched by most but entertainment is more popular in Cambodia

Unit: % Sector 3 Vietnam Vietnam Cambodia

National news 95 91 80Local news 72 68 35Film/ movies/ series 69 70 81

Agricultural expansion encouraging programs (knowledge program)

35 30 28

Music 18 17 73Sports 18 13 44Comedy or game show 17 21 80Traditional soap opera 17 15 20Talk show 4 6 32Kids program 2 3 18

Sector 4




Media Consumption: Radio Not only do a larger proportion of people in Cambodia listen to radio, they also have a broader repertoire of programs


National news 81 78 84Local news 57 54 30Traditional music 20 18 46Local music 12 12 10Talk shows 12 13 55Sports 8 4 15Comedy show 6 7 53Kids program 2 2 8Pop music 1 0 75Quiz or game show 1 2 31None 5 10 0

Unit: % Sector 4




Media Consumption TV Channels Watched

Vietnam Total Sector 3 Sector 4 Cambodia Sector 4

VTV 3 84 83 85 TV5 PP 79VTV 1 79 79 80 TV21 CTN 68VTV 2 35 41 32 TV27 PP 52Thai Binh TV 25 25 24 TVK 45Nam Dinh TV 23 23 22 CTV9 33Nghe An TV 21 22 20 TV11 28Hau Giang TV 20 21 19 TV3 PP 25Can Tho TV 20 20 19 TVK BB 1Vinh Long TV 19 18 19 Battambang TV 1Hai Phong TV 4 6 3 Cable TV 1Hanoi TV 3 3 3Hung Yen TV 2 3 1VTC1 1 2 1HTV 7 1 1 1Ben Tre TV 1 1 1HTV 9 0 1 0Tien Giang TV 0 1Ha Tay TV 0 0 0Ca Mau TV 0 0 0Long An TV 0 0 0Thanh Hoa TV 0 0

Unit: %

Vietnam total : n=1182, sampling error: +/- 2.9% (max)




Media Consumption Radio Channels Listened To

Vietnam Total Sector 3 Sector 4 Cambodia Sector 4

VOV 1 48 52 47 FM 103 37Hau Giang Radio 25 26 24 FM 95 29Nam Dinh Radio 20 24 18 FM 105 26VOV 3 14 17 12 FM 93.25 26VOV 2 13 16 11 FM 102 15Vinh Long Radio 11 10 12 FM 100.5 12Hanoi Radio 5 5 5 FM 98 11Tien Giang Radio 1 2 0 FM 99 11Ca Mau Radio 1 0 1 VOA 10Thanh Hoa Radio 0 1 0 FM 88 7Ben Tre Radio 0 0 0 AM 918 6None 10 7 11 FM 96 5

FM 93.5 5RFA 5FM 91 5FM 103.25 4FM 106 4FM 90.5 4FM 97 4FM 90 3FM 99.5 2FM 104 2FM 107 1AM Battambang 1FM 97.5 0

Unit: %

Vietnam total : n=376, sampling error: +/-5.1% (max)

Vietnam sector 3: n=128, sampling error: +/- 8.7% (max) Vietnam sector 4: n=248, sampling error: +/- 6.2% (max) Cambodia sector 4: n=386, sampling error: +/- 5.0% (max)


Summary: Media usage

TV and Radio are the main media owned and used in Vietnam and Cambodia. Vietnam has higher TV penetration and should be considered the main media. In Cambodia TV needs to be complemented with Radio for more effective reach.

However, ca. 43% of backyard poultry farmers in Cambodia may notconsume any media regularly and 12% of farmers indicated they donot have any access to media at home. This means grassroots activities will need to be considered to a greater extent in Cambodia.

Program interest differ between countries. While Vietnamese farmers mainly watch or listen to news, Cambodian farmers have a significantly broader repertoire and also consume quite a bit ofentertainment programs.


Recommendations


Vietnam is faced with a long term risk when the vaccination program is no longer sustainable. Cost for example, is a barrier for sector 4 farmers. Behavioral communication needs to go beyond vaccinations and educate farmers about simple actions to take to protect both their poultry and humans. More focus is needed on:

- Separating poultry both from humans and keeping chickens and ducks apart

- General hygiene to protect poultry

- Personal hygiene after coming in contact with poultry

- AI symptoms in humans, especially in Cambodia

People are not concerned about AI top of mind and this has implication for the creative aspect of message development. Apart from ensuring good reach and build awareness, messages must be able to gain attention and increased involvement. Consider to:

- To increase involvement it will be important to make a clear link between AI prevention and potential loss of income.

- Focus on behavior that is simple to implement, especially for poultry protection measures where cost can have significant impact non-compliance.

- In Cambodia it will be important to compliment mainstream media with some form of ‘on site’ media that serves as a direct reminder at the point of action.

- Women are at greater risk and also children in Cambodia so this needs to be considered for communication.

Recommendations


There is potential to achieve a lot by simply building on awareness. Whilst farmers in general are well informed about who to report and AI outbreak and that a AI victim should be taken to a health facility, knowledge about preventative action is fragmented. It would be worth while to look at initiatives that have taken place in the Nam Dinh region in Vietnam, as this region had a relatively high barometer score. Cambodia, on the other hand, is uniformly low and needs a focused campaign.

Past campaigns have not had much impact, especially in Cambodia. There may be too messages about different preventative actions. There really is need for focus on what best prevention should be. For example, is the focus on protecting poultry or humans? And within that set, what should be considered best practice so that messages can be more focused and thereby more effective.

The media strategy need to be different in Vietnam and Cambodia. For Vietnam television can be highly effective, especially using PSA and other news announcements. For Cambodia Radio as a booster media needs to be considered. Grass roots campaigns will also be important in Cambodia as media watching is much lower compared to Vietnam.

Recommendations


Recommendations for upcoming Baseline StudyIt is recommended to include Stakeholders as part of the quantitative survey as it was discovered that this group may not be clear on what farmers understand about AI.

Important to incorporate program implementation partners as part of the evaluation on program effort and effectiveness as well as looking at different communication initiatives and media channels.

The KAP indicators needs to be reviewed for better focus and once decided it may be necessary to recalculate the barometer score based on the new set of indicators.

Recommendations


Annex

• Vietnam (Sector 3)• Vietnam (Sector 4)• Cambodia (Sector 4)• Laos (Sector 4)

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