University of Calgary
PRISM: University of Calgary's Digital Repository
Graduate Studies
The Vault: Electronic Theses and Dissertations
2020-07-24
Biosocial Complexities of Antimicrobial Use in Dairy
Farming in Alberta, Canada
Ida, Jennifer A.
Ida, J. A. (2020). Biosocial Complexities of Antimicrobial Use in Dairy Farming in Alberta, Canada
(Unpublished master's thesis). University of Calgary, Calgary, AB.
http://hdl.handle.net/1880/112339
master thesis
University of Calgary graduate students retain copyright ownership and moral rights for their
thesis. You may use this material in any way that is permitted by the Copyright Act or through
licensing that has been assigned to the document. For uses that are not allowable under
copyright legislation or licensing, you are required to seek permission.
Downloaded from PRISM: https://prism.ucalgary.ca
UNIVERSITY OF CALGARY
Biosocial Complexities of Antimicrobial Use in Dairy Farming in Alberta, Canada
by
Jennifer A. Ida
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN VETERINARY MEDICAL SCIENCES
CALGARY, ALBERTA
JULY, 2020
© Jennifer A. Ida 2020
ABSTRACT
Antimicrobial resistance (AMR), or the ability of a microbe to withstand treatment with
antibiotics, is an emerging health issue that has been largely attributed to the inappropriate use of
antimicrobial treatments. Many of the current research and policy initiatives focus on knowledge
translation and behavioral change mechanisms as ways to achieve absolute reductions in
antimicrobial use across all health sectors. However, the current approach fails to address
underlying drivers of practice and is narrowly focused on achieving a numeric goal. Given the
failure to understand the underlying drivers of decisions made by dairy farmers concerning
antimicrobial use (AMU), this study sought to understand one community’s perceptions
surrounding AMU, AMR, and regulation in the dairy farming industry in Alberta via the use of
ethnography. Specifically, this included participation in on-farm activities (i.e., milking) and
observations of relevant interactions (i.e., herd health exams) on dairy farms in Central Alberta
for a period of 3.5 months. Interviews were conducted with 25 dairy farmers. Nine of these
interviews were analyzed using thematic analysis. Thematic analyses resulted in four key
takeaways. Farmers: 1) feel that AMU policies implemented in other contexts are impractical
and are concerned that such policies, if implemented in Alberta, would constrain their freedom to
make what they perceive to be the best decisions about AMU for their animals; 2) believe that
their first-hand knowledge is undervalued by both consumers and policy makers; 3) do not
believe that the public trusts them to make the correct AMU choices and, consequently, worry
that AMU policy will be guided by what they believe are misguided consumer concerns; 4)
farmers are skeptical of a link between AMU in livestock and AMR in humans. Based on these
findings, a better understanding of the sociocultural and political-economic infrastructure that
supports such perceptions is warranted and should inform future policy.
ii
ACKNOWLEDGMENTS
This study was made possible by all of the dairy farmers who took time to contribute
their thoughts, knowledge, and experiences and who were so willing to show me what dairy
farming is all about. I would especially like to thank all of the families who opened their homes
to me, shared their food with me, invited me to Sunday service, and who so patiently showed me
how to milk a cow. It was a period of my life that I will never forget and that likely changed me
in ways that I have yet to realize.
I would like to acknowledge and thank my committee members, Dr. Warren Wilson, Dr.
Cindy Adams, Dr. Craig Gerlach, and Dr. Susan Kutz, for being game for cross-disciplinary
collaboration as well as for their patience, time, and unwavering support throughout the many
changes and difficult moments of my graduate program. Without their guidance, feedback and
encouragement, this thesis would not have been possible. I especially would like to thank my
supervisor, Dr. Herman Barkema, who provided immense support for my career goals, believed
in me even when I did not, and who did not let me give up.
A special thank you to Ashley Cornect-Benoit for her solidarity in questioning the status
quo. To Anne-Marieke Smid and Ellen de Jong for their emotional support and neighborhood
walks. To Andrea Hanke and Roxann Perez for their friendship, yummy meals, and moo love.
To Sonia Mukherjee who provided me with the strength I needed to continue via many Skype
work sessions. To Julián Cortés for being there from Day 1 and for having someone with which
to tackle biostatistics. To Joaquin Paredes for helping me put things in perspective. To Carmen
Bataller Casanova, Alejandra Santa, Diana Jeong, and Noelia Robledillo for their constant
encouragement. To Ximena Velasco Guachalla for being near even when far. To Dr. Celeste
Gagnon and Dr. Alexa Dietrich for their continued support of my career goals. To Dr. Pasquale
iii
Meleleo for encouraging me to shoot high. To my grandma and uncles for reminding me to
“keep my head above water.” To my sisters, Mary and Victoria, and parents, Joseph and
Deborah, for dealing with my repetitive Facetime calls. To Wameeth for holding my hand
through the toughest moments and for being the best quarantine partner I could have ever asked
for. Lastly, to “The Moos,” the two beings who I owe the world to for carrying me through this
experience.
iv
DEDICATION
To my dad, Joseph Ida, for subjecting me to his ‘unorthodox’ theories on antibiotic treatment of
his homing pigeons and raising my curiosity about beliefs surrounding human-animal health and
corresponding medical practices
v
Table of Contents
ABSTRACT .................................................................................................................................. II
ACKNOWLEDGMENTS .......................................................................................................... III
DEDICATION.............................................................................................................................. V
LIST OF TABLES ................................................................................................................... VIII
LIST OF FIGURES .................................................................................................................... IX
LIST OF ABBREVIATIONS ..................................................................................................... X
CHAPTER 1: INTRODUCTION................................................................................................ 1
1.1. THESIS OUTLINE .................................................................................................................... 1
1.2. BACKGROUND ....................................................................................................................... 1
1.2.1. Antimicrobial resistance ............................................................................................... 1
1.2.2. One Health approach .................................................................................................... 4
1.2.3. Role of the Social Sciences ........................................................................................... 6
1.3. PROBLEM STATEMENT ......................................................................................................... 12
1.4. OVERALL AIM ..................................................................................................................... 13
1.5. BENEFITS AND ANTICIPATED OUTCOMES ............................................................................. 13
1.6. RATIONALE ......................................................................................................................... 14
1.7. POSITIONALITY STATEMENT ................................................................................................ 14
CHAPTER 2: METHODOLOGY............................................................................................. 16
2.1. THEORETICAL ORIENTATION ............................................................................................... 16
2.1.1. Ontology ...................................................................................................................... 16
2.1.2. Epistemology ............................................................................................................... 16
2.1.3. Methodology ............................................................................................................... 17
2.2. OVERVIEW OF ETHNOGRAPHY ............................................................................................. 17
2.3. SAMPLING AND STUDY SITE ................................................................................................. 19
2.3.1. Field site...................................................................................................................... 19
2.3.2. Sample size .................................................................................................................. 20
2.3.3. Sampling strategy........................................................................................................ 21
2.3.4. Study sample ............................................................................................................... 22
2.4. DATA COLLECTION METHODS .............................................................................................. 23
2.4.1. Role of the researcher ................................................................................................. 23
2.4.2. Participant observation .............................................................................................. 24
2.4.3. Direct observation ...................................................................................................... 25
2.4.4. Open-ended interviews................................................................................................ 27
2.5. DATA ANALYSIS .................................................................................................................. 29
2.5.1. Overview ..................................................................................................................... 29
2.5.2. Thematic analysis........................................................................................................ 29
2.5.3. Analysis of ethnographic data .................................................................................... 30
2.6. QUALITATIVE RIGOR, INTERNAL RELIABILITY AND VALIDITY.............................................. 30
2.7. PRIVACY, CONFIDENTIALITY AND DATA HANDLING ............................................................ 31
2.8. ETHICS APPROVAL ............................................................................................................... 31
CHAPTER 3: RESULTS ........................................................................................................... 37
vi
3.1. INTRODUCTION.................................................................................................................... 37
3.2. CONTEXT ............................................................................................................................ 39
3.2.1. Political-economic ...................................................................................................... 39
3.2.2. Social-community ........................................................................................................ 40
3.2.3. Technology .................................................................................................................. 41
3.2.4. Built environment ........................................................................................................ 42
3.2.5. Natural environment ................................................................................................... 42
3.3. THE DAIRY FARMER ............................................................................................................ 43
3.3.1. Daily life...................................................................................................................... 43
3.3.2. Gender roles................................................................................................................ 44
3.3.3. ‘Cow person’............................................................................................................... 44
3.3.4. Lifestyle ....................................................................................................................... 44
3.3.5. Family bonds & multigenerational farming ............................................................... 45
3.3.6. Part of cultural heritage: Europe to Canada ............................................................. 46
3.4. THEMES AND SUBTHEMES ................................................................................................... 47
3.4.1. Theme 1: Farmers as stewards of the land ................................................................. 47
3.4.2. Theme 2: Dairy farmers as autonomous actors.......................................................... 49
3.4.3. Theme 3: Mutual distrust between the farmer and the public .................................... 55
3.4.4. Theme 4: Frustration with impractical policies ......................................................... 65
CHAPTER 4: SUMMARIZING DISCUSSION ...................................................................... 75
4.1. SUMMARIZED RESULTS ....................................................................................................... 75
4.2. LITERATURE ........................................................................................................................ 77
4.2.1. How are decisions made? ........................................................................................... 77
4.2.2. AMU among Dairy Farmers ....................................................................................... 79
4.3. STRENGTHS AND LIMITATIONS ............................................................................................ 82
4.4. FUTURE RESEARCH .............................................................................................................. 84
4.5. BROADER IMPLICATIONS ..................................................................................................... 85
BIBLIOGRAPHY ....................................................................................................................... 88
APPENDIX A. PROJECT OVERVIEW FOR PARTICIPANTS ....................................... 102
APPENDIX B. INTERVIEW CONSENT FORM: DAIRY FARMERS ............................. 104
APPENDIX C. INTERVIEW CONSENT FORM: VETERINARIANS ............................. 107
APPENDIX D. CONSENT FORM: PARTICIPANT OBSERVATION ............................. 110
APPENDIX E. INTERVIEW TEMPLATE: DAIRY FARMERS ....................................... 114
APPENDIX F. INTERVIEW TEMPLATE: VETERINARIANS ....................................... 119
APPENDIX G. PARTICIPANT AND DIRECT OBSERVATION PROTOCOL ............. 122
APPENDIX H. SELF-PERCEIVED ROLE OF VETERINARIANS IN ANTIMICROBIAL
STEWARDSHIP ....................................................................................................................... 124
vii
LIST OF TABLES
Table 1. Descriptive summary of farms included in the sample subset ........................................ 32
Table 2. Descriptive summary of personal attributes of dairy farmers included in the sample
subset............................................................................................................................................. 34
viii
LIST OF FIGURES
Figure 1. Map of Central Alberta .................................................................................................. 35
Figure 2. Representation of sample selection ............................................................................... 36
Figure 3. Thematic map of dairy farmers’ perceptions of AMU, AMR, and regulation .............. 74
ix
LIST OF ABBREVIATIONS
AMU Antimicrobial use
AMR Antimicrobial resistance
AMS Antimicrobial stewardship
DCT Dry cow therapy
SSC Somatic cell count
x
CHAPTER 1: INTRODUCTION
1.1. Thesis outline
This thesis consists of four chapters. The present chapter provides background
information on the subject of antimicrobial resistance (AMR), One Health approaches, and the
need for inclusion of the social sciences (namely, anthropology) in addressing this global health
issue. It also includes the problem statement, overall aim, and rationale of the thesis as well as
the author’s positionality statement. Chapter 2 provides detailed information about the
methodology employed in this study. The results are presented in Chapter 3. Chapter 4 is the
concluding chapter. This chapter serves as a summarizing discussion of the study. It also
highlights the strengths and limitations of this study, and outlines directions for future research.
1.2. Background
1.2.1. Antimicrobial resistance
1.2.1.1. The problem
Antimicrobials are pharmaceutical drugs used in the treatment of bacterial, viral, and
fungal infections (World Bank, 2017) and have played critical roles in disease control since they
were first introduced in the 1940s (Center for Disease Dynamics Economics & Policy, 2015;
Laxminarayan et al., 2016). However, in the last ten years, there has been a steep increase in
pathogens resistant to antimicrobials, posing a significant public health issue (Roca et al., 2015).
The increase in the prevalence of resistant pathogens, largely created by exposure to the drugs
via use, misuse or overuse (Roca et al., 2015), cultivates a situation in which infections that were
once treatable may no longer be (Center for Disease Dynamics Economics & Policy, 2015).
Additionally, reduced efficacy of antimicrobials raises concerns that modern day medical
1
procedures (i.e. surgeries, caesarian sections, chemotherapy etc.) may eventually be too risky to
undertake (Center for Disease Dynamics Economics & Policy, 2015; Laxminarayan et al., 2016;
O’Neill, 2016). The increasing severity of the problem has led to reports produced by leading
global health organizations, which stress the importance of safeguarding our current supply of
antimicrobials (Center for Disease Dynamics Economics & Policy, 2015; World Health
Organization, 2015; O’Neill, 2016; World Bank, 2017), particularly those that are critically
important for human health (i.e. Category I drugs: fluoroquinolones, third- and fourth-generation
cephalosporins, and carbapenems) (Woolhouse and Ward, 2013). They also highlight the urgent
need to adopt new practices surrounding how antimicrobials are prescribed by human clinicians
and veterinarians, used in animals, consumed by humans, and consequently disseminated into the
environment (Center for Disease Dynamics Economics & Policy, 2015; World Health
Organization, 2015; O’Neill, 2016; World Bank, 2017).
1.2.1.2. Impact on human health and the economy
AMR poses a significant threat to human health (World Health Organization, 2015; Wall
et al., 2016; World Bank, 2017), particularly for those in low-income countries (Wall et al.,
2016; World Bank, 2017), where it may be difficult to obtain newer-generation drugs to treat
resistant infections (Laxminarayan et al., 2016). AMR is currently associated with 700,000
deaths annually, with the potential for that to increase to 10 million in the next 30 years (O’Neill,
2016). The global economic impact of these projections would be devastating (World Health
Organization, 2015; World Bank, 2017) with a cumulative cost estimated at US$100 trillion
(O’Neill, 2016). These projections are described by some as questionably apocalyptic, but
clearly of great concern (Robinson et al., 2016).
2
1.2.1.3. Role of agriculture
The management of antimicrobials spans three public health arenas: the pharmaceutical
industry, human medicine and healthcare, and food production systems (O’Neill, 2016).
Intensive farming systems are of particular importance due to the ways in which antibiotics are
prescribed and used in food animals in order to optimize production, including prophylactic uses
(i.e. dry off in dairy cattle), metaphylactic uses (i.e. blanket treatment for pneumonia in calves),
and doses at sub-therapeutic levels (i.e. as growth promoters) (Center for Disease Dynamics
Economics & Policy, 2015; Robinson et al., 2016; Wall et al., 2016). Antimicrobial use (AMU)
in the agricultural industry exceeds (Robinson et al., 2016) or is at least comparable to quantities
used in human health (Woolhouse and Ward, 2013) and the literature suggests there is probable
misuse (Robinson et al., 2016). These systems create a selection pressure and allow for bacteria
to develop resistant genes, which have the potential to cross-over to human bacteria and the
human microbiome (Laxminarayan et al., 2016; Robinson et al., 2016; Wall et al., 2016).
However, although multi-drug resistant genes have been documented in many shared humananimal-environmental pathogens (Robinson et al., 2016), direct links between AMU in animals
and AMR in humans are still unclear (Tang et al., 2017). Some studies suggest the association is
not fully understood or is indirect (Wall et al., 2016; Tang et al., 2017), while others present it as
a clear pathway with consumption of food animals as a known route of exposure (Woolhouse
and Ward, 2013). However, there is consensus that agricultural workers or those directly
involved in intensive farming are more at risk (Woolhouse and Ward, 2013; Tang et al., 2017).
1.2.1.4. The environment
The importance of the environment in addressing this emerging health issue is evident.
Antimicrobials used to protect crops as well as waste produced by intensive farming may be
3
contributing to increased levels of AMR in humans (Woolhouse and Ward, 2013; Robinson et
al., 2016; Wall et al., 2016). Manure excreted by livestock may contain antibiotic residue, which
is then spread over crop fields as fertilizer, leading to contamination of the crops, soil and
groundwater (Woolhouse and Ward, 2013). Waste produced by the pharmaceutical industry
(Robinson et al., 2016; Wall et al., 2016), human hospitals (Robinson et al., 2016), and waste
water treatment plants (Laxminarayan et al., 2016) are also likely leading to environmental
contamination.
1.2.2. One Health approach
AMR has been recognized as a quintessential One Health issue due to its emergence at
the human-animal-environmental nexus (Robinson et al., 2016; Wall et al., 2016). A One Health
challenge is defined as a condition with adverse effects on the shared health of humans, animals,
and the environment (Robinson et al., 2016; Magalhães-Sant’Ana et al., 2017; McEwen and
Collignon, 2018). Additionally, these are challenges that require multidisciplinary solutions and
the collaboration of actors with distinct expertise, working across multiple scales (Zinsstag et al.,
2005). Although the One Health movement claims to recognize the need for inclusion of experts
from multiple disciplines, many One Health approaches are lacking in terms of social science
expertise and consequently overvalue expert opinion and place little emphasis on community
knowledge and perspective (Zinsstag et al., 2009; Craddock and Hinchliffe, 2015). This is
potentially due to the movement’s origin in the biomedical sciences, where social science
research is met with great skepticism as it is “[in]consistent with their definition of legitimate
science” (Albert et al., 2008, 2527) and, at times, dismissed as unreliable and based on anecdotal
evidence (Albert et al., 2008). Increased attention has been given to the marginalization of the
social sciences within the One Health movement and the need for further inclusion (Rock et al.,
4
2009; Degeling et al., 2015; Lapinski et al., 2015; Rock and Degeling, 2016). This is further
supported by calls to action from outside of the social sciences (Zinsstag et al., 2009; Coker et
al., 2011). However, it should be noted that the absence of researchers trained in the social
sciences from shared human-animal health projects is not solely in the hands of biomedical
scientists. Social scientists, namely anthropologists, have been slow to recognize the importance
of animals (with the exception of nonhuman primates) and animal health to human health,
highlighting the anthropocentric flaw inherent to the discipline (Noske, 1993). The siloed nature
of these scientific disciplines is no longer serving today’s societal needs (Zinsstag et al., 2009).
The fragmentation present within academic infrastructure has led to a gap in contextual
knowledge surrounding many One Health challenges (Zinsstag et al., 2009), namely AMR. Here,
context is shaped by such variables as the natural and built environments, the broader ecosystem,
the biology of both humans and animals and culture. Culture when considered in relation to
health can be defined as, “…not only habits and beliefs about perceived wellbeing, but also
political, economic, legal, ethical, and moral practices and values (Napier et al., 2014, 1607).”
Because anthropological theory is centered on the significance of context (Vayda, 1983), it can
help us to understand that biological variation in humans is often mediated by culture (e.g.
prevalence of Covid-19) as culture impacts biology and changes disease outcomes (Wolf, 2015).
“Whereas the notion of “one health” is built upon the assumption of a shared biological destiny,
the anthropological perspective might provide useful insights into the wide range of diverging
practices, institutions, norms, and bodies that contribute to microbial globalization processes and
their governance (Wolf, 2015, 6).”
5
1.2.3. Role of the Social Sciences
AMR is perceived by many as a biological phenomenon requiring innovative solutions
found in the natural sciences. Funding is often directed to cutting-edge research that promises
new technologies, and advancement in the development of new antimicrobials, or alternatives to
antimicrobials (i.e. peptides) (Powers, 2004; da Costa et al., 2015; Doshi, 2015; Smith, 2015;
Wang et al., 2016). However, a shift in our perceptions of the phenomenon of AMR itself – from
one of biological origin to one of biosocial complexity - would reveal new solutions. Biosocial
complexities can be defined as,
“interacting, co-present, or sequential diseases and the social and environmental factors
that promote and enhance the negative effects of disease interaction. This emergent
approach to health conception and clinical practice reconfigures conventional historical
understanding of diseases as distinct entities in nature, separate from other diseases and
independent of the social contexts in which they are found. Rather, all of these factors
tend to interact synergistically in various and consequential ways, having a substantial
impact on the health of individuals and whole populations (Singer et al., 2017, 941).”
The application of the social sciences is one avenue by which to pursue this as the social
sciences provide a structured way of understanding complex phenomena, in this case human
behavioral variation and biology (Mathew and Perreault, 2015). The social sciences can also be
defined as, “the scientific study of human society and social relationships” (Greenhalgh, 2018,
1). As suggested above by Wolf (2015), human behavior varies by context (e.g. pig sector vs.
dairy sector, human medicine vs. veterinary medicine, intensive vs. extensive farming, Canada
vs. China) and an understanding of this variation is significant as cultural values and beliefs
impact behavior and, in turn, behavior impacts infection (ESRC Working Group, 2014). Wiley
6
and Allen (2013) highlight a variety of questions that social scientists seek to answer including:
What constitutes “healthiness” in a given culture? How do people come to understand disease in
a given context? How does social inequality impact disease outcomes? How is perceived “risk”
locally situated? Wiley and Allen (2013) draw on the work of Mangione-Smith et al. (1999,
2006) to demonstrate the importance of cultural knowledge and expectations when seeking to
understand AMU in context. Studies of doctor-patient interactions demonstrate that prescribing
practices among clinicians are related to the parent’s belief that an antibiotic is a necessary
treatment for their child’s symptoms (Mangione-Smith et al., 1999, 2006).
People hold deeply ingrained beliefs about medicine, which impact their prescribing
practices and use (ESRC Working Group, 2014). Therefore, prior to implementing behavior
change regulations or intervention, it is important to understand how antimicrobials are valued
and used within a given context as well as relevant community dynamics in order to understand
variation in prevalence of AMR (ESRC Working Group, 2014). The continuation of siloed work
will only further perpetuate one size fits all policies that may be largely ineffective at the
community level. By drawing on the existing methods utilized in the social sciences, we will be
better equipped to understand the drivers of AMU and their downstream impacts on AMR
(ESRC Working Group, 2014). Dr. Macintyre clearly lays out the role the social sciences can
play in working to understand AMR and highlights the potential for the social sciences to shift
the social environment relative to AMR (ESRC Working Group, 2014):
“The mechanisms which lead to antimicrobial resistance are biological. However, the
conditions promoting, or militating against, these biological mechanisms are profoundly
social. How our farmers, vets, and regulatory systems manage livestock production for
human consumption; how regulatory and fiscal frameworks incentivise or deter
7
antimicrobial development, production and use; how the public and healthcare
professionals understand, value and use antimicrobials; the context in which animals and
humans interact; the ways in which particular groups of humans are exposed to particular
microbial infections; all these are shaped by social, cultural, political and economic
forces. Social science therefore has a key role to play in measuring, modelling,
understanding, and where appropriate changing the social environment in relation to
antimicrobial resistance.”
By shifting our perspective surrounding antimicrobials, we can begin to see antimicrobials as a
shared resource (Laxminarayan et al., 2016; World Bank, 2017) or a global public good and one
that should be governed by public health ethics founded on “solidarity amongst humans and
more-than-human solidarity” (Rock and Degeling, 2015, 61). That is, we have a responsibility to
not only act in the best interest of humanity, but also in the best interest of animals and the larger
ecosystem.
1.2.3.1. Anthropology
Anthropology is one of many disciplines that falls under the larger social science
umbrella. It can be defined as the study of human cultural, biological, and behavioral variation
across cultures and time. It seeks to understand what it means to be human (Schultz and
Lavenda, 2009). Unlike other disciplines, it gives particular attention to the social infrastructure
in which our lives are situated: work, family, power, and meaning (Schultz and Lavenda, 2009).
These concepts are often referred to as culture, which is a key concept explored in
anthropological work. Although the definition of culture has long been an issue of
anthropological debate, for the purposes of this thesis we will assume Frans de Waal’s definition:
8
“culture is how we do and think about things, transmitted by nongenetic means (De Waal, 2001;
Sapolsky, 2017).”
Anthropology generally differs from other scientific approaches in that it is immersive
and so utilizes fieldwork as a key research method to explore its central questions concerning
human nature and society. Other defining elements of anthropology are its holism, as well as
comparative and evolutionary perspectives (Schultz and Lavenda, 2009). Because anthropology
is concerned with understanding the cultural context in which human activities are entangled and
the complex patterns of these activities, it can provide great insight into human behavior (Schultz
and Lavenda, 2009; Wilson, 2019). For example, the Tatuyo, in the Northwest Amazon, obtain
~75% of their dietary energy from manioc. They prefer to cultivate toxic manioc despite the fact
that non-toxic varieties are available. Because of this preference, women have to spend several
hours each day detoxifying manioc so that it is safe to eat. Anthropological work by Dufour
(1983), identified that it is, in fact, fundamental to their identity. That is, they enjoy the taste of
the resulting foods, their mothers did it and raiding tribes cannot steal their crops. Additionally,
their creation story includes the cultivation of toxic manioc. From a biological perspective, this
variety yields higher starch content than the non-toxic varieties (Dufour, 1983). Through this
example, we can see that both biology and culture need to be taken into account in order to
understand what some may consider the counterintuitive behavior of the Tatuyo.
An in-depth understanding of human behavior requires immersive fieldwork. By
immersive, we mean that data collection is done in natural settings and involves direct
interaction or close involvement with the people or animals of interest for extended periods of
time. In the application of this fieldwork, the anthropologist becomes involved in the everyday
life of the community in which he/she/they are living and takes part in the routine chores of the
9
informants, or those who provide insight into a particular way of living (Schultz and Lavenda,
2009). The term used to describe this immersive fieldwork is ethnography, a term also used to
describe the body of work produced from this fieldwork (Schultz and Lavenda, 2009).
Traditionally, this text contains a description of, “the customary social behaviors of an
identifiable group of people” (Wolcott, 1999, 252). The two research methods unique to
ethnographic work are 1) participant observation, and 2) direct observation. Participant
observation requires that the field researcher engages in the social and, in this case, work-related
activities of the community (Schultz and Lavenda, 2009). In contrast, direct observation allows
the researcher to observe the activities of the community as an outsider and without direct
participation in the activity itself. Both participant and direct observation provide a means by
which to gain cultural insight by living in the community and close to the informants. It is the
application of these methods that allows one to interpret the actions and words of community
members in light of their cultural values, beliefs, and the larger political and cultural context.
These methods will be described in further detail in the following chapter. Lastly, the
information gleaned through the process of ethnography is considered situated knowledge.
Situated knowledge recognizes that the identity, beliefs, and culture of the researcher shapes the
interactions with the participants and therefore the observations (Harraway, 1991). See
Positionality Statement for researcher’s background and relevance to current study.
Anthropology’s holistic perspective allows for an integrated approach to observing and
understanding how humans interact with one another, animals, the environment, and the material
world. It is this holism that further distinguishes it from other social science disciplines and
provides opportunity for nonlinear connections to be made. The discipline is also grounded in
comparison. That is, anthropologists are interested in the similarities and differences, or the
10
overall variation, that exists across humanity. This is a key difference between research
undertaken with an anthropological lens and that which is common in standard public health and
some areas of epidemiology. While generalizability is considered to be one of the central criteria
of a well-designed study in epidemiology (Patten, 2018), anthropologists try to abstain from
generalizing from culture to culture (Schultz and Lavenda, 2009). Lastly, by evolutionary
perspective, it is meant that the discipline contends that many aspects of human phenotypic
variation, from morphology to aspects of behavior, are the result of long-term evolutionary
processes.
1.2.3.2. Use of an anthropological lens to address animal health issues
The emerging health issue of AMR has been recognized as context-dependent and so
needs to be addressed using locally-specific solutions (Robinson et al., 2016). Social,
environmental, and economic contexts vary widely from one locale to another and ultimately
determine how antimicrobials are used and which mechanisms may serve to sustainably improve
stewardship (Robinson et al., 2016; Wall et al., 2016).
One example of this is a study of AMU and veterinary care among agro-pastoralists in
Northern Tanzania (Caudell et al., 2017). This study, resulting from a fruitful collaboration
between anthropologists and veterinary scientists, examined the role of cultural-ecological
factors (including urbanization and animal husbandry) on AMU and veterinary consultation
among the Maasai, Arusha, and Chagga, and found, for example, that acculturation variables (i.e.
owning transportation) had different impacts across each of the groups, with a positive
association to AMU among the Maasai.
11
By working to understand the lived experience, daily life, and world view of those who
are interacting with, caring for, and medically treating animals, we are better equipped to
understand how the decisions concerning animal health and welfare are made. In this particular
study, using an anthropological lens will tell us which variables may be influencing farmers’
decisions regarding AMU. It will offer a unique perspective to the dairy science community as
information regarding the farmers’ decisions will be interpreted in light of a wider cultural
context. For example, veterinary scientists and, in some cases, clinical veterinarians are
encouraging dairy farmers to switch from blanket dry cow therapy, an antibiotic treatment
administered to all cows during milking cessation to aid in the prevention of mastitis, to selective
dry cow therapy (refers to the same treatment; however, cows are selected for treatment based on
pre-specified parameters). In this case, anthropological fieldwork will allow us to situate
ourselves in the position of the farmer to better understand the perceived risk and increased
vulnerability experienced by the farmer in attempting to adopt an unfamiliar practice with
uncertain consequences.
1.3. Problem statement
Much of the current research and policy initiatives have focused on knowledge
translation and behavioral change mechanisms as a means to achieve absolute reduction in
antimicrobials across all health sectors (Raymond et al., 2006; Friedman et al., 2007; Charani et
al., 2011; Center for Disease Dynamics Economics & Policy, 2015; Lam et al., 2017). However,
the current approach fails to address underlying drivers of practice and is narrowly focused on
achieving an arbitrary numeric goal (e.g. 50 and 25% reduction of AMU in The Netherlands and
the United Kingdom, respectively) (Kuipers et al., 2016). There is an ever-growing body of
literature on farmers’ knowledge, attitudes, and practices concerning antimicrobials (Andersen,
12
2002; McClure et al., 2010; Jones et al., 2015; McIntosh and Dean, 2015; Wolf et al., 2016;
Kramer et al., 2017; Higham et al., 2018; Fischer et al., 2019; Golding et al., 2019; Parkunan et
al., 2019; Vasquez et al., 2019). However, there is a paucity of literature that provides an indepth understanding of the context in which antimicrobials are situated or that looks beyond
individual agency of the farmers.
1.4. Overall aim
The overall aim of the research that has resulted in this thesis was to understand one
community’s perceptions surrounding AMU, AMR, and prospective regulation in the dairy
farming industry in Alberta. Specifically, we examine locale-specific AMU practices and
contextualize them within the study site. We also highlight the perceived barriers and negative
implications to absolute reduction of AMU, and farmers’ concerns about external pressure to
reduce AMU. Additionally, we explore the underlying values of dairy farmers in this community
and how they may shape their beliefs and use of antimicrobials in dairy cattle. Hoof trimmers
and veterinarians were also included in the sample, but they will not be the focus of this thesis.
1.5. Benefits and anticipated outcomes
We will obtain an understanding of how best to work for and in collaboration with the
farmers by learning about their unique experiences and insights as they relate to AMU as well as
their expectations for future dairy research interventions related to this topic. This study will also
provide policymakers with context-specific information to develop effective strategies to
improve antimicrobial stewardship (AMS) in the dairy sector in Alberta.
13
1.6. Rationale
This research offers a means to assess the biocultural complexity of AMR in the dairy
industry via the integration of anthropological methods. The integration of anthropological
methods will allow us to contextualize the current practices that are driving AMR. Human
behavior, such as AMU, is the outcome of a complex mix of variables and thus is best
understood in context. Immersive ethnography, in which the researcher builds rapport with
participants, situates the researcher in the context of interest and enables him/her/them to
understand the topic from the perspective of the participant. In this case, it will provide an
opportunity to understand the dairy farmers’ internal model for on-farm decision-making.
1.7. Positionality statement
Because ethnographic fieldwork draws together individuals with distinct cultural
backgrounds and places them in a context together (Schultz and Lavenda, 2009), it is important
to understand the identity and the culture of the researcher. The background of the researcher has
shaped her worldview and consequently had some impact on her interactions with community
members as well as her interpretation of the information gleaned through the fieldwork.
The student researcher is 30 years old, female, queer, and unmarried. She is an MSc
student in the Department of Production Animal Health in the Faculty of Veterinary Medical
Sciences at the University of Calgary. She previously completed an MA in anthropology at
University of Colorado Boulder, USA. Prior to that, she completed a BA at Wagner College in
New York, USA, where she majored in anthropology and minored in microbiology and Spanish.
Her multidisciplinary background spans the natural and social sciences and so made her uniquely
positioned to carry out this project. She was born and raised in Staten Island, New York, a
borough of New York City, NY, USA. Although having grown up in a politically conservative
14
borough, she identifies as liberal. She has some clinical veterinary experience, but no previous
experience with dairy cattle, farming, or medicine in intensive farming systems. Because she is
not from an agricultural background, she was able to begin her fieldwork as a non-expert,
acknowledging the importance of the farmers’ knowledge and experience. She culturally
identifies as Italian American. She was raised Catholic, although does not regularly engage in
religious activities. Her parents refrained from overuse of Western medicine during her early
childhood, promoted alternative forms of care and were particularly cautious about antibiotic
use. Lastly, the researcher does not consume dairy products due to a food intolerance and so is
not a regular part of the consumer population.
15
CHAPTER 2: METHODOLOGY
2.1. Theoretical orientation
Philosophical paradigms are identified and explained below as the researcher’s alignment
with these paradigms influences the practice of research and selection of the appropriate
methodology and methods (Tebes, 2005; Braun and Clarke, 2013).
2.1.1. Ontology
Ontology addresses the nature of reality (Tebes, 2005; Braun and Clarke, 2013).
Ontological paradigms exist on a continuum, where, on one end, a known reality exists that can
be unveiled through research inquiry, and, on the other end, reality depends on human
understandings, interpretation, and perspective (Braun and Clarke, 2013). Critical realism, which
lies in the middle of this continuum, was employed as the ontological approach in this study.
Critical realism was selected as the ontological paradigm that aligns best with this study as it
understands that reality is interpreted through a lens which is informed by one’s experience while
also acknowledging the biological reality (Willig, 1999). In this case, the biological reality refers
to the emergence of AMR in humans, animals, and the environment. Critical realism recognizes
the existence of this reality, but also assumes that it cannot be fully known (Braun and Clarke,
2013). It was used to inform the analysis of this study in that, for example, farmers’ frustrations
with impractical regulations will be acknowledged as real as a means to produce knowledge that
may translate to the development of context-specific policies.
2.1.2. Epistemology
Epistemology brings into question “what is possible to know” (Braun and Clarke, 2013,
29) and what exactly constitutes knowledge. It differs from ontology in that it is focused on
16
forms of knowledge and knowledge claims, whereas ontology is focused on the existence of
reality (Tebes, 2005). Epistemology addresses whether there is one valid and acceptable truth or
if there are in fact multiple truths (Braun and Clarke, 2013). Additionally, it addresses whether or
not knowledge is learned or produced through research. Contextualism was selected as the most
appropriate epistemology via which to conduct this research. It lies between constructionism, an
epistemology which suggests that there is no one truth, and positivism, which assumes that there
is a single truth that can be known through objective data collection (Henwood and Pidgeon,
1994; Braun and Clarke, 2013). The contextualist method falls within the larger umbrella of
social constructivism and examines how participants give meaning to their experiences and how
the broader social context impacts that meaning (Willig, 1999; Braun and Clarke, 2006). It
recognizes that knowledge is situated within a context (Tebes, 2005) and reflects the assumptions
of the researcher (Braun and Clarke, 2013). Because this study is interested in behavior in
context, this paradigm was deemed most appropriate. The contextualist paradigm was used to
inform this analysis. For example, farmers’ knowledge surrounding antimicrobials will hold
value as will scientific understandings of antimicrobials.
2.1.3. Methodology
Methodology addresses the construction of knowledge (Tebes, 2005) or rather how it is
acquired. Ethnography, which falls under the constructivist paradigm (Williamson, 2006), was
the methodology employed and is described below.
2.2. Overview of ethnography
Any effort to understand human behavior must be grounded in an understanding of the
context of that behavior (Vayda, 1983; Bernard, 2011). Indeed, public health campaigns
conducted without an understanding of local context generally fail (Craig et al., 2018). For
17
example, the Nurse Family Partnership, an intervention aimed to improve outcomes related to
pregnancy and maternal health, was shown to be effective in trials in the US (Craig et al., 2018).
However, once implemented in the UK, the same effects were not seen, indicating the
importance of contextual variables in intervention implementation. There are also many
examples of public health campaigns that succeeded due to a consideration of local context. The
eradication of rinderpest is one well-known example (Mariner et al., 2012), where success was
due to collaboration between veterinarians and those very familiar with the local context. A
thermostable vaccine was developed that enabled it to be delivered by ground transport (i.e. foot,
bicycle, animal) to remote areas of eastern Africa (Sudan, Ethiopia, Uganda, Somali rangelands).
Local communities were directly involved in identifying pastoral herds as they were aware of
seasonal movements and therefore location of the herds. This approach resulted in herd
immunity levels that exceeded 80%. Another example is the babyClear intervention, which
aimed to prevent smoking in pregnancy (Craig et al., 2018). Smoking interventions successfully
implemented in other populations were not as effective among expecting mothers. By gaining an
understanding of the local context, researchers were able to identify that midwife-patient
relationships would be key to successful interventions.
By drawing on Vayda’s (1983) concept of progressive contextualization, we can begin to
understand how those who are engaging in the activities of concern, make decisions based on the
confines and resources of their given situation (Vayda, 1983). In an effort to understand the
context in which decisions are made about the use of antimicrobials by Alberta dairy farmers,
ethnographic methods were employed.
As noted above, ethnography is an immersive research method employed by
anthropologists (and others, including agricultural geographers) in order to gain insight into a
18
particular culture (Hammersley and Atkinson, 2007; Berg, 2009; Green and Thorogood, 2009;
Schultz and Lavenda, 2009; Bernard, 2011). Generally, ethnographic research requires that the
researcher observe and participate in the daily life of the community of interest for an extended
period of time (Hammersley and Atkinson, 2007). This immersion affords an opportunity to gain
an in-depth understanding of the factors, such as values and beliefs, which influence human
behavior and decisions in the community (Hammersley and Atkinson, 2007), such as, in this
study, decisions concerning the use of antimicrobials. In this study, three broad categories of
ethnographic research were used: participant observation, direct observation, and open-ended
interviews.
2.3. Sampling and study site
2.3.1. Field site
To conduct the ethnographic aspect of this project, the researcher lived in Ponoka, a small
agricultural community in Central Alberta, for approximately three-and-a-half months. Although
the duration of typical anthropological fieldwork normally ranges from a year to a year-and-ahalf (Hammersley and Atkinson, 2007), three-and-a-half months was deemed feasible and
appropriate given the interdisciplinary nature of the project, as well as financial and time
constraints. During her time in Ponoka, the researcher lived with a veterinarian who practices at
the local mixed animal clinic, participated in on-farm activities, and engaged in community
activities. Further details on these activities are explained below.
Ponoka was selected as the primary research site as it was the location of the researcher’s
first point of contact in the dairy farming community in Alberta. Ponoka is located in southcentral Alberta, 100 km south of Alberta’s capital city, Edmonton, and has a population of
approximately 7,229 (Census Profile, 2016). See Figure 1 for map of area. The median age of the
19
population is 40.1 years old. Most residents live in a single-detached house. According to the
2016 census data, Dutch was the first language for 60 (<1%) residents. The median total
household income in 2015 was $74,313 CAD. Nine percent of the population is classified as a
visible minority. Of those who live in a private household (6,985), 750 are immigrants, most of
which either immigrated prior to 1981 or between 2011 and 2016. Forty of which immigrated
from the Netherlands. Of 3,735 individuals, 1,175 individuals earned a high school diploma,
1,965 completed post-secondary education, and 465 completed a university certificate.
2.3.2. Sample size
This study focused on 25 dairy farm owners/operators1. Different protocols, described
below, were used to answer the research questions. Twenty-five (100%) dairy farmers were
interviewed. In 10 of the cases (40%), children, parents, or in-laws joined these interviews. The
researcher also engaged in informal discussions with approximately twelve other dairy farmers
during herd health visits. Of the 25 dairy farmers interviewed, seven (28%) were included in the
participant and direct observation aspect of the study and resulted in >30 days on farm. In
addition to data arising from the participant and direct observations and interviews with dairy
farmers, the researcher also conducted participant and direct observation with veterinarians, hoof
trimmers, on-farm employees (i.e. milkers, DHI personnel, AI/genetics company technician), and
other members of the broader community in the context of community events (three), hoof
trimming visits (two), religious services with two different congregations (six), herd health
exams (23), and an antimicrobial workshop. Data considered, although not analyzed, for this
thesis also included both the recording of an antimicrobial workshop delivered by a veterinarian
Two hoof trimmers and nine veterinarians were also interviewed. However, these data will not be analyzed as part
of this thesis.
1
20
to the local community and shared with the researcher and a participant’s thesis detailing their
perspectives on regulation and religion.
2.3.3. Sampling strategy
Snowball sampling was used to recruit informants in Central Alberta, specifically in areas
of Ponoka and Lacombe. (See Figure 2 for representation of sample selection. This figure depicts
the semi-structured interviews nested within the context of ethnographic fieldwork.) Snowball
sampling is a recruitment strategy that falls within the social network paradigm and refers to a
process that begins with a single respondent and expands outward from that single point of
contact (LeCompte and Schensul, 1999). The initial respondent introduces the researcher to
others in their immediate social network and from those primary contacts the researcher is
referred to additional members of the community who may have insight regarding the topic of
interest. The recruitment process for the interviews continued until no new findings were
revealed, a point known as saturation (Green and Thorogood, 2009). Although there are some
disadvantages to employing snowball sampling (i.e., non-random sample, may not be
generalizable), there are also advantages. These advantages include the ability to build trust
within a community and hear the perspectives of individuals who are otherwise “hard-to-reach”
or do not regularly engage in research projects (Sadler et al., 2010).
Primarily, the researcher was introduced to potential participants via a dairy farmer in the
Ponoka area. The sample expanded from there via contact with his veterinarian and colleagues at
the local clinic as well as his immediate social network of dairy farmers. In terms of recruitment
through the veterinary clinic, the researcher accompanied veterinarians on their herd health
exams to meet dairy farmers and share information about the study with them. The veterinarians
were not directly involved in determining if the farmer met inclusion criteria. The veterinarian
21
simply invited the researcher to ride-along with him/her when he/she/they had scheduled visits
on dairy farms. The researcher did not make the veterinarian aware of the farmer’s decision to
participate in either part of the study.
2.3.4. Study sample
All individuals who own or operate a dairy farm in Central Alberta were eligible for the
study. This includes the immediate family members, such as adult children, of the primary
owners. Although all producers in Central Alberta were eligible, study participants primarily
came from Ponoka and surrounding areas as snowball sampling was used for recruitment and the
location of the researcher’s first contact was Ponoka. Although the central point of the study site
is Ponoka, Alberta, the study sample expands outward to Lacombe and surrounding towns. The
farmers interviewed were the same farmers asked to participate in the observational part of the
study. However, the observational sample also included other individuals participating in onfarm work, including milkers, hoof trimmers, and veterinarians, as well as other members of the
broader community.
A subset of nine farms/farmers was selected for analysis. The selection aimed to
represent the breadth of perspectives present in the sample. A descriptive summary of those nine
farms/farmers is provided in Tables 1 and 2. All farms were non-organic. Of the nine farms
included, five (56%) were located in Ponoka, one (11%) in Rimbey, one (11%) in Lacombe, one
(11%) in Mountain View, and one (11%) in Didsbury. Seven (78%) managed between 60 and
105 milking cows. Two (22%) managed between 400 and 480 milking cows. Three (33%) had
hired help. Three (33%) used an Automated Milking System, five (56%) had milking parlors,
and one (11%) had a flat (walk-through, step-up). Six (67%) had self-reported bulk tank somatic
cell counts of 150,000 cells/mL, two (22%) were between 150,000 and 300,000 cells/mL, and
22
one (11%) was > 300,000 cells/mL. Seven (78%) currently practiced blanket dry cow therapy
(DCT) and two (22%) practiced selective DCT. Of the seven that practice blanket DCT, three
(43%) would consider switching to selective. Eight (89%) currently vaccinate their herd.
Of dairy farmers included in this subset, five (56%) immigrated to Canada from the
Netherlands an average of (21.6 +- 4.4) years ago (includes Farm 7, in which case, the spouse is
from Canada), two (22%) immigrated from Switzerland an average of (32.5 +- 9.2) years ago,
one (11%) was the child of parents who immigrated from Switzerland, and one (11%) was
Canadian dating back multiple generations. Of farms included in the study, seven (78%) farmed
as part of multigenerational families, and one (11%) was predominately operated by a female.
All farmers pursued postsecondary education. Of the farmers included, all (100%) were from a
lineage of dairy farming families with two extending back as far as four generations and one as
far back as the 1600s. However, not all spouses were from a dairy farming background 2. Ages of
those who participated in the interviews ranged from 29-61.
2.4. Data collection methods
2.4.1. Role of the researcher
The role of the researcher is to provide a description of the topic of interest that is
consistent with the farmers’ perspectives (Green and Thorogood, 2009, 151). The researcher
assumed an “observer as participant” role (Gold, 1958). The “observer as participant” role refers
to a researcher that has minimal connection to the field site or social setting. In this case, she was
not a member of the observed group. However, she was also not strictly observing the
2
In some cases, spouses and other family members participated in the interviews.
23
interactions from an external position. That is, she engaged in the daily work and routine of the
farmers and sought to understand AMU from the farmer’s position.
2.4.2. Participant observation
Participant observation is one of the key data collection methods utilized in ethnographic
fieldwork (Hammersley and Atkinson, 2007; Schultz and Lavenda, 2009). It requires that the
researcher participate in the daily chores, activities, and social events of the community. By
doing so, the researcher is able to “absorb their mode of reasoning” and to gain some
understanding of family dynamics and values (Opala and Boillot, 1996, 4). All of the activities
described below demonstrate the dedication of the researcher to the community and helped to
build rapport, a critical component of ethnographic fieldwork (LeCompte and Schensul, 1999).
It is important to note that the process of building rapport can sometimes be more difficult if the
community perceives the researcher to be very different from them (LeCompte and Schensul,
1999). In this case, the researcher, a New Yorker with Italian American ethnicity, may have been
seen as different due to having grown up in a large city or perhaps was seen as having some
similarities (i.e. interested in dairy farming).
In this study, observations took place on the dairy farms and at community events.
Research settings included the barns, milking parlors, surrounding fields, homes, community
centers, and churches. This involved participating in daily farm routines, including milking cows,
“picking up cows” or encouraging cows to move toward the parlor or go to be milked in an
automated machine, bottle-feeding calves, relocating calves and heifers, cleaning bedding,
holding areas, automated milking machines, and parlors, collecting and delivering feed, picking
up bales via tractor use, and assisting with dehorning of calves and associated anesthetic
procedures. By learning to milk and participating in milking shifts, the researcher was able to see
24
first-hand how protocols are implemented on individual farms and how such procedures vary
across farms. It also allowed the researcher to understand the importance of communication in
the milking parlor, the routine sequence of events, how unintended errors can be made during
milking shifts, and the variability in preventative measures taken to ensure milk safety. Finally,
spending time with the milkers during a three-to-four-hour shift provided ample opportunity for
informal discussion and interpersonal connection. The other activities mentioned above (i.e.,
cleaning, feeding) allowed the researcher to understand the priorities and daily concerns of the
farmer as new tasks and issues arose throughout the day. Furthermore, by participating in daily
tasks, the researcher learned about the work ethic and endurance required to sustain such a
livelihood.
Home chores included caring for young children, assisting with cooking, and gardening.
The researcher also attended events hosted by a local community group, including a pancake
breakfast, Wiener roast/hockey game, and a local gathering of farmers in which they toured a
designated barn. This provided an opportunity to engage with other non-dairy community
members, observe community relations, and learn more about community interests, values, and
concerns. Finally, the researcher, after being invited by members of two different congregations,
attended local church services on Sundays. Doing so allowed for a greater understanding of the
community’s belief system and values. See Appendices D and G for consent forms and
protocols.
2.4.3. Direct observation
Direct observation is another method used in ethnographic research to understand
behavior in context (Schultz and Lavenda, 2009) and it provides a means by which to compare
what people say to what people do (Gobo, 2008). It differs from participant observation in that
25
the researcher does not participate in the activity, but simply observes the behavior first-hand and
records it. Unlike participant observation, which utilizes an emic perspective, direct observation
utilizes an etic perspective (Bernard, 1998). By emic, we mean that the data will reflect the
participant or an insider’s perspective, whereas etic suggests that the data will reflect an
outsider’s perspective.
In this study, direct observation was employed by observing on-farm activities. These
included making silage and other crop-related activities, treatment of sick cows and calves,
surgical procedures (i.e. displaced abomasum), a calf euthanasia, necropsies, calvings, milking
procedures for animals previously treated with antimicrobials, dry cow treatment, hoof trimming
and herd health exams. Observing crop-related work provided a holistic understanding of farm
operations beyond what is typically given attention to in studies of AMU on dairy farms. It also
allowed for a more complete understanding of the connection between manure, crops, and the
broader environment. By being present for antimicrobial treatments of sick and dry cows, we
were able to understand how farmers make treatment decisions in real-time and how their
behavior in context may differ from that described in the interviews. It was worthwhile to
observe the standard procedures followed by milkers when a cow currently being treated with
antimicrobials entered the milking parlor because it highlighted the importance of
communication and behavior in that context. By observing hoof trimming appointments, the
researcher saw first-hand how hoof trimmers make decisions regarding use of antimicrobials,
who is responsible for providing the antimicrobial, and the dynamic between the farmer and the
trimmer. By attending herd health exams, the researcher was able to observe farmer-veterinarian
interactions, and the decision-making process for antimicrobial selection. There were
approximately three days of observation on each farm. Each daily visit lasted between four to
26
eight hours depending on the farmer’s schedule and approval. There were also two one-week
homestays on one farm prior to commencement of the interviews. Additionally, the researcher
toured all 25 farms and a Hutterite colony. Observations were recorded as fieldnotes.
2.4.4. Open-ended interviews
Open-ended interviews were conducted with the dairy farmers 3. The primary objective of
open-ended interviews is to understand the full breadth and diversity of the respondents’ answers
(Braun and Clarke, 2013). Open-ended questions allow for a more comprehensive understanding
of the topic of interest by providing the participants with opportunities to offer detailed responses
and to explore aspects of the topic that are most important to them (Braun and Clarke, 2013).
Unlike in standardized interviews, in qualitative or open-ended interviews, “the interviewer plays
an active role in the interview, co-constructing meaning with the participant. It is neither possible
nor desirable to attempt to minimize the interviewer’s role (Braun and Clarke, 2013, 79).”
These interviews may take one of three forms: structured, semi-structured or
unstructured. A structured interview is an interview in which the researcher has a predetermined
list of questions and the researcher does not stray from that set of questions (Braun and Clarke,
2013). Similar to a structured interview, a semi-structured interview also makes use of an
interview guide (Braun and Clarke, 2013). However, this style of interview allows for deviation
from the predetermined questions based on issues raised by the interviewee and unexpected
information revealed through probing. This form allows the researcher to ask unplanned
questions. In contrast to the interview styles described above, the researcher does not develop a
set of questions when conducting an unstructured interview. The researcher may develop a list of
Interviews were also conducted with hoof trimmers and veterinarians. However, these data will not be analyzed as
part of the thesis.
3
27
themes when preparing for this style of interview (Braun and Clarke, 2013). However, it is
largely participant-led.
The majority of the interviews conducted with the dairy farmers followed a semistructured form, allowing for unanticipated topics to be discussed based on the farmers’ interests
or concerns. However, in some cases and during some parts of the interview, it followed a more
structured form. The first part of the interview covered demographic information and was
relatively structured. In some cases, the rapport between the interviewer and the interviewee
encouraged a more structured form. See Appendices E and F for interview guides, Appendices B
and C for consent forms and Appendix A for project overview, which was distributed to
participants. Interviews took place either in the barn, office or home of the farmer. Interviews
required one to 4.5 hours, with lengthier interviews reflecting a keen interest on the part of the
research subject in discussing the topic. Interviews were audio-recorded. Key topics covered
during interviews included, but was not limited to: antimicrobials most commonly used and
stored on farm, primary reasons for use, place of purchase, key on-farm actors in decisions
related to treatment of illness, concerns and perceptions regarding reduction in use and increased
regulation, perceptions of AMR, and perceived risks of adopting new protocols. Areas for
increased AMS and potential pathways for collaboration with the veterinarian and hoof trimmer
were discussed. Additional information was gathered to obtain a more in-depth understanding of
the belief systems and lived experiences of the dairy farmers. Many of the dairy farmers in
Alberta are part of a lineage of dairy farmers that extends back to the Netherlands. By
understanding sociocultural values, familial relationships, and past experiences, we may better
understand farmer knowledge and its current implementation on farm.
28
2.5. Data analysis
2.5.1. Overview
A number of analysis styles were considered. In light of the interdisciplinary nature of
this study, we employed one that focuses on unpacking the broader meaning of the text while
also sharing the point of view of the participants. That is, we aim to describe the complexity of
the phenomenon and highlight the lived and subjective experiences of the participants (Green
and Thorogood, 2009). We also hope to provide an in-depth understanding of the biocultural
context. Biocultural context refers to a setting in which biology and culture are intertwined in
such a way that the resulting effect poses a significant challenge to standard approaches to public
health. Such a perspective recognizes that humans and animals do not exist independently of
their sociocultural, ecological, and historical contexts (Wiley and Allen, 2013).
2.5.2. Thematic analysis
Interview audios were transcribed by a third party. Thematic analysis was used as the
analytic framework (Vaismoradi et al., 2013). Thematic analysis refers to the process by which
data are reviewed and recurring themes or patterns are identified and analyzed (Braun and
Clarke, 2013; Vaismoradi et al., 2013). An inductive approach was used to identify the themes.
Although there is a body of literature on knowledge, attitudes, and practices of dairy farmers as it
pertains to AMU, the author did not deeply engage with said literature prior to the time of
analysis and so was able to maintain a wider analytic field of vision, facilitating an inductive
approach. These common themes spanned the course of the interview dataset. The results of this
type of analysis are a detailed account of the insights shared by the farmers.
The following steps were taken to conduct the analysis:
29
1) Familiarization with the data: The researcher reviewed the transcripts and fieldnotes.
She listened to the audios and recorded and summarized notes from each interview.
2) Organization: A separate document of commonly held values, perceptions, and beliefs
was then created.
3) Themes: Based on this document, ideas were grouped into themes and subthemes.
Identification of themes followed a more latent, rather than semantic approach (Braun and
Clarke, 2006). That is, themes were not solely descriptive in nature, but also took into
consideration underlying ideas that may be informing participants’ responses (Braun and Clarke,
2006). A concept map (Figure 3) was developed to aid in visualizing the relationships between
themes.
5) Reporting: Quotes were extracted to provide the reader with concrete examples of the
text.
2.5.3. Analysis of ethnographic data
Field notes based on the observations and informal discussions were transcribed from
handwritten fieldnotes and organized. They were used to contextualize and elaborate on the
information gleaned through the interviews and to provide a holistic account of the social context
(Gertz, 1973). The researcher then provided an interpretation of the observations. This included
highlighting any emerging patterns or themes (Berg, 2009). The observations in combination
with the interview data are used to describe the phenomenon of interest (i.e. AMR, AMU, AMS).
2.6. Qualitative rigor, internal reliability and validity
The interview guide was tested and validated by a farmer external to the study to ensure
that questions were appropriate to the context and topic of interest. Qualitative analytical rigor is
30
ensured by listening to the audios, taking detailed notes, summarizing those notes, creating a list
of most commonly expressed ideas and comparing them across interviews. Interpretation of the
results and accompanying relevant text extracts for each theme were reviewed by HB, WW, CA
and JI for the purposes of quality assurance. Points of disagreement were resolved via group
meetings and discussion.
2.7. Privacy, confidentiality and data handling
The privacy and confidentiality of participants were protected during the course of this
research. Identifiers were removed from the audios prior to third-party transcription. Interview
transcripts and audios were only accessible by JI.
2.8. Ethics approval
This research study was reviewed and approved by the University of Calgary Conjoint
Faculties Research Ethics Board has approved this research study, study ID number REB180795.
31
Farm
Residence
No.
milking
cows
Workers
on the
farm1
Milking
system
1
Ponoka
400
NF=9;
F=5
Parlor,
parallel
2
Ponoka
180
NF=3;
F=1
3
Ponoka
60
NF=0;
F=5
4
Ponoka
480
NF=7;
F=2+adult
children
5
Ponoka
103
NF=1;
F=4
Didsbury
95
NF=0;
F=4
Mountain
View
116
6
Parlor,
double 10
herringbo
ne
Parlor,
herringbo
ne
Parlor,
double 20
parallel
Auto.
Milk Sys.
(recently
switched
from tiestall)
Somatic
cell
count2
200
233
B
Y
100
S
Y
100-130
B (trying
to switch
to S)
Y
375
B
N (plans to
start)
110
B
(discussin
g S with
family)
Y
S
Y
B
Y
B (would
consider
switching
to S)
Y
Auto.
Milk Sys.
Auto.
140
Milk Sys.
Flat
NF=1;
8
Rimbey
90-100
(walk80-150
F=3
through)
Parlor,
double 8
NF=1;
9
Lacombe
85
parallel
125
F=2
(switching
to AMS)
Table 1. Descriptive summary of farms included in the sample subset
7
1NF=non-family
2Self-reported
3B=blanket
Method of Vaccinates
dry cow
herd
therapy3
B (would
consider
Y
switching
to S)
NF=0;
F=4
members; F=family members
bulk tank somatic cell count in 1,000 cells/mL
dry cow therapy; S=selective dry cow therapy
32
Farm
No. interviewed
participants
Age
(yrs)
Sex
Postsecondary
education
(Y=yes;
N=no)
1
1
32
M
Y
2
1
44
M
Y
3
1
39
M
Y
4
5
1
(Husband
present)
4 (Wife,
father-inlaw,
mother-inlaw also
present
and
engaged)
41
31
49
F
M
M
Y
Dairy farming
background
10 years farming; Can
be traced back 4
generations
20 years farming; Can
be traced back to
1950s; Grandparents
and parents; Parents
started in 1972, still
farming in the
Netherlands
20 years farming; Can
be traced back two
generations; Dad and
grandfather farmed
23 years farming; Can
be traced back before
1600
Immigrated
to Canada
(Y=yes,
N=no,
P=parents
immigrated)
Y (28 years
ago;
Netherlands)
Y (22 years
ago;
Netherlands)
-1
Y (23 years
ago;
Netherlands)
Y
10 years farming; Can
be traced back 3
generations
N
Y
Farming entire life;
Can be traced back 4
generations
Y (26 years
ago;
Switzerland)
2
participants:
Y (17 years
ago;
Netherlands);
1 participant:
N
P (39 years
ago;
Switzerland)
6
1
7
3
(Husband,
wife,
husband’s
father,
equal
participati
on)
30; 29;
61
M; F;
M
Y; Y; Y
Farming 10, 1, and 43
years, respectively;
Can be traced back 1
generation
8
1
37
M
Y
Farming entire life
33
2
(Husband,
16 years farming; Can Y (18 years
9
wife, equal
37
M
Y
be traced back 2
ago;
participati
generations
Netherlands)
on)
Table 2. Descriptive summary of personal attributes of dairy farmers included in the sample
subset
1-
= Missing data
34
Figure 1. Map of Central Alberta
35
Figure 2. Representation
Flow chart of sample
of sample selection
36
CHAPTER 3: RESULTS
3.1. Introduction
Four content-driven themes related to dairy farmers perceptions concerning antimicrobial
use (AMU), antimicrobial resistance (AMR) and regulation emerged from the analysis. Each of
these themes was apparent in transcripts from most of the participant categories. See Figure 3 for
thematic map. As noted above, an understanding of these themes must be informed by context.
Consequently, findings concerning context are provided below, prior to details concerning the
emergent themes.
Theme 1: Farmers as stewards of the land
Subtheme 1: Work ethic and pride
Theme 2: Dairy farmers as autonomous actors,
Subtheme 1: Resistance to increased regulation as fueled by concerns of ‘becoming
Europe’
Subtheme 2: ‘Rules create liars’
Theme 3: Mutual distrust between the farmer and the public
Subtheme 1: Lack of transparency surrounding biological pathways and connection
to milk safety and procedures
Subtheme 2: Skepticism regarding connection between AMU in agriculture and
AMR in humans
37
Subtheme 3: Antimicrobial regulation as fueled by consumer perception and not
Scientifically driven
Subtheme 4: Lack of value for farmer knowledge, experience, and education by the
public as further exacerbated by implementation of ‘extreme’ policies
Theme 4: Frustration with impractical policies
Subtheme 1: Tools with value (in support of animal welfare)
Subtheme 2: Antimicrobials (i.e. blanket DCT, Ceftiofur (most often referred to by
the farmers using its brand name, Excenel) provide a sense of safety, act as an
insurance policy
38
3.2. Context
3.2.1. Political-economic
3.2.1.1. Supply management system
A distinguishing feature of the Canadian dairy industry is its supply management system,
also referred to as milk quota. When the field researcher first arrived in Canada, she attended an
event hosted by the Dairy Research and Extension Consortium of Alberta (DRECA), which
served as an initial introduction to the field site. On the bus ride home from the event, she was
introduced to Susan, a representative from Alberta Milk, a non-profit organization which is run
by and represents Alberta dairy farmers (Alberta Milk). Susan explained that it is this system that
is unique to this context and sets dairy farming in Canada apart from dairy farming in other
contexts. In order to produce and sell milk, producers are required to purchase quota. They then
are only paid for milk produced within their monthly quota limit. Throughout the interviews, the
producers referenced the quota system frequently, sharing how they have fought hard to keep
this system and it has provided them with economic stability (in terms of fluctuations in milk
price). One farmer shared that because of the stability guaranteed by the supply management
system, he feels he can take on greater challenges on the farm and take greater risks (i.e. making
changes to housing, nutrition, etc.) than he otherwise would be able to.
3.2.1.2. US-Canada trade agreements
However, producers also shared that this system is threatened by negotiations between
the United States and Canada, particularly with regard to the North American Free Trade
Agreement (NAFTA), and they expressed specific concerns about the current US administration
pushing for the abolishment of the supply management system. According to some producers,
39
the removal of this system would change the current structure of dairy farms in Canada, moving
from the current small, family farm to larger, more commercialized farms.
3.2.2. Social-community
3.2.2.1. Religion
Although not all individuals in the dairy farming community are religious, religion is
undeniably a part of the social fabric of this context. Of those that do take part in religious
activities, many belong to a Dutch Reformed congregation and worship each Sunday. After the
service each Sunday, there is time to meet and speak with other members of the congregation
over coffee, which not only provides an opportunity to reflect on the week’s sermon, but also
serves as a way to strengthen community ties.
As described by one informant, religion and social relationships are often tied in rural
communities. For instance, it is common practice for events held by local dairy farming
organizations (i.e. Alberta Milk, Alberta Holstein Association, Western Canadian Dairy
Seminar) to begin with prayer. However, for those dairy farmers who do not regularly partake in
religious activities, this was described as a point of tension. One farmer expressed concerns over
the role religious beliefs and adherence may play in delegate selection for the board of Alberta
Milk. “You can see it. You can feel it,” he says. Another states, “We have friends who are
Christian and non-Christians, and it’s fine…I don’t think about them different if they are or
aren’t. They’re just friends, and what they believe, it’s their belief. But I find that there’s a lot of
people here – Christians – if you’re not a Christian, you’re not a good guy...They are a very
closed community.”
40
One participant explained that this tension likely dates back to the Protestant Reformation
in the Netherlands which ended in 1571, with a separation of the Dutch Reformed Church from
the Roman Catholic Church. A couple participants shared that once Dutch dairy farmers
immigrated to rural Alberta, they built their own communities and as one participant explained,
because they were far from home and far from their families, the church served a familial role.
3.2.3. Technology
When compared to other farming sectors, the dairy farming sector places a great
emphasis on technological innovation and strives for constant improvement, which is fueled by
positive peer competition. For example, during the fieldwork, the researcher was invited to a
Friday evening event. This social gathering is held every couple of months at a different friend’s
barn, often after there has been a recent change, technological installment, or barn renovation.
Such an event not only provides an opportunity for socializing with other friends who are also in
the industry, but also serves as a way to observe cutting-edge technologies in the field, discuss
their advantages/disadvantages, and consider options that may work to improve management on
one’s own farm. In this particular case, the host farmer had recently switched from a milking
parlor to an automated milking system and so his friends grabbed a beer and took a stroll around
the barn. He presented the unique features of the system to them, and they compared the model
with other automated milking system models. The high importance given to technological
innovation was also evident via the interviews, in which the farmers discussed the relevance of
heat detection, rumination, and activity monitors as well as the wide range of data collected from
these systems and the role these data collection sources can play in improving decision-making
on-farm, particularly as it relates to AMU.
41
3.2.4. Built environment
One key aspect of the built environment is the relative size of the farms in comparison to
dairy farms in other regions. The dairy farmers describe farms in Alberta as small, family farms.
They also point out that farms are spread out over the landscape, which strongly influences the
most appropriate measures for veterinary medical resource allocation. More specifically, this
makes AMU policies, such as those that have been implemented in some European countries
which require the veterinarian to provide all on-farm medical treatment, impractical from the
farmers’ perspective. This point will be elaborated on below.
3.2.5. Natural environment
Through informal discussion with the farmers as well as more formal interviews, it
became clear that one element of the natural environment that will need to be considered in light
of the research aim is the Alberta winter. It is a very long, cold winter with heavy snowfall. The
farmers note the importance of this environmental element in reference to the overall wetness in
the barn during the winter months and its corresponding impact on calf health and therefore
AMU. However, another farmer indicates the importance of this element when he compares
winters in Alberta to winters in British Columbia, which he describes as damp and humid,
leading to increased occurrence of pneumonia in calves. Because Alberta winters are a dry cold
in comparison, he is more likely to opt to just ‘keep an eye’ on the calf, as opposed to
immediately treating her after onset of symptoms (i.e. cough). He explains that he needed to
change his thought process regarding AMU in calves in order to adapt to this climate. Another
shares the impact of weather, “But weather impacts you, especially in a Northern climate when
it’s -30 outside, the barn gets damp and humid. So, risk of mastitis goes up and there’s nothing
you can do about it. We still will depend, always, on antibiotics.” Although farmers expressed
42
contrasting experiences regarding the role of the Alberta winter, it is clear that the natural
environment does in some form impact their use of antimicrobials.
3.3. The dairy farmer
3.3.1. Daily life
Depending on the farm, a typical day on a dairy farm may entail rising at around 3:30AM
and heading straight to the barn. The farm on which the field researcher conducted a two-week
homestay used a parallel parlor milking system. Therefore, one person was needed to ‘pick-up’
cows, or encourage them to stand and begin to walk toward the parlor. In the case of this
particular farm, the person responsible for this duty was the father. While ‘picking-up’ cows, he
would also scrape manure from the alleyways and clean the stalls. The first milking shift began
at 4:15AM. There was a total of 3 milking shifts/day on this farm (4:15AM, 12:15PM, 8:15PM).
Each milking shift lasted about 3.5-4 hours. After the morning milking shift, family members
would nap until about 10AM and employed milkers would return home/leave the farm. After the
morning nap, they would have coffee and then return to the barn to complete other activities (i.e.
relocating calves and heifers, checking on sick cows). Lunch was at 12PM (although not for
those who were scheduled to milk at the 12PM milking). In the afternoon, other on-farm
activities were conducted, including feeding. After the 12PM milking, the milkers would feed the
calves. At 4PM, there was a coffee break and dinner was at 6PM. The veterinarian came on
Tuesday mornings for their regularly scheduled herd health. The DHI technician came on
Tuesday evenings to test the milk samples. On Sunday, most family members attended a 10AM
church service, followed by lunch at home. This schedule also applies to holidays. One farmer
pointed out the dedication the profession requires as they still are required to milk on Christmas
morning.
43
3.3.2. Gender roles
Although it is certainly not the case on all farms, there seemed to be a pattern in terms of
labor allocation. On some farms, calves were the responsibility of women or female milkers.
However, on at least one farm, it was observed that a female farmer oversaw all dairy-related
work. She pointed out that as a child, she was expected to help in the house, but did not enjoy it
much. Instead she spent her time helping her father in the barn, where she learned much of what
she knows. She also notes that her family farm was passed to a woman four times, which seems
to be a unique occurrence in this context.
3.3.3. ‘Cow person’
Through the fieldwork it became clear that farmers either identify as a ‘cow person’ or
enjoy the business aspect of farming. With regard to this distinction, one farmer commented,
“…A dairy farmer used to [be about] cows, but a lot of farmers now are just businesswomen or
businessmen. It’s commercial...” For some, being a ‘cow person’ seemed to be a strong part of
their identity. One farmer recalls the first time he milked a cow. Several said that they know their
cows on an individual level and take great pride in that. The ability to know one’s cows is further
enhanced by the size of the farm. One farmer remarked that he loves being a dairy farmer of a
small farm as it allows him to really know his cows without needing to hire on-farm employees.
Another farmer shared that he keeps his cows even once they are no longer lactating or breeding
as they have earned their keep.
3.3.4. Lifestyle
In addition to a strong desire for freedom, which will be discussed below, there seemed to
be a consensus among dairy farmers in this sample with regard to the lifestyle that the profession
provides. In response to questions about choice of profession, informants stated that they opted
44
to become dairy farmers for the lifestyle it would provide. That is, it afforded them more time at
home with their families. One farmer mentioned that he is able to homeschool his children
because of the flexibility the profession provides. One farmer explained, “It’s not a job, it’s a
way of life… I was born...I learned to walk in the barn…I grew up walking in the barn, feeding
cows, walking underneath cows…” Another explained that the working conditions are suitable
because you are doing what you love. Another saw it as a challenge and found it rewarding to be
able to affect change on the farm. Additionally, he states, “I’m in a position, with my brothers
and my parents, to supply livelihoods for other people…And in that way, also reflect on my faith
in God. I get to provide for other people. Not just with giving them food with the milk. Like, I
get to give jobs to people. And give a good work environment to people. And hopefully, they see
in that, and how I talk about my faith, that I’m not just doing it for the bottom dollar. Yeah, and I
think for a Christian that sees it as something that God has created, it’s even more enjoyable. It’s
an increased level of enjoyment.” Another finds real joy and excitement in the changing of the
seasons and the corresponding work of each season. He draws on his sensory experience to
describe the springtime in which he will get the fields ready and the fall, when he feels the cool
air while combining. He comments that not everyone feels such passion for their job.
3.3.5. Family bonds & multigenerational farming
The strength of the family ties was quite evident both via the interviews as well as
through participant and direct observation. Multigenerational farming, with at least two
generations farming together, is common. Many farmers spoke about how they valued raising
their kids on the farm and the opportunity it provided to teach them good work ethic, how they
make decisions as a team, and decide if new on-farm considerations fit the ‘family picture.’
Some expressed hopes that their children would one day take over the family farm and become
45
dairy farmers themselves, a process so common that advisors are hired for succession planning.
Another spoke of the importance of his adult children’s views as they are the next generation and
will be farming for the future.
3.3.6. Part of cultural heritage: Europe to Canada
For most participants in the sample, farming is part of their cultural heritage – either in
Canada, the Netherlands, or Switzerland. For one participant, farming dates back to as early as
1600 in Holland. Dairy farmers that immigrated from Switzerland or the Netherlands did so with
the intentions of farming. One farmer who immigrated from the Netherlands says, “I left the
Netherlands because I was a small farmer in the space of trying to [develop] myself…You have
competition in Holland from big farmers, and the regulations there, they got tougher and tougher.
So, yeah, at the end, we decided we go to Canada. And not because we want to escape only the
regulations, because we can handle regulations…But it’s more [that] we have more. Now the
boys had a chance to farm.” They chose Alberta because they already had one family member
here and his wife thought, “it’s important for family to be a little bit closer in case she needed
somebody…you can always be in need of something when there’s sickness…” Others mentioned
that farmers in the Netherlands felt increased pressure due to increasing regulation, which no
longer made the profession enjoyable. One farmer who relocated from Switzerland said he too
moved to Canada to farm, as “You can’t farm in Switzerland if it’s not in the family pretty
much...You just can’t afford it.”
46
3.4. Themes and subthemes
3.4.1. Theme 1: Farmers as stewards of the land
The farmers can be seen as stewards of the land and, in some cases, stewards of God’s
creation. One informant shared that, “Farmers look after animals. That’s what farmers are. Or
they look after land. That’s their job, that’s their income. They’re gonna do a good job of it,
otherwise they’re not gonna have an income.” Another farmer shared her value for the cycle of
life. The producer says, “I like the cycle of life – from [birth] to calving.” Yet another explained
in great detail that he enjoys working with God’s creation. “I am a Christian, so I like working
with creation. I like working with the world that God has given us…God has placed me here. I
was born here to this family and near this farm with this potential, and I think it would be
irresponsible for me to not do well with it. It’s not stewardly. And God told Adam and Eve to
take care of the Garden of Eden. And we are supposed to take care of the world. That’s a
mandate. Take care of the creation. And I think it’s a witness to my love for God—It’s a witness
to my love for God by treating His creation carefully. And I don’t even see this farm as ours. It’s
God’s farm. This is His world. So, I don’t really own this. I’m a caretaker. So, I was born into
this family… I’m here to live for Him, right? To work for Him. To do what I can to… keep
healthy cows and have the calves perform, and the better they do, the happier that I am because I
think I am succeeding in taking care of what God has given me to take care of. I think that
glorifies Him. I think it reflects well on Him when I take care of His creation…If I’m using
drugs all the time, then I’m doing a bad job.”
For those informants in which their belief system aligns with the above described
sentiments, a culture of overuse of antimicrobials is unlikely or would be in direct contradiction
to their expressed values. This sentiment is further supported by insights gleaned through
47
fieldwork. As described in the methodology section, the researcher attended church services with
community members and noted one sermon in which the key message was, “A little is enough
(Mark 6.30-44).” If according to God’s message, a little is enough and life should be lived
according to that principle, it perhaps may be intuitive for some farmers to adopt farming
practices that align with this message, namely ones aimed at judicious use of antimicrobials.
3.4.1.1. Subtheme 1: Work ethic and pride
The dairy farmers take great pride in their product and are committed to making sure that
they are producing a clean, safe, wholesome product. One states, “We care about the product,
what comes off the farm...That’s why we do this.” They are also quite proud of their farms,
especially when new additions or expansions are made. The same farmer states, “We [are a]
family farm [as opposed to a big business]. We try to do better every time, and it doesn’t always
go that way, but it’s what we try.” And, that sentiment is reflected in their perceptions of work
and work ethic. One farmer explained that you have to work hard if you really want something.
He explains, “You have to work hard if you want something. I know I’ve been working hard to
make a go of this and we’re succeeding. I mean, it’s not easy work.” Through informal
discussion during the fieldwork another shared that it is not like other professions in that they are
required to milk on Christmas morning. This concept is further supported by the daily routine,
which for many farmers involves rising at 3:30am for milking shifts that begin at 4am as noted
by on-farm participant observation.
Considering the integrity with which they pursue their work and the degree to which they
care about the product they are producing and the manner in which it is produced, it is reasonable
to suggest that they desire to do what is right and act in the best interest of the cow and
humanity. This arguably includes responsible use of antimicrobials on farm.
48
3.4.2. Theme 2: Dairy farmers as autonomous actors
Despite the variability that exists in terms of farmers’ perceptions of AMR and
regulation, dairy farmers in this sample seem to be united on one front – freedom. When asked
what they valued most about being a dairy farmer, most responded with a version of, “I am my
own boss” or simply, “my freedom.” One farmer explained, “At least if we fail, we fail on our
own terms.” They enjoy the ability to set their own schedule and the flexibility and room for
ingenuity and creativity that comes in having similar goals to other dairy farmers, but having the
freedom to reach those goals in a way that is unique and specific to the needs of their farm, cows,
and family. This autonomy, in some cases, also translates to being proactive. This is exemplified
by a couple of farmers’ description of deciding to change the default settings on their milking
systems to ones that increase cow comfort. One farmer stated that the company’s mandate is
different than the farmer’s mandate and the default settings reflect that. This drive to be
autonomous is further demonstrated in discussions about the prospect of increased regulation in
which one farmer stated, “I’m a farmer…I don’t like increased regulation.” However, this
statement does not fully encompass the perspectives of all dairy farmers in this context. This will
be elaborated on below when the concept of ‘rules’ is discussed.
Coupled with their desire to remain autonomous is their hope to maintain the freedom to
choose and the freedom to act. One farmer hopes that antimicrobials will continue to be available
for producers to make autonomous decisions and to do what they think is right. The producer
says, “I hope [antimicrobials] will always stay available to us. Because if it’s not available then it
would not be beneficial. You try to reduce as much as you can, as long as it’s still available so
you can act when you think you need it…So, I personally hope that we will always have that
choice.” In this way, one can begin to see that their ability to administer antimicrobials when
49
they deem necessary or appropriate provides them with a sense of agency, a way to act when
they need to and without relying on external resources. Another farmer supports this idea, while
also demonstrating that impinging on their freedom to choose or act calls into question their
knowledge or expertise. He states, “…we’ve grown up doing this our whole lives. We know how
to administer drugs. Why should they take that right away from us?” The undervaluing of farmer
knowledge and expertise will be discussed further in Theme 4.
3.4.2.1. Subtheme 1: Resistance to increased regulation as fueled by concerns of ‘becoming
Europe’
When approaching the topic of antimicrobials during a Saturday afternoon community
gathering, one farmer turns and says, “We are becoming Europe.” This concept, concern of
Canada turning into Europe, was consistent throughout the interviews as well as through
informal discussion in the community. Another farmer shares, “The thing is, they keep saying,
‘This regulation program is going to be the answer.’ Then there’s another regulation program
installed. That’s gonna be the answer. Now we have another regulation program coming in. Is it
ever gonna stop? No. We’re gonna get to be the Netherlands shortly. So, after the first one didn’t
work, the second one hasn’t worked, now a third one’s coming in. Where’s it stop?”
Many specifically expressed concern about the potential for Canada to adopt similar
protocols to European countries, specifically ones that would require a veterinarian to administer
all treatments. The same farmer shares, “I hope we don’t come to the point of Europe and we
have to have a vet to administer every drug, because I believe dairy farmers will lose a lot of
money. If that ever happens, I don’t know if we’ll have enough veterinarians to do that. And
then, I can see a lot of farms going the opposite way. I can see things getting really bad, because
they won’t be treating sick cows. They won’t be—you will have cows in barns that should not be
50
in barns. They should be in the dead pile. Because, financially, the farmers won’t be able to do
it.” Another says, “In Europe, the vet has to treat each animal…which would be unfortunate if it
happened here. Plus, we have way bigger farms than they do there…Mainly it would be an
economic challenge. Yep. Because any regulation going forward is just going to make it harder
for the farmer…And you have to have a vet. And that all costs money.”
Even another supports this idea when he says, “I know there are some countries where
the vet has to be involved in everything…if we just start working hard at making sure that what
we’re doing is the right way…we’re not just overdoing it…we can prevent, yeah, it going that
route.” He also suggests that the built environments are sufficiently different and so the same
solutions would not be practical in both contexts. In reference to the Netherlands and Denmark,
he says, “there, too, it’s a smaller country. I think it’s easier to get around. I think Canada or the
US, maybe countries like Mexico, North America in general, we’re more spread out, bigger
farms…” A farmer from Switzerland adds, “I know in Switzerland you have to have the vet there
to administer drugs…My sister and my brother-in-law, both of them are still farming in
Switzerland…Their vet lives five minutes [away] from their home. So, cost-wise, it’s a different
thing. My vet comes out to the farm. It’s a whole different bill. So, that way I don’t see that
feasible.” Others have added that in some cases time is critical, particularly with some cases of
mastitis. One farmer says, “…if I don’t treat fast enough, the cow is doomed. She will not
recover well…As long as we treat quickly enough, I don’t see issues. The cow recovers.” When
applied to a scenario in which a vet might be required to treat, the farmer may lose valuable time
waiting for the veterinarian to arrive due to distance between clinics and farms in this context.
However, perceptions of farming regulations in Europe are not always straightforward.
For example, the producer who stated that he would like to prevent us from taking that route also
51
shared that he decided to switch from blanket to selective DCT based on European-based
literature, which outlined the appropriate parameters to consider when deciding to treat a cow,
suggesting that he does value the European approach, at least partially. In his particular case, it
seems that perhaps some aspects of the system are desirable, but, in other cases, are too extreme.
For example, he later states, “I think Denmark is to the extreme.” This resistance to the extreme
nature of European regulations is echoed by a farmer who generally supports increasing
antimicrobial regulation in order to protect human health. The producer says, “Everyone should
get behind it. It’s just often people get scared if it’s gonna get to a point that you’re not allowed
to grab your own antibiotics as we have to call the vet. That’s gonna be a hassle and [in the case
of] Denmark, you have to phone your vet if the cow has mastitis. See, that goes too far.” With
regard to Denmark, one farmer who immigrated from Holland and whose family still farms in
Holland and Germany shares, “In Denmark, the vet has to dry out the cows…Can you imagine
[our vet] has to come to farms…and do the Dry Cow Treatment on Monday morning when [he]
does Herd Health? He’s got better things to do…he probably needs more vets then, but it’s way
too expensive. I mean, they’re 200 some dollar an hour. You can’t have that guy sitting there
drying off cows. So, that kind of situation would be kind of annoying.” He also says, “It would
be nice if we don’t get prescription per cow. Because that’s how they do it in Holland now. So, if
you got a cow with foot rot, and I go to the vet and I get, ‘Well, how much does your cow
weigh?’ ‘1500 pounds.’ ‘Okay, well, then I give you 12cc x 3 is 36cc. Here you go.’ That’s it.
Bah, that gets really annoying.” He explains that his parents who still farm in Holland are
required to obtain a prescription per animal and are checked a couple times a year to see if the
appropriate amount is remaining. If not, they are fined. He comments, “It cost a lot to keep the
system going and it’s really annoying for farmers.”
52
However, this same farmer also shared that we can learn from farmers’ experiences in
Europe. In reference to switching to selective DCT, he states, “In the beginning, there were big
disasters [in Holland] and people said that, you know, it’s never gonna work. And now, it seems
like everybody’s doing it because they have to.” However, he then also adds, “If Holland and
Europe do it now first, then we can learn from that. And if it works over there, we can also
implement it here.” He also points out that the implementation of regulation is done very
differently in Canada as compared to Europe. “Over here, they implement, usually, the opposite
way that they do it in Holland, or in Europe. In Europe, they say, kind of like, “Yeah, no, it’s
gonna be forbidden next year, or two years from now.” Done. “Figure it out.” And over here, it’s
kind of like, “Yeah, no, here’s a little bit of incentive. If we are able to get away from that, we
can give everybody a bit of an incentive to get there. Here’s all the help you can get, and then
we’ll see if we can phase it out in a few years, maybe.” And then everybody starts to work on it a
bit, and in two years from now, they’re gonna say, “Yeah you know, maybe we should get a date
on paper when we’re gonna quit.” And then three-four years later, they say, “yeah, you know,
that’s gonna be the date we’re probably gonna quit.” And by that time, everybody switched
already.” He notes that the European approach is more effective. However, the Canadian system
is more pleasant for farmers.
However, there was at least one family who shared an opposing perspective. One family
member shares, “Yeah, but sometimes the issue is that farmers don’t get pushed too hard to think
different. Like…they’ve been pushing in Holland like crazy, and look, … they do better than us
here.” If you talk antibiotics, if you talk about environmental things…everything is recorded,
from bringing manure to and fertilizer on the ground, cows and milk you sell, it’s all on paper.
So, the push for them to do better is harder. Otherwise, if you don’t do a good enough job, they
53
get penalized.” Another family member adds, “They’ve cut antibiotic use in half there...maybe
Europe is ahead a bit, like trying to figure it out, trying to be proactive.”
3.4.2.2. Subtheme 2: ‘Rules create liars’
The prospect of increased regulation was met with strong resistance by some. It was
particularly evident through informal discussions during herd health exams and outside the
context of the interviews that some producers feel that the implementation of more stringent
regulations would encourage non-compliance. One producer states, “Rules create liars.” Another
shares information regarding the current system in the Netherlands which already has much
stricter regulations than in Canada, noting that farmers in the Netherlands “cheat the system.” He
says, “I do know that they cheat the system… So, their drug inventory is monitored, and they
have to stay within a certain level of drug usage, so they can only use so many treatments on
their farm before they get slapped on the wrist. So, they will underdose drugs to build up a
reserve of drugs so they can dose extra if they need to…Yeah, let’s say I’m supposed to give 20
mL of Excenel to a cow— Well, they can’t use Excenel. If … If they are prescribed 60 mL of
penicillin to a cow—they’ll use 55 and, after so many treatments, they’ll have another full
treatment available for another cow if they need to treat her. And that will—So, they’re cheating
the system. So, the vet and the monitoring system thinks that they’ve treated 20 cows, but
they’ve actually treated 21. Maybe not every farmer, but there are farmers that do that because
they have been put into a system where they, I don’t know, think they need to cheat it. I don’t
know why, exactly, but that’s what they’re doing.” Another confirmed that the potential for this
to occur here as it would allow the farmer to keep an extra dose in the event of a future
emergency. One farmer also shares, “But if you force me to do something that I’m already doing,
I’m just not writing on paper—excuse my language—I’m going to tell you to get stuffed, and
54
then I’m gonna do it every seven months before I get audited… that’s what 95 percent of dairy
farmers do.” However, not all are opposed to “the rules” as some, in fact, shared that they
believe rules are needed to create change. One shares, “The pressure won’t come until they say,
“Okay, this is the rule.” Her husband shares that his family in Holland, who currently practices
selective dry cow therapy (DCT), asked him why he does not switch, and his response was
simply because he does not have to. Although he notes that they (as an industry) are slowly
moving toward it, he feels it will not fully happen until they are forced to. “But I think the
bottom line – really, the bottom line would be if the government or whomever … decided to
bring in regulation, we would all just conform because you have to. But until that happens, I
don’t think things will change. I really don’t.” Another farmer states, “Rules are rules, and a lot
of guys always try to fight rules. I’m not one of those guys. A rule is a rule. I work with what’s
there. If the rules change, I gotta change. I’ll find something. I’ll talk to vets or other places that I
can get info from and I’ll get ‘er done.” For this particular farmer, the motivator is the rule.
However, he expects the rules to be fair. “Lets everybody be on the same playing field, though.
Because if half of them still use it and the other half doesn’t, that’s not a fair game. Fair game
means everybody has to play with the same rules.” If the tool is available for use, he will use it.
“You gotta follow the rules and whatever – I use every tool that’s available in the toolbox.”
3.4.3. Theme 3: Mutual distrust between the farmer and the public
Many farmers did express frustration regarding the role of consumer perception. On one
end of the spectrum, farmers feel harshly blamed for environmental and health issues that affect
society on a global scale. One family shares their views, specifically as it relates to the
environment. One family member says, “Every major city in North America dumps more raw
sewage into our water ways than all the farms across the entire continent. And that’s a fact, Jack.
55
But do we address that problem? No! It’s the farmer’s fault. And farmers all across North
America are sick and tired of being blamed for urban areas’ problems…Winnipeg dumps raw
sewage into the river 60 to 75 times a year, [proof]. But who pollutes our waterways? Oh, it must
be farms.” Another says, “It is tough to be in Ag in any sector…because you are constantly being
told you are doing it wrong, right?”
Another farmer notes the mutual disconnect between farmer and consumer, “I think some
of the farmers have lost a little trust in the consumers, and the consumers maybe lost a little bit of
trust in the farmers here and there.” Although he also provides a somewhat contradictory
statement, suggesting he may be conflicted or hold multiple views on the topic. He then says,
“Generally, I think people do trust us to make sure we’re doing a good job and providing a safe,
wholesome product.” However, generally there is the desire to close the gap between producers
and consumers. As one farmer states, “And somehow, we have to close that gap between people
consuming milk products and what we’re actually doing on the farm.” Unfortunately, many
farmers are not optimistic about the prospect of doing so. Many noted the lack of trust by the
consumer and the difficulty there is in trying to change consumer perception despite repeated
efforts to cultivate a positive image of the industry and to assure consumers of the quality and
safety of the product. Additionally, there is increased frustration by the farmer particularly in
cases where they consider the consumer to be uninformed, unable to see the whole picture or
misguided by antibiotic-free packaging of other products, social media, and influential
groups/people, which all paint the conventional farmer in a negative light. In response to
addressing and attempting to change consumer perception, one farmer says, “Yeah, they try; we
all try. But I actually – I tried for a while on Twitter to, you know, share the right stuff, but it just
never goes anywhere…Like it’s just really depressing.” Another farmer also notes overall
56
feelings of discouragement, “It’s really discouraging sometimes. We do a lot of farm tours with
school classes and colleges and all that stuff. Two cows go down to Aggie Days and we are both
with Stampede for years and years and different things. So, yeah, it gets more and more
discouraging to do that…Especially with school classes, there’s more and more of a disconnect.
Teachers and parents bringing up the Canada slug words: antibiotics, hormones…Sometimes it
makes you wonder if it’s worth it.”
He goes on to say that the constant criticism from the public creates an environment in
which the producer is not open to change and rather becomes more radical in his thinking or
position. He shares, “…if we get criticized long enough, you kind of get more radical with your
stance, defending what you’re doing instead of looking to a new approach to maybe change.”
Unfortunately, he feels that this is currently happening in many farming sectors. “We are so in
the public eye now... A lot of times you’re kind of that monster who takes away the calves from
their moms, has antibiotics, hormones, and pus in their milk and then the other side is you’re the
rich, rich farmer and should produce for free.” Several of the farmers note the growing
detachment of the public from farms, in that consumers have no real understanding of the daily
happenings on a farm and what food production actually entails. For that reason, if changes are
made (such as reducing AMU), there is some doubt that consumers will be aware of it,
acknowledge it, or that it will improve public relations. He asks, “So, [what] is the point [if] we
make changes, [will] they grant us for making those changes?... I really sometimes doubt that.”
However, there is also the perspective that the consumer and the consumer’s perception is
critical as without the consumer, there is no market. One farmer states, “As an industry, yeah, I
mean we’re always trying to get our message out. ‘You know what? We have decent employees.
We do our due diligence. We want to make sure that, you, the consumer, [is] happy.’ And we’re
57
always looking for consumer feedback.” So, while some see it as a challenge or perhaps not
feasible to gain the trust of the consumer, others see it as critical to the sale of their product. This
same farmer feels that the voice of the consumer is now louder than it once was, and that the
industry is adapting in response (i.e. introduction of organic market) and farmers are
consequently held to a higher standard.
3.4.3.1. Subtheme 1. Lack of transparency surrounding biological pathways and connection
to milk safety and procedures
The interviewers’ questions were met with confusion and frustration by some of the
farmers. One farmer shared, “…they act like we’re shipping milk and meat with antibiotics in
[it]. I’m kind of like, ‘No, there’s not. You’re not allowed to do that, so.’ And, in the milk, it
doesn’t work because you can’t make cheese, you can’t make yogurt, you can’t make anything.
So, there are no antibiotics in it.” It was clear that many dairy farmers take great pride in
ensuring Canadian milk standards are met on their farm by themselves and the farm’s
employees. Many of them responded to the interview itself with arguments that assured the
safety of the milk. Their explanations were similar to those advertised by Dairy Farmers of
Canada in 2019. Specifically, they explained that there are no antibiotic residues in the milk.
They can attest to this because when they administer an antibiotic to a milking cow, they must
adhere to strict withdrawal times. That is, they need to wait a specified amount of time prior to
allowing the cow’s milk to re-enter the bulk tank. One farmer states, “The only other, maybe,
around drug use is residues, but we don’t have issues with residues because we have withdrawal
periods. So that’s where public education comes in. It should have nothing to do with the
producer. The producer should be free – as long as he practices the researched withdrawal
periods on drugs, he can use as much as he wants. There should be no issues.” With that same
58
sentiment in mind another family asks, “I just want to know how people are getting…contact
with it?” Another family member states, “Well the antibiotics [are] not coming through in your
food.” The first family member speaks of Excenel specifically as it has zero-day milk
withdrawal. He says, “Excenel doesn’t even go into [the food chain]. If there’s not a withdrawal,
it’s because it’s not getting into your product.” If they do not follow these guidelines and
contaminated milk enters the bulk tank, there are penalties to follow, namely a hefty fine taken
from their milk check. However, if milk withdrawal times are incorrect and do not allow for
sufficient amount of time in between last treatment and entrance into the food chain, one farmer
suggests that it is the responsibility of pharmaceutical companies (or those accountable for
establishing those guidelines) to correct those guidelines and inform farmers of the new safety
guidelines. However, it is important to highlight here that this perspective assumes that the
global health issue is exclusively due to contamination of the product and does not consider other
mechanisms that may increase AMR (i.e., environmental contamination). So perhaps, the
incongruency, at least partially, lies in the conception of the health issue itself and the assumed
notion that AMR has become a burden in the human population strictly due to consumption of
unsafe food.
3.4.3.2. Subtheme 2: Skepticism regarding connection between AMU in agriculture and
AMR in humans
Based on the protocols they are required to follow, some of the farmers were unclear on
how dairy farming could be contributing to AMR in the human population. In reference to
addressing agricultural practices that may lead to AMR in humans, one farmer responds with,
“Well, address it? Why does it need to be addressed if it’s not actually happening? You’re gonna
keep asking the question, but I’m gonna keep disagreeing. It’s not actually happening. Or at least
59
show me proof, because the proof is in the pudding. If I have proof that people are consuming
milk and they are getting resistance to antibiotics because of it, maybe I’ll change my tune. But I
do not believe that’s happening.” Another asks, “Is it causing issues in people? Is the antibiotics
in the animals that we’re using, is it causing the antibiotics to not work as well in the people?
Some say it so. I don’t believe so.” These same farmers stated that they would need to see a
direct, scientifically-supported link between AMU in food animals and AMR in humans. “I think
there needs to be solid evidence that people are becoming resistant because of food.” They want
to see “hard facts.” Another farmer says, “I’m kind of like, ‘Okay, well, give us some hard facts
on it.’ Because I don’t mind acting on hard facts. I mean, [if] it’s bad, it’s bad. Don’t use it.”
However, if it is more of a preventative step, that is not going to convince him not to use it.
In general, the farmers largely feel blamed for many issues, including rising rates of
AMR in humans. Not only do they feel blamed, but they also feel that the attention is
overwhelmingly on them, while use (overuse and misuse) in human medicine is overlooked. One
farmer says, “All the research there says as well, that most resistance to antibiotics is because
people don’t finish their own, what do you call it, prescriptions or medication, and they’re all
blaming because it’s coming through the animals. And then they say, ‘Yeah, we eat meat that
had antibiotics, this and that.’ But, I mean, there’s no antibiotics left in the meat.” Another shares
similar perceptions, “I also think people need to look at lowering their antibiotic use. ‘Cause
some people are so quick to jump on drugs. I think that has more to do with it than what’s
coming through in your food supply.” Another family member adds, “And the doctors need to
start slowing down with what they’re handing out. So, I don’t think it’s actually the farmer’s
problem. I think it’s public perception. But you’re never gonna convince the public that it’s not a
farmer’s problem.”
60
Another wonders how much over-prescription is happening in human medicine and
speculates that physicians may be overly responding to patient complaints, rather than their own
professional opinion. He says, “I wonder in…human health, how much over-prescription of
drugs there is? Like, how many doctors have had someone come in and they write them up as if
they needed medication, but they don’t actually need it, because the person’s complaining…So,
they’re saying that a patient needs something, but their professional opinion is no.” In terms of
proper use of antimicrobials, another farmer shared that he thinks the farming sector is doing a
better job.
Others were less skeptical of the connection. One shares, “…but I just feel it’s just
important for human health. It is. That’s the bottom line. That’s the reason we have to reduce the
use. It’s not because people want to see us use less because [they] want to be the boss.” There
were also others that were very aware of the issue of AMR, at least as it pertained to their herd.
One farmer will only try two different treatments prior to deciding to cull in order to prevent
AMR in the herd. Another follows a similar protocol and is very clear on her decision-making
process regarding treatment, culling, communication and expectations with employees regarding
treating and milking. The farmer states, “If it’s Staph, or whatever, it’s never going to be fixed,
so you give a cow a chance, but not continuously trying again and again. I think that’s important
to me. And that’s how you build resistance too, if you keep on using stuff where it’s not going to
be fixed.” Others noted a generational discrepancy in terms of awareness regarding the topic
with younger farmers being more cognizant of the growing global health issue in comparison to
their parents. One farmer says, “I think there’s a bit of a generational difference, too, though. Me
and [my husband’s] generation, we’re more concerned about those issues than my parents’ and
[his] parents’ generation.”
61
3.4.3.3. Subtheme 3: Antimicrobial regulation as fueled by consumer perception and not
scientifically driven
Some felt strongly that it was unlikely for increased regulation to be scientifically-driven
and instead is largely influenced by misinformed consumers who tend to live in urban centers
with little knowledge about farming practices and industry standards. One farmer states, “It’s not
about science. Most of the changes to regulations have nothing to do with science. They might
have some scientific merit that started somewhere, but it’s not about science. Another farmer
states, “[Consumers] influence policy and government…and that’s what all regulations come
from there…very little of it is science-based…I think everything we should do should be
completely science-based. It should be very scientific, and we have to certainly push for that as
much as possible. And if we don’t do the science research, we don’t have anything to push with.
But I don’t think it has near the influence or power that it should.” However, not all agree with
this perspective. Another farmer shared that he does think social pressure is there, but it will not
impact regulation. He says, “The social pressure is there every day, but I don’t think it would
affect regulation.”
Another farmer specifically questions acting in the perceived desire of the public versus
in the benefit of the animal, highlighting the weight of the word “antibiotic” when heard through
the consumer’s ear. “Even when you try to tell [them you are treating to address] Johne’s or
clinical problem and [doing it] for the betterment of the animal, it’s still that word, [antibiotic],
that’s out there and kind of harmful…So, do I rather be safe and keep on treating those animals?
Making sure I don’t get an outbreak, [but] then knowing that the perception in the public is still
like they’re using antibiotics? So, it really doesn’t matter. At least my herd is safe. Kind of this
approach or do I radically change? Go away from this and just trust that the public is going to be
62
seeing that as a benefit?” After theoretically weighing out his options, he concludes that, “But, I
definitely think it’s important to really start a discussion about it…how it should happen, what
really we can do. You know, first to make sure the animal is still safe. We reduce antibiotics and
it’s kind of granted from the public to be a good thing.”
3.4.3.4. Subtheme 4: Lack of value for farmer knowledge, experience, and education by the
public as further exacerbated by implementation of ‘extreme’ policies
Overall farmers expressed frustration and disappointment with how they are perceived by
the public, specifically in terms of their knowledge, education, and farming experience. They
feel that they are educated, but not seen or treated as such. Considering the prospect of taking
away their ability to treat animals further exacerbates these feelings, implying that they do not
know what they are doing. One farmer states that efforts should be put into addressing other
societal issues “instead of bothering a bunch of hardworking dairy farmers that know what
they’re doing already.”
The thought of not being able to treat his own cows did not sit well with one farmer,
especially because he is already working in collaboration with his vet. He says, “I'm not saying
I'm a vet, but most farmers have at least two years [of college or university education], but a lot
of them have university degrees… I've learned a lot of the [same] stuff that the vets learn too.
And then I work with the vet to learn the stuff that I need to know specifically for my operation.
So, I know a lot of what I need to--what a vet would know specifically for here. In terms of the
treatments that we have to do here. We're pretty educated with that too. So, that's the other part
that bothers me. When they say, ‘the farmers--why shouldn't they be able to do it?’ Most young
farmers going back all have university or college degrees. It's not that we're uneducated.”
63
Yet another farmer shares a similar perspective, but specifically mentions frustration with
consumer perception. The producer says, “I think a lot of the consumers think farmers don’t
know what they’re doing, they’re not educated, and that a lot of the non-farming people know
better what’s supposed to be done than the farmers themselves. I think that’s a problem…I hope
people understand that a lot of farmers are educated and they do get training, right? I think that’s
a general misconception about farmers that they’re not going to school or they don’t finish high
school, they just do whatever they do.” They also add that for these reasons, “[the proAction
Initiative] needs to be there because of trust in the farmer.” Additionally, this producer would
like the consumer to know that they are educated and do get training. They think that the public
should be educated about the farmer as a person – who they are and how they make decisions.
Although generally supportive of reducing use to protect human health, another farmer
shares his thoughts if told he may need an expert/professional to treat his cows as he too would
like to maintain the right to treat his own animals. He says, “I think it totally takes away the
experience and knowledge that the farmers already have, right? Like you’re kind of, I don’t
know, essentially being told that you don’t know what you’re doing and you just need to
conform…So, I would almost say – if that were to happen, it would be very disappointing. I’m
sure there would be a better way to do it.”
Another farmer demonstrated his confidence in his ability to observe symptoms and treat
accordingly, “If I see certain signs…I know what needs to be done.” He also shared that he is
often less aggressive with treatment than his veterinarian, “There have been times where the vet
is telling us to treat a cow and we don’t think we need to and we don’t, and the cow gets
better…So, the vet actually seems to us to be more aggressive in terms of prescribing treatment
than we would ourselves.”
64
3.4.4. Theme 4: Frustration with impractical policies
Overall farmers expressed great frustration with policies that appear to be impractical or
illogical when implemented in a dairy farming context, do not create meaningful change at a
societal level, do not improve on-farm management or make economic sense. Many farmers
spoke of the proAction Initiative and the Canadian Quality Milk Program, two programs
implemented by farmer-run organizations to improve industry standards. Although most thought
that generally the programs served a purpose, even if just as a “consumer blanket” or a means by
which to maintain consumer trust, some were displeased with the specific requirements, and feel
especially irritated by the amount of paperwork as it does not actually work to improve on-farm
management. One farmer says, “I’m a farmer. I don’t like paperwork; I don’t like increased
regulation. If you can come and show me something I’m doing wrong on my farm and how it’s
gonna make me more money because of cow comfort, I would gladly do it… rather than doing
paperwork, I could be looking at my cows, tending to my cows. I don’t care if someone walks
through my barn and tells me I need to do a little better job…That’s fine…but I don’t think I
should have to write down every time I take a cow to my west quarter and when I come back. I
think that’s bullshit…To me, it’s just more paperwork, more time out of my day, and for what?
The price of milk hasn’t gone up. The price of feed hasn’t gone down.”
Common grievances, particularly evident through informal discussions in the community,
included that policies are often created by individuals who are not familiar with farming
practices and have not engaged in similar work. The same farmer states, “I can guarantee you
one thing. If farmers created this program, there would be no paperwork. Or limited paperwork.”
And, it is important to specify here that by “farmers,” he is referring to farmers that currently
take part in daily chores and maintenance, not ones that are hands-off, manage or are retired.
65
Additionally, it is important that new regulations make economic sense and alternatives
to previous practices are provided to them, particularly in the case of Excenel, which is discussed
below. One farmer shares, “But it’s gotta make economic sense and then after that, yeah, you
gotta do what’s right, but they gotta come up with an alternative before they can change it, I
guess.”
One farmer’s concern was regarding the potential for there to be arbitrary and absolute
reductions in use and was frustrated with the prospect of authorities not acknowledging effort
already directed toward reducing AMU. He says, “If we’re already treating case by case, how
can you tell me, ‘Oh, you gotta reduce it.’ Well, why do I have to reduce it from this point? What
if I’ve reduced it already from five years ago? … Or why does it have to be less? And that’s all
the policymakers. It all sounds good. Even with our carbon footprint and stuff like that. They
want to reduce it. Well, we have been. We’ve been reducing it for 50 years already with all our
practices and cows becoming more efficient. But we don’t get credit for that. It’s gotta be from
now forward. It’s hard when you’ve already reduced, it can be difficult to reduce more.” With
regard to absolute reductions in use, he says, “I don’t think there needs to be a measurable goal
in reduction. Because, first you need to establish how much is being used and for what. And then
you can determine, should it be reduced or not. You can’t start by saying, ‘Okay, we need to
reduce.” And then looking that way. To me, that’s backwards. You gotta start with what’s
happening and what – is there potential to reduce or not. If there is, then let’s go for it. If not,
why should there be a set level? Why should we decide, ‘Okay, we’re going to reduce 50%?’
How come 50% is okay? Why shouldn’t it be 75 or 25? It’s just a number somebody picks
because it sounds good.’
66
Another farmer is quite skeptical of the underlying drivers of the push to switch from
blanket DCT to selective DCT. He articulates that the reason to implement this practice change
would be for economic cost and to demonstrate to the public that there has been an overall
reduction in use. However, he questions the human health impact of such a reduction, suggesting
that, although potentially cost-effective, it would not be a meaningful change and could be
considered public deception. He says, “There’s good reason to do blanket treatment. We can
lower it, that’s fine. It might save us some costs.” He cites recent work conducted by dairy
researchers at a local university when he says that blanket DCT does not lead to AMR in
humans. “I just think we can save ourselves some money doing it. It’s an economic reason for us.
It’s not because of antibiotic usage. Because blanket dry cow treatment has nothing to do with
resistance. Research has shown that blanket dry cow treatment is not related to resistance…So, I
can [do] blanket dry cow treatment all I want with no resistance issues. There’s a public health
perception, but it’s a false one.” With regard to future antimicrobial regulation changes, he says,
“If you wanna affect numbers, go from blanket treatment to selective dry cow treatment. That
will get huge effect on numbers. But will it have an effect on antimicrobial resistance?... I don’t
think so. Not based on what the research says, anyways. It would be misleading. There would be
a deception to the public if you went from blanket to selective to deceive the public into thinking
antimicrobial usage is reduced in a way that will affect resistance. It will show a decrease, so the
public might be happy, but it’s deceptive.” With regard to increased regulation and antimicrobial
reduction, he later says, “I want to do it because it does something, not because it makes people
feel good.”
In reference to adopting new practices, other farmers shared different outlooks, including
the need to approach it with an open mindset. One states, “I think too many people – some
67
people are always set in their ways. ‘This is how we’ve always done it.’…People have to start
being more open to what’s out there…the farmer needs to be a little more proactive and say,
‘You know, the consumer’s demanding this and this.’ Maybe we just need to change and not do
[away with the], ‘This is the way we’ve always done it attitude.’ We need to change to a more
progressive, open attitude.” Similarly, another farmer states, “[We need] to help producers know,
and that could be myself too – that we need to be following research, not just doing what we’ve
always done, right?”
3.3.4.1. Subtheme 1: Tools with value (in support of animal health and welfare)
Antimicrobials can be understood as tools that hold quite a bit of value for dairy farmers,
as one farmer notes that, “They are critical [to maintaining health of the herd]. If we didn’t have
antibiotics, we’d be down a lot of cows.” Though this was not expressed by all farmers, many
shared concerns of the negative impact that changes to AMU and regulation (e.g. increased
pressure to reduce use) would have on animal health and welfare. For some, antimicrobials serve
as a means by which to act in the best interest of the animal and as dairy farmers, they see it as
their responsibility to do so, as the animal is subject to the actions and will of the farmer and
cannot act in its own best interest.
In response to banning or limiting Category I antimicrobials (or those critically important
for human health), one farmer says, “I think that’s not a good idea…Because there are going to
be a lot of cows that are going to die…Yeah, I don’t think that would be right…” They also share
that it would impact her desire to continue farming. “I probably wouldn’t even want to be
farming because then you have to let your cows die and suffer…I do think if you are not able to
use those antibiotics anymore…Yeah, I think it would be a lot of suffering for cows and a lot of
death too, I think, I would hate to see that. As a farmer, I would hate to see a cow suffer knowing
68
that there is something you can do but you’re not allowed to do anything. This is what it would
end up to be, and I don’t think that would be right. I don’t think I could handle it knowing that
you cannot help an animal…I know each and every cow and you care for them and you want the
best for them. You want them to be happy and healthy and taken care of.” Another shares a
similar sentiment, “…yeah, we wanna use less. Of course, it’s good for the cows, good for the
people, and good for our wallet, but if they’re sick, we have to do something.”
Antimicrobials are arguably also a tool to deal with the uncertainty or unpredictability of
a situation. For example, one farmer also notes that you never know when you might get an
outbreak. “I think most farmers already would like to reduce as much as they can just because of
the chunk that you keep yourself is bigger if you reduce antibiotic use...; but you never know
what happens, right? That’s the problem, you never know what’s coming next. You might try to
line everything up well and then something unexpected happens. You get a whole bunch of
pneumonia or you get diarrhea. We had rota/corona in 2001; we lost six calves...”
Additionally, many expressed frustration with trending “antibiotic-free” campaigns,
particularly those advertised by the A&W fast food chain, as they signal to the consumer that all
other animal products contain antimicrobials and abstaining from use of antimicrobials is a
positive practice. However, some feel this perspective fails to recognize that when a cow is sick,
she deserves to be treated, just as people do. One farmer states, “Medicines are there to help
people but I think, also, you want animals to have a good quality of life. So, I do feel that there’s
no need to suffer and they need treatment just like people.” Another shares, “…You can’t tell an
organic guy who’s got a pneumonia cow or a cow with mastitis, ‘No, you can’t use any
antibiotics.’ …I think that’s an animal welfare issue. …as a dairyman, we have to do what we
can to save an animal… So, you’re going to have to use antibiotics…you’ve still got to save the
69
animals…otherwise every time a cow got sick, it’s like, I don’t know, shoot her and bury her.
That’s not something I can do. That’s just wrong.”
However, not all were so concerned with the prospect of increased regulation or pressure
for reduced use. Others clearly stated that they perceived the use of antimicrobials as ‘Band-Aid
solutions.” One family says, “When there’s a band-aid solution, people can let things go.” They
go on to say that the issue is not AMU, the issue is management and the demands of large animal
production. They also speak about the idea of a farm being “over-stretched” and that this state
puts farmers in a position where they might lean heavily on antimicrobials. They state, “I think if
we keep our cows in the situations they are in today, on concrete, on rubber mats, in the barn all
the time and on silage all the time, I don’t think you can reduce [antimicrobial usage] by much.”
They also shared that they went from milking three times a day to two times a day, whereby
giving up 2000 litres of milk per cow per year, a shift that is counterintuitive to the conventional
objectives of intensive farming systems. Additionally, if increased regulations were to be put in
place, they think it would encourage farmers to consider other options “outside the antimicrobial
box.” In reference to increasing regulation, they share, “…farmers [would] have to think harder
how to solve a problem…but sometimes the issue is that farmers don’t get pushed too hard to
think different.” They also add, “But when you know there’s those regulations, I think there’ll be
more people who will do things, like more preventative things.”
3.3.4.2. Antimicrobials (i.e. blanket DCT, Ceftiofur) provide a sense of safety, act as an
insurance policy
Blanket treatment. Blanket treatment of cows (i.e. dry cow therapy, treatment for
pneumonia in calves) serves as a safety net in some cases. With regard to blanket dry cow
therapy (DCT), one farmer shares, “Animal welfare-wise, I think optimal is still blanket
70
treatment because you have no – There’s no holes in the wall because blanket treatment is - If
you look at blanket treatment as a big wall to help prevent mastitis, you have no holes there,
nothing gets through because it’s a complete wall, right?” When discussing the practice of
blanket treating animals with the farmers, it was clear that for some farmers it provides them
with a sense of safety, reassurance or protection, a way for them to know that they have done all
they could to protect the cows (in terms of disease prevention) as well as themselves (in terms of
financial hardship). However, one farmer mentions that although blanket treating acts as an
insurance policy, it may be unnecessary. He states,“…on one side, it's kind of a blanket
insurance for using it on everything. And on the other hand, it just doesn't make a whole lot of
sense… you do a lot of things sometimes to make sure nothing happens. To protect the animal.
Like…not really knowing, if you move away from this, is it going to be really a problem? Is it
not?...that's why it kind of gives me kind of a better feeling [to use it].”
Excenel (Ceftiofur). Excenel, which is considered a Category 1 antimicrobial or more
commonly known as a critically important antimicrobial (CIA) for human health due to limited
or no available alternatives, is a significant antimicrobial in this context and one that was
discussed frequently in the interviews. Similar to the practice of blanket treating cows, it
provides the farmer with a sense of safety due to its label for zero-day milk withdrawal. It is
especially important to farmers with hired milkers as it prevents unintentional errors as the milk
from cows who have been recently treated with an antimicrobial can still be put into the bulk
tank and shipped. However, if a cow were recently treated with an alternative antimicrobial, the
cow would need to be milked into a separate bucket (which is then either discarded or fed to
calves) in order to prevent contamination of the bulk tank. If the milker did not follow
recommended procedures and contaminated milk did in fact enter the bulk tank and was shipped,
71
the farmer would face heavy penalties. In this way, the use of Excenel provides the farmer with a
sense of assurance, knowing that such an error cannot be made, as well as a means of
convenience and a way to prevent excess waste. Additionally, although the farmers consider the
antimicrobial to be expensive, many felt that it was worth it as they are still able to ship the milk
and are not at increased financial loss from inability to ship milk.
When asked to consider the potential of limits or bans to Category I antimicrobials (or
critically important antimicrobials), farmers responded with a variety of different positions,
many of which were opposed to the idea and those that were open to such a regulation shared
that they would expect to see research that supported its connection to AMR in humans and to be
provided with effective alternatives. One farmer questions the concerns surrounding Category I
antimicrobials, “[Category I antimicrobials] are administered case-by-case. Everything has a
withdrawal time. So, you tell me how that’s gonna make it more for the people or less effective
for people.”
Another farmer says, “…if we have more cows in treatment, then I’m [more likely] to use
the Excenel, because we can keep her milking.” He shares that his family members who farm in
Holland are surprised with the quantity of Excenel that is used here. “But they cannot believe we
use that, as much Excenel as we do.” This farmer later states that if told he could no longer use
it, he will stop using it, but he would need to be informed of a good alternative and his
veterinarian would need to provide advice on the matter. In terms of placing restrictions on
Category I antimicrobials, he says, “I don’t see a problem in doing that. Like I said, give me
another option [for] for my Excenel.”
72
In response to potential ways to practice better AMS, one farmer says, “Maybe quit using
Excenel…We would have to discuss alternatives…And that one, I could see us changing for
public perception…And if there aren’t [alternatives], then research needs to be done to find
alternatives. Before banning the drug. Because if they ban the drug and there’re no alternatives in
place, then animal welfare is impaired.” With regard to banning Excenel this farmer also states
that although he disagrees with banning Excenel, he expects that it will happen. He also shares
that he hopes to see clear links between AMU and AMR in humans. He says, “Although I don’t
agree, I think Excenel will probably be banned… That’s not true…Excenel being banned from
agricultural use makes sense to me if there is a clear relationship between agricultural use and
human resistance. If agricultural use shows agricultural resistance, use should be lowered, but
not banned. But if agricultural use is related strongly—If there’s a weak link, maybe it’s okay.
But if there’s a strong link to public resistance, then it should be banned. I can understand
that…If agricultural use of Excenel has an effect on human resistance, do that research. Prove it
before you make people change.” With regard to changes based on political drivers, “If there’s
political reason but also a health reason, I have no issue with it. But if it’s pure political, it’s a
bunch of bullshit…That’s not a strong reason. There’s no good reason, then.”
73
Figure 3. Thematic map of dairy farmers’ perceptions of AMU, AMR, and regulation
74
CHAPTER 4: SUMMARIZING DISCUSSION
4.1. Summarized results
AMU among dairy farmers is a concern as AMR poses a significant threat to human
health. Although there is a growing body of literature on knowledge, attitudes, and practices of
dairy farmers as they pertain to AMU, there is a dearth of literature that works to contextualize
these practices. However, one exception includes work conducted with Swedish dairy farmers
which illustrates the importance of considering emotions when attempting to understand farmer’s
decisions, particularly surrounding antimicrobial use (AMU) (Fischer et al., 2019). Hence, not
surprisingly and unlike most other studies on this topic, Fischer et al., (2019) acknowledge the
importance of context, recognizing that behavior is built upon a socially-constructed foundation.
As the public health intervention research (PHIR) literature demonstrates, such information is
essential for public health interventions to be effective (Edwards and Barker, 2014; Craig et al.,
2018). Therefore, the purpose of this study was to understand dairy farmers’ perceptions as they
relate to AMU, antimicrobial resistance (AMR), and regulation in light of the broader context.
The farms included in this study varied in terms of milking parlor, bulk tank somatic cell
count, and farm size. However, all the farms considered themselves to be family farms and most
had a long tradition of farming, that for most originated in Europe, in either the Netherlands or
Switzerland.
The key findings of this study were:
1) Farmers are stewards of the land and, in some cases, steward’s of God’s creation.
Therefore, they see themselves as having a responsibility to take care of nature and the
exploitation of resources, whether natural or synthetic, would not align with these values.
75
This includes the inappropriate use of antimicrobials. Particularly noteworthy was the
farmers’ value of a strong work ethic and the pride and integrity inherent in ensuring that
they produce a safe product.
2) However, dairy farmers in Alberta also value their autonomy and freedom, which in the
case of AMU, may at times conflict with their desire to act in a ‘stewardly’ way. In terms
of AMU and regulation, many of the farmers expressed a desire to maintain agency. That
is, they hope antimicrobials will remain available to them. Many farmers in the sample
immigrated to Alberta either from the Netherlands or Switzerland or are descendants of
recent immigrants. Thus, they were very familiar with the stricter regulatory systems in
Europe and many expressed concern with regard to ‘becoming Europe’ or adopting
similar antimicrobial regulations in Alberta. The concept of ‘Rules’ emerged via
examination of the interviews, where some farmers expressed concern that additional
regulations may place farmers in a position where they may feel compelled to “cheat the
system.” However, not all shared this perspective. In fact, some stated that indeed rules
were necessary in order to create change.
3) Mutual distrust between the farmer and the public was identified as a central theme, with
downstream impacts on dairy farmers’ perceptions of antimicrobial regulation.
Specifically, some perceived antimicrobial regulation as fueled by consumer perception
rather than scientifically-driven and expressed an overall skepticism regarding the causal
relationship between AMU in agriculture and AMR in humans. This skepticism is further
exacerbated by what many of the farmers perceive as a lack of transparency concerning
the biological mechanisms that may lead to AMR in humans and their connections to onfarm practices. Further exacerbating the farmers’ view of the public is the farmers’
76
perception that the public undervalues the farmers’ knowledge, experience, and
education. The farmers see this reflected in what some consider to be the implementation
of ‘extreme’ policies, particularly ones that would require veterinarians or ‘experts’ to
administer all antimicrobials.
4) Overall, farmers are frustrated with policies that are impractical in a dairy farming
context, namely ones that increase paperwork, but do not improve on-farm management,
create meaningful change at a societal level, or make economic sense. Many farmers
considered antimicrobials to be tools with value in support of animal health and welfare.
The findings suggest that Ceftiofur (Excenel), a critically important antimicrobial for use
in humans, is especially valuable to the dairy farmers due to zero-day milk withdrawal,
which not only provides an economic benefit, but also an emotional one in that it
removes any concerns of costly, unintended errors occurring in the milking parlor.
Blanket practices, such as blanket dry cow therapy (DCT), provide the farmer with a
sense of safety or act as an insurance policy. However, a minority of farmers consider
antimicrobials to be ‘Band-aid solutions,’ utilized to compensate for underlying
management issues or necessary due to the demands of intensive animal production
systems.
4.2. Literature
4.2.1. How are decisions made?
Ultimately, this work seeks to understand the variables which influence farmers’
decisions about AMU. Useful here is work by behavioural economist and psychologists on
decision-making, including, notably, that of Kahneman and Tversky (1979) and Thaler (1980,
1985). These authors point out that until relatively recently, many behavioural scientists
77
subscribed to utility theory, a view that holds that people are rational actors who make decisions
strictly in accordance with logic and reasoning. Work by Kahneman and Tversky originating in
the 1960s, Thaler in the 1980s, suggested otherwise: people are only rarely rational actors, a
finding known as prospect theory. Prospect theory has been subsequently supported by a robust
body of work in the social sciences (Brosnan and De Waal, 2003; Sapolsky, 2017). In short, this
work finds that utility theory is myopic in its failure to take into account the role of other factors
that shape decisions, including emotion and broader cultural influences. Hence, prospect theory
tells us that the assumption by veterinarians and public health experts that dairy farmers will
follow their recommendations as it “makes logical sense” is likely misguided. Rather, these
recommendations will be considered by the farmers in light of their personal experience,
emotions, and cultural context.
Given this, the advice provided by public-health experts and veterinarians may well be
useful and the dairy farmer may well have a complete understanding of the rationale for the
advice, but these two facts alone may have little impact on their behavior. This observation is
borne out in Buller et al.’s (2015) Rapid Evidence Assessment (REA), Q-sort, qualitative survey
of 31 studies with farmers, veterinarians and key stakeholders across the poultry, dairy, and pork
livestock sectors in Europe and North America. These authors find that, thanks to veterinary
information and voluntary schemes to establish production standards covering animal welfare
and food safety, all were aware of the broad issue of AMR in human health, and recognized the
need to act responsibly in AMU, but this knowledge alone did not lead to behavior change.
Likewise, Raymond et al. (2006) find no change in AMU practices after an educational
intervention. The work presented in this study of Alberta dairy farmers is consistent with both
prospect theory and Buller et al.’s (2015) REA, Raymond et al. (2006) and qualitative work with
78
Swedish dairy farmers (Fischer et al., 2019): farmers do not make decisions based on simple
economic calculations or logical public-health recommendations. Given this, those dispensing
expert advice may benefit from an awareness that the decisions by farmers are the result of a
dynamic interaction between public policy, personal experience, and cultural context.
4.2.2. AMU among Dairy Farmers
While relatively few studies have contextualized the variables which shape behaviors of
dairy farmers, the existing body of literature generally presents findings consistent with those
found for Alberta dairy farmers. For example, in the present study and several other studies
(Buller et al., 2015; Swinkels et al., 2015), when discussing restrictions to AMU, farmers
expressed concerns regarding the effect of not having access to AMU on animal health and
welfare. Indeed, Buller et al. (2015) documents the consistency with which farmers shared
concerns about compromised animal health and welfare if antimicrobials were not to be used. An
exception to this includes dairy farmers in Sweden who exhibited few concerns about animal
health and welfare when considering restrictions to AMU, despite the fact that they are subject to
relatively strict AMU regulations compared to other countries (Fischer et al., 2019). Not
surprisingly and contrary to the results presented in the current study, the Swedish farmers were
not interested in taking on responsibility for medicating their own animals and were content with
the veterinarians holding that responsibility (Fischer et al., 2019).
This finding may reflect the importance of culture as Swedes generally trust that the
government has the best interest of society at heart so are more likely to obey its rules (Savage,
2020). Furthermore, 64% of Swedes agree that most people can be trusted vs. 41% in Canada
and 38% in the United States (World Values Survey, 2014). Additionally, AMS has always been
an important issue for the Nordic countries, as evidenced by longstanding encouragement and
79
practice of selective DCT (Ekman and Østerås, 2003). That said, a qualitative phone survey in
Sweden with 136 dairy farmers concerning adherence with veterinary recommendations finds
that farms fully implemented a mean of only 47% of suggested preventive measures and partially
implemented 25% of measures and that failure to implement the measures was primarily due to
lack of trust of the veterinarian or the infeasibility of the recommendation (Svensson et al.,
2019). Although lack of trust of the veterinarian does not appear to be a critical issue in Alberta,
given the lack of trust in policies perceived to be consumer-driven, buy-in from local
veterinarians would likely be necessary in order to promote farmer adherence to antimicrobial
recommendations.
A qualitative study with 17 dairy farmers in the Netherlands and 21 in Germany
documents an emotional gap between farmers and society in both countries, in line with the
findings of the current study (Swinkels et al., 2015). They reported that farmers perceived
society as a negative reference group, or group with which they do not wish to belong or by
which they could not be influenced, and ultimately reject society’s perception of farmers
overusing antimicrobials on account that these perceptions are unjustified, disrespectful to the
farmer, and do not consider animal health and welfare. Considering the cultural heritage of the
dairy farmers in this study and continued close ties to family and friends still farming in the
Netherlands, the consistency of these findings is not surprising. Similarly, Swedish dairy farmers
were quite frustrated with how they were viewed by the public and in the media, particularly
with regard to AMU, and generally felt a lack of appreciation for their work as farmers (Fischer
et al., 2019). This perception held by the farmers is supported by a US study, which surveyed
2,001 members of the public, and found that 63% were indeed concerned with dairy cattle
welfare (Wolf et al., 2016). However, in England and Wales, one of the strongest predictors of
80
farmers’ AMU decisions was the public’s perception of milk safety, although it was unclear to
the farmers if the public preferred increased or decreased AMU (Jones et al., 2015).
In Canada, the 2185 dairy farmers enrolled in dairy herd improvement associations who
replied to a questionnaire distributed by mail to assess their knowledge and attitudes towards
food safety, stated that, overall, they are concerned about AMR, but only 10% perceived AMU
in the dairy industry to be linked with AMR in humans (Young et al., 2010), consistent with the
findings of the current study. Similarly, many dairy farmers (68%) in England and Wales
believed that AMR was a serious issue for humans. However, only 6% believed that AMR in
humans was attributable to AMU in dairy farming (Jones et al., 2015). In the US, however,
AMU was a top concern of dairy producers as it pertains to threats to dairy beef food safety
(VanBaale et al., 2003) and most dairy producers (59%) in Washington State thought that human
health could be affected by AMU in food animals (Raymond et al., 2006). However,
contradictory evidence was presented in a pilot study of 20 dairy farmers in South Carolina, in
which 86% of those surveyed were not concerned that AMU in animals could lead to AMR in
farm workers (Friedman et al., 2007).
In line with the findings of the present study, Dutch farmers (inclusive of dairy, veal, and
pig) expressed an ‘undesired attitude to regulations’ (Kramer et al., 2017). The authors
specifically found that dairy farmers disagreed with antimicrobial regulation more so than
farmers from the other two sectors. They supported having antimicrobials freely available to
them, which again is consistent with the findings of the current study. The authors attribute this
negative perception of regulation to a number of factors including intensification in the dairy
sector and related societal criticisms. Again, the consistency of these findings with the findings
81
of the present study makes sense in light of the extended social network and cultural heritage of
participants in this study sample.
So, among qualitative studies of AMU by dairy farmers, there exists some consistency,
with a few exceptions, with five of the findings of the current study: dairy farmers 1) are
concerned that restricted AMU may compromise herd health, 2) reject the views of the lay public
as uniformed, 3) are concerned about antimicrobial regulation, 4) would like to continue to have
antimicrobials available to them, 4) feel underappreciated by society, and 5) are skeptical that
AMU in livestock is linked to AMR in humans. Given these findings it is suggested that those
experts providing farmers with advice engage with the farmers they serve to understand the
farmers’ needs, understandings of the relevant issues, and perceptions of the effectiveness and
feasibility of recommended measures. Additionally, these findings exemplify the
conceptualization of AMR as a biological phenomenon shaped by social forces as described by
Dr. Macintyre. Particularly, they speak to how farmers, in combination with current regulatory
systems, manage animal production for human consumption and how the public and those who
use antimicrobials understand and value them.
4.3. Strengths and limitations
Semi-structured interviews and ethnographic fieldwork (i.e. direct and participant
observation) were used to uncover the dairy farmers’ perceptions surrounding AMU, AMR, and
regulation. These perceptions, engendered by the sociocultural and political-economic context,
are essential to understanding the behavior of AMU. Many studies conducted on this topic have
utilized surveys as the primary form of data collection (Raymond et al., 2006; Young et al.,
2010; Jones et al., 2015; Vasquez et al., 2019). However, this study utilized semi-structured
interviews, which allowed the farmers to express themselves in their own way and to respond to
82
aspects of the topic that resonated most with them. Semi-structured interviews also allowed for
probing by the researcher, which would not be available via a survey. As AMU is considered to
be a sensitive topic in agriculture, it is possible that informants may provide socially desirable
responses, particularly via survey response, where there is no rapport between the researcher and
informant. However, because the interviews were conducted within the context of ethnographic
fieldwork, it is likely that the farmers felt more comfortable to share their thoughts openly with
the researcher. The ethnographic fieldwork component is one of the greatest strengths of the
study as it allowed the researcher to build relationships and trust within the community, which is
not feasible through most other methods. Additionally, insights gleaned through the fieldwork
were used to contextualize the perceptions shared via the interviews.
However, there were also a number of limitations. Interviewer bias could have been
introduced via the unintentional use of leading questions. Additionally, the researcher’s presence
and engagement at the field site could have influenced the activities of participants. Because
snowball sampling was used as the sampling strategy and participants primarily consisted of
dairy farmers residing in the areas of Ponoka and Lacombe, it cannot be assumed that the results
of this study are generalizable to all dairy farmers in Alberta. It is also possible that the
interviewed farmers differed in their perceptions of AMU and AMR from those that did not
agree to participate in the study, leading to a selection bias. In terms of analysis, only nine of the
25 interviews were analyzed. Additional insights might have been gleaned if all 25 interviews
were analyzed. It is also possible that the researcher’s own perceptions on the topic may have
influenced the identified themes. Lastly, a qualitative software, such as NVivo, was not used to
create a formal coding system.
83
4.4. Future research
While the current study contributes to the understanding of AMU in the dairy sector,
there is further need to understand the societal and cultural infrastructure that supports AMU.
Much of the literature in the field focuses on attitudes and individualistic behavior of farmers and
pays little attention to the context in which these behaviors are embedded (Burton, 2004; Fischer
et al., 2019). The current study begins to consider the contextualization of AMU, but is only a
first step. A deeper understanding of the culture of intensive dairy farming is warranted. Of
particular relevance is a consideration of the goal to maximize milk production with relatively
few considerations of its downstream impacts on AMR in livestock or other organisms.
Additionally, society would likely benefit from a greater emphasis on increasing stewardship
than it would from calls for absolute reductions in AMU. Lastly, future research should be
directed away from educational interventions as previous health research has already made
evident that awareness does not necessarily lead to behavior change. Instead, research on how
best to utilize context-specific information to inform policy on AMU might be an area for further
development.
With regard to this thesis, data on farmer-suggested mechanisms to improve AMS were
collected. Initial analysis suggests that prevention (i.e. vaccine protocols), management changes
(i.e. barn structure, bedding, nutrition), technological innovations (i.e. rumination systems),
financial incentives, benchmarking, and advice from the veterinarian were all considered
potential mechanisms by which to improve stewardship. Additionally, although this work
suggests that expert advice may be received with some skepticism, the farmers did express
interest in education of both producer and consumer regarding AMU and AMR. This can be
84
further explored in future work, drawing from the same dataset as the interviews also covered
current AMU, but were not presented in these results.
Additionally, the remaining 16 transcripts can be further explored and used to enrich the
context of this study, particularly as it pertains to the political-economic context, religion, and
value for technological innovation. They can also be used to further embellish upon Theme 1:
‘Farmers as stewards of the land.’
Further, the researcher interviewed other stakeholders. Nine interviews were conducted
with veterinarians. Future work may entail exploring the barriers to improving prescribing
practices within the confines of current clinical business structure and the potential moral
conflict created by the veterinarian serving both as the prescriber and the supplier of
antimicrobials. See Appendix H for further details. Interviews were also conducted with two
hoof trimmers. Further investigation of the vulnerability and human health risk inherent to hoof
trimmer practices is certainly necessary and deserves great attention.
This study might be replicated in other communities in Alberta, such as a Hutterite
community in which the social context may be distinct. A cultural comparison study could be
conducted with an ethnographic study of dairy farming in China, which is currently being carried
out through the University of British Columbia. Additionally, the researcher plans to return to the
community to share and validate the findings of the study via member-checking.
4.5. Broader implications
The purpose of this study was to work toward bridging the gap between biomedical and
social science disciplines by specifically addressing the research gap in contextualized
understandings of antimicrobial use in dairy farming. With this approach, attention was directed
85
to the realities on the ground. We found that antibiotics are tools that hold quite a bit of value for
dairy farmers and it is essential to consider that value in combination with producers’ personal
values (namely, autonomy and their role as stewards), their previous experiences, which in the
case of this sample is that many immigrated from places with more stringent regulations, and
broader societal issues, specifically the perceived mutual distrust between farmers and the public.
These need to be considered in combination with one another if future interventions and policies
are to be effective.
We concluded that farmers: 1) feel AMU policies implemented in other contexts are
impractical and are concerned that such policies, if implemented in Alberta, would constrain
their freedom to make what they perceive to be the best decisions about AMU for their animals;
2) believe that their first-hand knowledge is undervalued by both consumers and policy makers;
3) do not believe that the public trusts them to make the correct AMU choices and, consequently,
worry that AMU policy will be guided by what they believe are misguided consumer concerns;
4) are sceptical of a link between AMU in livestock and AMR in humans. Based on these
findings, a better understanding of the sociocultural and political-economic infrastructure that
supports such perceptions is warranted and should inform future policy.
We hope that this research will lay the contextual foundation for the development of a
community-based, bottom-up antimicrobial stewardship initiative driven and sustained by joint
collaboration between the dairy farmers and relevant stakeholders (i.e., herd veterinarians, hoof
trimmers, policy makers) in Alberta, Canada. We also hope that it will serve to open up new
avenues of institutional dialogue between anthropology and veterinary medicine, and stimulate
fruitful collaboration among research scientists, veterinarians, and farmers. By integrating
existing clinical literature with social science insights, we are better equipped to inform public
86
debate concerning AMR and the food supply and to develop effective intervention strategies to
help put Canada at the forefront of this emerging health field.
87
BIBLIOGRAPHY
Albert, M., S. Laberge, B.D. Hodges, G. Regehr, and L. Lingard. 2008. Biomedical scientists’
perception of the social sciences in health research. Soc. Sci. Med. 66:2520–2531.
doi:10.1016/j.socscimed.2008.01.052.
Alberta Milk. About Alberta Milk. Accessed May 22, 2020. https://albertamilk.com/.
Andersen, H.J. 2002. Farmers’ choice of medical treatment of mastitis in Danish dairy herds
based on qualitative research interviews. J. Dairy Sci. 85:992–1001. doi:10.3168/jds.S00220302(02)74159-3.
Beemer, F., M. Zunderdorp, T. Wesselink, T. van der Rijken, N. Oud, P. Krauss, D.-J.
Schoneveld, and N. de Blaay. 2011. Naar Een Nederlands Model: De Positie van de
Dierenarts Bij Het Verminderen van Het Gebruik van Antibiotica in de Veehouderij.
Accessed June 30, 2020.
http://www.agripress.be/_STUDIOEMMA_UPLOADS/downloads/1616_0_1_2_3.pdf.
Berg, B. 2009. Qualitative Research Methods for the Social Sciences. Allyn and Bacon, Boston.
Bernard, H.R. ed. . 1998. Handbook of Methods in Cultural Anthropology. AltaMira Press,
Lanham, MD, USA.
Bernard, H.R. 2011. Research Methods in Anthropology: Qualitative and Quantitative
Approaches. AltaMira Press, Lanham, MD, USA.
Braun, V., and V. Clarke. 2006. Using thematic analysis in psychology. Qual. Res. Psychol.
3:77–101. doi:10.1191/1478088706qp063oa.
88
Braun, V., and V. Clarke. 2013. Successful Qualitative Research: A Practical Guide for
Beginners. SAGE Publishing Inc, Thousand Oaks, CA, USA.
Brosnan, S.F., and F.B.M. De Waal. 2003. Monkeys reject unequal pay. Nature 425:297–299.
doi:10.1038/nature01963.
Buller, H., S. Hinchcliffe, J. Hockenhull, D. Barrett, K. Reyher, A. Butterworth, and C. Heath.
2015. Systematic review and social research to further understanding of current practice in
the context of using antimicrobials in livestock farming and to inform appropriate
interventions to reduce antimicrobial resistance within the livestock sector. Dep. Environ.
Food Rural Aff. 1–70.
Burton, R.J.F. 2004. Reconceptualising the “behavioural approach” in agricultural studies: A
socio-psychological perspective. J. Rural Stud. 20:359–371.
doi:10.1016/j.jrurstud.2003.12.001.
Carmo, L.P., L.R. Nielsen, L. Alban, P.M. Costa, and G. Schüpbach-. 2018. Veterinary expert
opinion on potential drivers and opportunities for changing antimicrobial usage practices in
livestock in Denmark. Front. Vet. Sci. 5:1–14. doi:10.3389/fvets.2018.00029.
Cattaneo, A.A., R. Wilson, D. Doohan, and J.T. Lejeune. 2009. Bovine veterinarians’
knowledge, beliefs, and practices regarding antibiotic resistance on Ohio dairy farms. J.
Dairy Sci. 92:3494–3502. doi:10.3168/jds.2008-1575.
Caudell, M.A., M.B. Quinlan, M. Subbiah, D.R. Call, C.J. Roulette, J.W. Roulette, A. Roth, L.
Matthews, and R.J. Quinlan. 2017. Antimicrobial use and veterinary care among agropastoralists in Northern Tanzania. PLoS One 12:1–18. doi:10.1371/journal.pone.0170328.
89
Census Profile, 2016 Census - Ponoka, Town [Census subdivision], Alberta and Alberta
[Province]. 2016.
Center for Disease Dynamics Economics & Policy. 2015. The State of the World’s Antibiotics.
Accessed April 19, 2020. https://cddep.org/wpcontent/uploads/2017/06/swa_edits_9.16.pdf.
Charani, E., R. Edwards, N. Sevdalis, B. Alexandrou, E. Sibley, D. Mullett, B.D. Franklin, and
A. Holmes. 2011. Behavior change strategies to influence antimicrobial prescribing in acute
care: A systematic review. Clin. Infect. Dis. 53:651–662. doi:10.1093/cid/cir445.
Coker, R., J. Rushton, S. Mounier-Jack, E. Karimuribo, P. Lutumba, D. Kambarage, D.U.
Pfeiffer, K. Stärk, and M. Rweyemamu. 2011. Towards a conceptual framework to support
one-health research for policy on emerging zoonoses. Lancet Infect. Dis. 11:326–331.
doi:10.1016/S1473-3099(10)70312-1.
da Costa, J.P., M. Cova, R. Ferreira, and R. Vitorino. 2015. Antimicrobial peptides: an
alternative for innovative medicines?. Appl. Microbiol. Biotechnol. 99:2023–2040.
doi:10.1007/s00253-015-6375-x.
Craddock, S., and S. Hinchliffe. 2015. One world, one health? Social science engagements with
the one health agenda. Soc. Sci. Med. 129:1–4. doi:10.1016/j.socscimed.2014.11.016.
Craig, P., E. Di Ruggiero, K.L. Frohlich, E. Mykhalovskiy, M. White, R. Campbell, S.
Cummins, N. Edwards, K. Hunt, F. Kee, C. Loppie, L. Moore, D. Ogilvie, M. Petticrew, B.
Poland, V. Ridde, J. Shoveller, S. Viehbeck, and D. Wight. 2018. Taking account of context
in population health intervention research: guidance for producers, users and funders of
90
research. Can. Institutes Heal. Res.. doi:10.3310/CIHR-NIHR-01.
Degeling, C., J. Johnson, I. Kerridge, A. Wilson, M. Ward, C. Stewart, and G. Gilbert. 2015.
Implementing a One Health approach to emerging infectious disease: Reflections on the
socio-political, ethical and legal dimensions. BMC Public Health 15:1–11.
doi:10.1186/s12889-015-2617-1.
Doshi, P. 2015. Speeding new antibiotics to market: A fake fix?. BMJ 350.
doi:10.1136/bmj.h1453.
Dufour, D.L. 1983. Nutrition in the Northwest Amazon: Household dietary intake and time–
energy expenditure. Elsevier, Amsterdam, The Netherlands.
Edwards, N., and P.M. Barker. 2014. The importance of context in implementation research. J.
Acquir. Immune Defic. Syndr. 67:S157–S162. doi:10.1097/QAI.0000000000000322.
Ekman, T., and O. Østerås. 2003. Mastitis control and dry cow therapy in the Nordic countries.
Pages 18–30 in National Mastitis Council Annual Meeting Proceedings, Fort Worth, TX,
USA.
ESRC Working Group. 2014. Anti-Microbial Resistance: Setting the Social Science Agenda.
Accessed June 30, 2020. https://esrc.ukri.org/files/funding/funding-opportunities/amr/antimicrobial-resistance-setting-the-social-science-agenda/.
Fischer, K., K. Sjöström, A. Stiernström, and U. Emanuelson. 2019. Dairy farmers’ perspectives
on antibiotic use: A qualitative study. J. Dairy Sci. 102:2724–2737. doi:10.3168/jds.201815015.
Friedman, D.B., C.P. Kanwat, M.L. Headrick, N.J. Patterson, J.C. Neely, and L.U. Smith. 2007.
91
Importance of prudent antibiotic use on dairy farms in South Carolina: A pilot project on
farmers’ knowledge, attitudes and practices. Zoonoses Public Health 54:366–375.
doi:10.1111/j.1863-2378.2007.01077.x.
Gertz, C. 1973. The Interpretation of Cultures. Basic Books, Inc., New York, NY, USA.
Gobo, G. 2008. Doing Ethnography. SAGE Publishing Inc, London, UK.
Gold, R.L. 1958. Roles in sociological field observations. Soc. Forces 36:217–223.
doi:10.2307/2573808.
Golding, S.E., J. Ogden, and H.M. Higgins. 2019. Shared goals, different barriers: A qualitative
study of UK veterinarians’ and farmers’ beliefs about antimicrobial resistance and
stewardship. Front. Vet. Sci. 6:1–17. doi:10.3389/fvets.2019.00132.
Green, J., and N. Thorogood. 2009. Qualitative Methods for Health Research. SAGE Publishing
Inc, Thousand Oaks, CA, USA.
Greenhalgh, T. 2018. What have the social sciences ever done for equity in health policy and
health systems?. Int. J. Equity Health 17:124. doi:10.1186/s12939-018-0842-9.
Hammersley, M., and P. Atkinson. 2007. Ethnography: Principles in Practice. Routledge,
London, UK.
Harraway, D. 1991. Simians, Cyborgs and Women: The Reinvention of Nature. Routledge, New
York, NY, USA.
Henwood, K., and N. Pidgeon. 1994. Beyond the qualitative paradigm: A framework for
introducing diversity within qualitative psychology. J. Community Appl. Soc. Psychol.
92
4:225–238. doi:10.1002/casp.2450040403.
Higgins, H.M., S.E. Golding, J. Mouncey, I. Nanjiani, and A.J.C. Cook. 2017. Understanding
veterinarians’ prescribing decisions on antibiotic dry cow therapy. J. Dairy Sci. 100:2909–
2916. doi:10.3168/jds.2016-11923.
Higham, L.E., A. Deakin, E. Tivey, V. Porteus, S. Ridgway, and A.C. Rayner. 2018. A survey of
dairy cow farmers in the United Kingdom: knowledge, attitudes and practices surrounding
antimicrobial use and resistance. Vet. Rec. 183:1–9. doi:10.1136/vr.104986.
Jones, P.J., E.A. Marier, R.B. Tranter, G. Wu, E. Watson, and C.J. Teale. 2015. Factors affecting
dairy farmers’ attitudes towards antimicrobial medicine usage in cattle in England and
Wales. Prev. Vet. Med. 121:30–40. doi:10.1016/j.prevetmed.2015.05.010.
Kahneman, D., and A. Tversky. 1979. Prospect theory: An analysis of decision under risk.
Econometrica 47:263–291. doi:10.1142/9789814417358_0006.
Kramer, T., L.E. Jansen, L.J.A. Lipman, L.A.M. Smit, D.J.J. Heederik, and A. Dorado-García.
2017. Farmers’ knowledge and expectations of antimicrobial use and resistance are strongly
related to usage in Dutch livestock sectors. Prev. Vet. Med. 147:142–148.
doi:10.1016/j.prevetmed.2017.08.023.
Kuipers, A., W.J. Koops, and H. Wemmenhove. 2016. Antibiotic use in dairy herds in the
Netherlands from 2005 to 2012. J. Dairy Sci. 99:1632–1648. doi:10.3168/jds.2014-8428.
Kumar, V., J. Gupta, and H.R. Meena. 2019. Assessment of awareness about antibiotic resistance
and practices followed by veterinarians for judicious prescription of antibiotics : An
exploratory study in Eastern Haryana region of India. Trop. Anim. Health Prod. 51:677–
93
687. doi:10.1007/s11250-018-1742-0.
Lam, T.J.G.M., J. Jansen, and R.J. Wessels. 2017. The RESET Mindset Model applied on
decreasing antibiotic usage in dairy cattle in the Netherlands. Ir. Vet. J. 70:1–9.
doi:10.1186/s13620-017-0085-x.
Lapinski, M.K., J.A. Funk, and L.T. Moccia. 2015. Recommendations for the role of social
science research in One Health. Soc. Sci. Med. 129:51–60.
doi:10.1016/j.socscimed.2014.09.048.
Laxminarayan, R., P. Matsoso, S. Pant, C. Brower, J.-A. Røttingen, K. Klugman, and S. Davies.
2016. Access to effective antimicrobials: a worldwide challenge. Lancet 387:168–175.
doi:10.1016/S0140-6736(15)00474-2.
LeCompte, M., and J. Schensul. 1999. Designing and Conducting Ethnographic Research.
AltaMira Press, Lanham, MD, USA.
Magalhães-Sant’Ana, M., S.J. More, D.B. Morton, and A.J. Hanlon. 2017. Challenges facing the
veterinary profession in Ireland: 2. On-farm use of veterinary antimicrobials. Ir. Vet. J.
70:1–9. doi:10.1186/s13620-017-0106-9.
Mangione-Smith, R., M.N. Elliott, T. Stivers, L.L. McDonald, and J. Heritage. 2006. Ruling out
the need for antibiotics: Are we sending the right message?. Arch. Pediatr. Adolesc. Med.
160:945–952. doi:10.1001/archpedi.160.9.945.
Mangione-Smith, R., E.A. McGlynn, M.N. Elliott, P. Krogstad, and R.H. Brook. 1999. The
relationship between perceived parental expectations and pediatrician antimicrobial
prescribing behavior. Pediatrics 103:711–718. doi:10.1542/peds.103.4.711.
94
Mariner, J.C., J.A. House, C.A. Mebus, A.E. Sollod, D. Chibeu, B.A. Jones, P.L. Roeder, B.
Admassu, and G.G.M. Van ’t Klooster. 2012. Rinderpest Eradication: Appropriate
Technology and Social Innovations. Science (80-. ). 337.
Mathew, S., and C. Perreault. 2015. Behavioural variation in 172 small-scale societies indicates
that social learning is the main mode of human adaptation. Proc. R. Soc. B Biol. Sci. 282.
doi:10.1098/rspb.2015.0061.
McClure, J.T., J. Sanchez, S.A. Mcewen, I. Young, S. Hendrick, S. Parker, and A. Rajic. 2010.
Knowledge and attitudes towards food safety among Canadian dairy producers. Prev. Vet.
Med. 94:65–76. doi:10.1016/j.prevetmed.2009.11.010.
McEwen, S.A., and P.J. Collignon. 2018. Antimicrobial resistance: A One Health perspective.
Microbiol. Spectr. 6. doi:10.1128/microbiolspec.arba-0009-2017.
McIntosh, W., and W. Dean. 2015. Factors associated with the inappropriate use of
antimicrobials. Zoonoses Public Health 62:22–28. doi:10.1111/zph.12169.
Napier, A.D., C. Ancarno, B. Butler, J. Calabrese, A. Chater, H. Chatterjee, F. Guesnet, R.
Horne, S. Jacyna, S. Jadhav, A. MacDonald, U. Neuendorf, A. Parkhurst, R. Reynolds, G.
Scambler, S. Shamdasani, S.Z. Smith, J. Stougaard-Nielsen, L. Thomson, N. Tyler, A.M.
Volkmann, T. Walker, J. Watson, A.C.C. De Williams, C. Willott, J. Wilson, and K. Woolf.
2014. Culture and health. Lancet 384:1607–1639. doi:10.1016/S0140-6736(14)61603-2.
Noske, B. 1993. The animal question in anthropology: A commentary. Soc. Anim. 1:185–190.
O’Neill, J. 2016. Tackling Drug-Resistance Infections Globally: Final Report and
Recommendations. The Review on Antimicrobial Resistance. Accessed June 30, 2020.
95
https://amr-review.org/sites/default/files/160518_Final paper_with cover.pdf.
Opala, J., and F. Boillot. 1996. Leprosy among the Limba: Ilness and healing in the conext of
world view. Soc. Sci. Med. 42:3–19.
Parkunan, T., M. Ashutosh, B. Sukumar, J.S. Chera, S. Ramadas, B. Chandrasekhar, S.A.
Kumar, R. Sharma, M.S. Kumar, and S. De. 2019. Antibiotic resistance: A cross-sectional
study on knowledge, attitude, and practices among veterinarians of Haryana state in India.
Vet. World 12:258–265. doi:10.14202/vetworld.2019.258-265.
Patten, S. 2018. Epidemiology for Canadian Students: Principles, Methods and Critical
Appraisal. Brush Education, Edmonton, AB, Canada.
Powers, J.H. 2004. Antimicrobial drug development – the past, the present, and the future. Clin.
Microbiol. Infect. 10:23–31. doi:10.1111/j.1465-0691.2004.1007.x.
Raymond, M.J., R.D. Wohrle, and D.R. Call. 2006. Assessment and promotion of judicious
antibiotic use on dairy farms in Washington State. J. Dairy Sci. 89:3228–3240.
doi:10.3168/jds.S0022-0302(06)72598-X.
Robinson, T.P., D.P. Bu, J. Carrique-Mas, E.M. Fèvre, M. Gilbert, D. Grace, S.I. Hay, J.
Jiwakanon, M. Kakkar, S. Kariuki, R. Laxminarayan, J. Lubroth, U. Magnusson, P. Thi
Ngoc, T.P. Van Boeckel, and M.E.J. Woolhouse. 2016. Antibiotic resistance is the
quintessential One Health issue. Trans. R. Soc. Trop. Med. Hyg. 110:377–380.
doi:10.1093/trstmh/trw048.
Roca, I., M. Akova, F. Baquero, J. Carlet, M. Cavaleri, S. Coenen, J. Cohen, D. Findlay, I.
Gyssens, O.E. Heure, G. Kahlmeter, H. Kruse, R. Laxminarayan, E. Liébana, L. López-
96
Cerero, A. MacGowan, M. Martins, J. Rodríguez-Baño, J.M. Rolain, C. Segovia, B.
Sigauque, E. Taconelli, E. Wellington, and J. Vila. 2015. The global threat of antimicrobial
resistance: Science for intervention. New Microbes New Infect. 6:22–29.
doi:10.1016/j.nmni.2015.02.007.
Rock, M., B.J. Buntain, J.M. Hatfield, and B. Hallgrímsson. 2009. Animal-human connections,
“one health,” and the syndemic approach to prevention. Soc. Sci. Med. 68:991–995.
doi:10.1016/j.socscimed.2008.12.047.
Rock, M., and C. Degeling. 2016. Toward “One Health” promotion. M.C. Singer, ed. WileyBlackwell, Malden, MA.
Rock, M.J., and C. Degeling. 2015. Public health ethics and more-than-human solidarity. Soc.
Sci. Med. 129:61–67. doi:10.1016/j.socscimed.2014.05.050.
Sadler, G.R., H.C. Lee, R.S.H. Lim, and J. Fullerton. 2010. Recruitment of hard-to-reach
population subgroups via adaptations of the snowball sampling strategy. Nurs. Heal. Sci.
12:369–374. doi:10.1111/j.1442-2018.2010.00541.x.
Sapolsky, R. 2017. Behave: The Biology of Humans at Our Best and Worst. Penguin Press, New
York, NY, USA.
Savage, M. 2020. Could the Swedish Lifestyle Help Fight Coronavirus? - BBC Worklife.
Accessed June 26, 2020. https://www.bbc.com/worklife/article/20200328-how-to-selfisolate-what-we-can-learn-from-sweden.
Scherpenzeel, C.G.M., I.M.G.A. Santman-Berends, and T.J.G.M. Lam. 2018. Veterinarians ’
attitudes toward antimicrobial use and selective dry cow treatment in the Netherlands. J.
97
Dairy Sci. 101:6336–6345. doi:10.3168/jds.2017-13591.
Schultz, E., and R. Lavenda. 2009. Cultural Anthropology: A Perspective on Human Condition.
Oxford University Press, New York, NY, USA.
Singer, M., N. Bulled, B. Ostrach, and E. Mendenhall. 2017. Syndemics and the biosocial
conception of health. Lancet 389:941–950. doi:10.1016/S0140-6736(17)30003-X.
Smith, R. 2015. Antimicrobial resistance is a social problem requiring a social solution. BMJ
350:h2682. doi:10.1136/bmj.h2682.
Speksnijder, D.C., A.D.C. Jaarsma, A.C. van der Gugten, T.J.M. Verheij, and J.A. Wagenaar.
2015. Determinants associated with veterinary antimicrobial prescribing in farm animals in
the Netherlands: A qualitative study. Zoonoses Public Health 62:39–51.
doi:10.1111/zph.12168.
Svensson, C., N. Lind, K.K. Reyher, A.M. Bard, and U. Emanuelson. 2019. Trust, feasibility,
and priorities influence Swedish dairy farmers’ adherence and nonadherence to veterinary
advice. J. Dairy Sci. 102:10360–10368. doi:10.3168/jds.2019-16470.
Swinkels, J.M., A. Hilkens, V. Zoche-Golob, V. Krömker, M. Buddiger, J. Jansen, and T.J.G.M.
Lam. 2015. Social influences on the duration of antibiotic treatment of clinical mastitis in
dairy cows. J. Dairy Sci. 98:2369–2380. doi:10.3168/jds.2014-8488.
Tang, K.L., N.P. Caffrey, D.B. Nóbrega, S.C. Cork, P.E. Ronksley, H.W. Barkema, A.J.
Polachek, H. Ganshorn, N. Sharma, J.D. Kellner, and W.A. Ghali. 2017. Restricting the use
of antibiotics in food-producing animals and its associations with antibiotic resistance in
food-producing animals and human beings: a systematic review and meta-analysis. Lancet
98
Planet. Heal. 1:e316–e327. doi:10.1016/S2542-5196(17)30141-9.
Tebes, J.K. 2005. Community science, philosophy of science, and the practice of research. Am.
J. Community Psychol. 35:213–230. doi:10.1007/s10464-005-3399-x.
Thaler, R. 1980. Toward a positive theory of consumer choice. J. Econ. Behav. Organ. 1:39–60.
Thaler, R. 1985. Mental accounting and consumer choice. Mark. Sci. 4:199–214.
Vaismoradi, M., H. Turunen, and T. Bondas. 2013. Content analysis and thematic analysis:
Implications for conducting a qualitative descriptive study. Nurs. Health Sci. 15:398–405.
doi:10.1111/nhs.12048.
VanBaale, M.J., J.C. Galland, D.R. Hyatt, G.A. Milliken, M.J. VanBaale L, and M. Hall
Manhattan. 2003. A survey of dairy producer practices and attitudes pertaining to dairy
market beef food safety. Food Prot. Trends 466–473.
Vasquez, A.K., C. Foditsch, S.-A.C. Dulièpre, J.D. Siler, D.R. Just, L.D. Warnick, D. V. Nydam,
and J. Sok. 2019. Understanding the effect of producers’ attitudes, perceived norms, and
perceived behavioral control on intentions to use antimicrobials prudently on New York
dairy farms. PLoS One 14:1–21. doi:10.1371/journal.pone.0222442.
Vayda, A.P. 1983. Progressive contextualization: Methods for research in human ecology. Hum.
Ecol. 11:265–281.
De Waal, F.B.M. 2001. The Ape And the Sushi Master: Cultural Reflections of a Primatologist.
Basic Books, New York, NY, USA.
Wall, B.A., A. Mateus, L. Marshall, D.U. Pfeiffer, J. Lubroth, H.J. Ormel, P. Otto, and A.
99
Patriarchi. 2016. Drivers, Dynamics and Epidemiology of Antimicrobial Resistance in
Animal Production. Accessed April 19, 2020. http://www.fao.org/3/a-i6209e.pdf.
Wang, S., X. Zeng, Q. Yang, and S. Qiao. 2016. Antimicrobial peptides as potential alternatives
to antibiotics in food animal industry. Int. J. Mol. Sci. 17:603. doi:10.3390/ijms17050603.
Wiley, A.S., and J.S. Allen eds. . 2013. Medical Anthropology: A Biocultural Approach. Oxford
University Press, Oxford, UK.
Williamson, K. 2006. Research in constructivist frameworks using ethnographic techniques.
Libr. Trends 55:83–101. doi:10.1353/lib.2006.0054.
Willig, C. 1999. Beyond appearances: A critical realist approach to social constructionism. D.J..
Nightingale and J. Cromby, ed. Open University Press, Buckingham, UK.
Wilson, W. 2019. Behave: The biology of humans at our best and worst, Sapolsky, Robert M.
Penguin Press: New York, NY. 2017. Am. J. Hum. Biol. e23336:1–4.
doi:10.1002/ajhb.23336.
Wolcott, H.F. 1999. Ethnography: A Way of Seeing. AltaMira Press, Lanham, MD, USA.
Wolf, C.A., G.T. Tonsor, M.G.S. McKendree, D.U. Thomson, and J.C. Swanson. 2016. Public
and farmer perceptions of dairy cattle welfare in the United States. J. Dairy Sci. 99:5892–
5903. doi:10.3168/jds.2015-10619.
Wolf, M. 2015. Is there really such a thing as “one health”? Thinking about a more than human
world from the perspective of cultural anthropology. Soc. Sci. Med. 129:5–11.
doi:10.1016/j.socscimed.2014.06.018.
100
Woolhouse, M.E.J., and M.J. Ward. 2013. Sources of antimicrobial resistance. Science (80-. ).
341:1460–1461. doi:10.1126/science.1243444.
World Bank. 2017. Drug-Resistant Infections: A Threat to Our Economic Future. Accessed April
18, 2020. https://www.worldbank.org/en/topic/health/publication/drug-resistant-infectionsa-threat-to-our-economic-future.
World Health Organization. 2015. Global Action Plan on Antimicrobial Resistance. Accessed
April 19, 2020. https://www.who.int/antimicrobial-resistance/global-action-plan/en/.
World Values Survey. 2014. . Accessed June 26, 2020.
http://www.worldvaluessurvey.org/WVSDocumentationWVL.jsp.
Young, I., S. Hendrick, S. Parker, A. Rajić, J.T. McClure, J. Sanchez, and S.A. McEwen. 2010.
Knowledge and attitudes towards food safety among Canadian dairy producers. Prev. Vet.
Med. 94:65–76. doi:10.1016/j.prevetmed.2009.11.010.
Zinsstag, J., E. Schelling, B. Bonfoh, A.R. Fooks, J. Kasymbekov, D. Waltner-Toews, and M.
Tanner. 2009. Towards a “One Health” research and application tool box.. undefined.
Zinsstag, J., E. Schelling, K. Wyss, and M.B. Mahamat. 2005. Potential of cooperation between
human and animal health to strengthen health systems. Lancet 366:2142–2145.
doi:10.1016/S0140-6736(05)67731-8.
101
APPENDIX A. Project overview for participants
Title of Project:
The biosocial complexity of antimicrobial use in the dairy farming community in Alberta
Purpose of the Study:
The focus of this project is to gather information needed to lay the groundwork for a sustainable
and effective community-driven antibiotic stewardship program
Overview of the study:
Antibiotic resistance, or the ability of a microorganism to stop responding to medication, is an
emerging health issue that has been largely attributed to the inappropriate use of antibiotic
treatments. Many of the current research and policy initiatives focus on knowledge translation
and behavioral change mechanisms as ways to achieve reductions in antimicrobial use. However,
the current approach fails to address underlying drivers of use and is narrowly focused on
achieving a numeric goal. This research will examine the social, cultural, economic, and
geographic factors that are related to use of antibiotics. Qualitative methods (i.e. interviews,
observation) will be used to address these objectives. Specifically, the researcher will participate
in daily on-farm activities and chores to learn about dairy farming management and life. The
researcher will also interview dairy farmers, veterinarians, and hoof trimmers to learn about their
perceptions and practices related to antibiotic use.
Benefit of the study:
We will obtain an understanding of how best to work for and in collaboration with the farmers,
veterinarians, and hoof trimmers on topics related to antibiotic use. This study serves as a means
to empower the dairy farming community to make their voices heard in future antibiotic
stewardship programs. It will do so by providing them an opportunity to share their unique
experiences and insights as they relate to antibiotic use. It will also allow them to share their
wishes and expectations for future dairy research interventions related to this topic. After data
collection and analysis are complete, the researcher will return to share the results with the
community. We hope that via this project we can begin to redistribute decision-making power as
it pertains to ongoing research in the community.
If you are interested in learning more about this study, please contact:
Jennifer Ida, MA, PhD Student
Department of Production Animal Health
Faculty of Veterinary Medicine
Telephone: (403) 542-3098
Email: Jennifer.ida1@ucalgary.ca
Supervisor: Dr. Herman Barkema
102
**The University of Calgary Conjoint Faculties Research Ethics Board has approved this
research study (REB18-0795). **
103
APPENDIX B. Interview Consent Form: Dairy farmers
Jennifer Ida, Faculty of Veterinary Medicine, Department of Production Animal Health,
Telephone & Email: (403) 542-3098, Jennifer.ida1@ucalgary.ca
Supervisor:
Dr. Herman Barkema, Faculty of Veterinary Medicine
Title of Project:
The biosocial complexity of antimicrobial use in the dairy farming community in Alberta
This consent form, a copy of which has been given to you, is only part of the process of informed
consent. If you want more details about something mentioned here, or information not included
here, you should feel free to ask. Please take the time to read this carefully and to understand any
accompanying information.
Purpose of the Study:
The focus of this project is to gather information in order to lay the groundwork for the
development of a sustainable and effective community-driven program to improve antibiotic use
in dairy farming and veterinary medicine.
What Will I Be Asked To Do?
You will be asked to participate in an interview. It will take around 60-90 minutes to complete.
Your participation is voluntary. You will be asked some questions about your particular
experience. You do not have to answer any questions you do not wish to answer, and you may
terminate the interview at any time. The interview will be audiotaped to make an accurate record
of what you say during the interview.
What Type of Personal Information Will Be Collected?
We will collect some farm demographics like herd size, somatic cell count, milking parlor
procedures, and use of antibiotics. Also, some information about your age, education, values,
perceptions, cultural background, and familial relationships will be gathered.
Are there Risks or Benefits if I Participate?
There are no foreseeable risks to you as a result of your participation in this research. We expect
that this work will be of direct benefit to the farmers and dairy farming community. Through this
interview, we will work to understand the farmers’ perceptions, interests, and concerns related to
antibiotic use and antibiotic use interventions. By doing so, we can obtain a locally-specific
understanding of how best to work for and in collaboration with the farmers on topics related to
antibiotic use. This interview will serve as a means to empower farmers in future initiatives to
improve antibiotic use. It will do so by providing them an opportunity to share their unique
104
experiences and insights. It will also allow them to share their wishes and expectations for future
dairy research interventions related to this topic. We hope that via this project we can begin to
redistribute decision-making power as it pertains to ongoing research in the community.
Please note: Local veterinarians and other farmers will serve as a means of introduction, but will
not know if you decide to participate in the interview.
What Happens to the Information I Provide?
A transcript, or written record, will be made of your interview. This transcript will not contain
any information that links the interview with you. Your name and the names of any people or
organizations you mention will be replaced with fake names in the transcript.
Only the interviewer (the student researcher), the supervisor, and one collaborator will have
access to the interview recording and the transcript made of the interview. The de-identified
transcripts and encrypted audio-recordings will be retained indefinitely for possible future
research purposes. However, identifiable data will be retained until completion of the thesis and
corresponding publications/presentations.
Quotes from your interview transcript will be used in the writing the student researcher does
based on this project. The student will make every effort to present the data in a way that
conceals your identity. You are free to withdraw from this research project up until four weeks
after the interview. If you decide to terminate the interview, the information you have provided
will not be used for thesis purposes.
***********
The pseudonym (fake name) I suggest for myself is:
______________________________________
Signatures (written consent)
Your signature on this form indicates that you 1) understand to your satisfaction the information
provided to you about your participation in this research project, and 2) agree to participate as a
research subject.
In no way does this waive your legal rights nor release the investigators, sponsors, or involved
institutions from their legal and professional responsibilities. You should feel free to ask for
clarification or new information throughout your participation.
Please note: If you are participating in both the interviews and the on-farm observation, you will
be asked to sign two separate consent forms.
Participant’s Name: (please print) ______________________________________________
Participant’s Signature:
______________________________________________
105
Date: _______________
Researcher’s Name: (please print) ______________________________________________
Researcher’s Signature:
______________________________________________
Date: ________________
Questions/Concerns
If you have any further questions or want clarification regarding this research and/or your
participation, please contact:
Jennifer Ida
Faculty of Veterinary Medicine
University of Calgary
1(403) 542-3098
Jennifer.ida1@ucalgary.ca
and
Dr. Herman Barkema
Faculty of Veterinary Medicine
University of Calgary
1(403) 220 2659
barkema@ucalgary.ca
If you have any concerns about the way you have been treated as a participant, please contact
the Research Ethics Analyst, Research Services, University of Calgary at (403) 220-4283/2206289; e-mail cfreb@ucalgary.ca.
A copy of this consent form has been given to you to keep for your records and reference. The
investigator has kept a copy of the consent form.
**The University of Calgary Conjoint Faculties Research Ethics Board has approved this
research study. **
106
APPENDIX C. Interview Consent Form: Veterinarians
Jennifer Ida, Faculty of Veterinary Medicine, Department of Production Animal Health,
Telephone & Email: (403) 542-3098, Jennifer.ida1@ucalgary.ca
Supervisor:
Dr. Herman Barkema, Faculty of Veterinary Medicine
Title of Project:
The biosocial complexity of antimicrobial use in the dairy farming community in Alberta
This consent form, a copy of which has been given to you, is only part of the process of informed
consent. If you want more details about something mentioned here, or information not included
here, you should feel free to ask. Please take the time to read this carefully and to understand any
accompanying information.
Purpose of the Study:
The focus of this project is to gather information in order to lay the groundwork for the
development of a sustainable and effective community-driven program to improve antibiotic use
in dairy farming and veterinary medicine.
What Will I Be Asked To Do?
Your participation is voluntary. You will be asked to participate in an interview. It will last 60-90
minutes. You will be asked some questions about your particular experience. You do not have to
answer any questions you do not wish to answer, and you may terminate the interview at any
time. The interviews will be audiotaped to make an accurate record of what you say during the
interview.
What Type of Personal Information Will Be Collected?
Questions will pertain to prescription of antimicrobials in dairy cattle in Alberta, perceptions of
reducing use, resistance and regulation. Also, some information about your age, education, and
background will be collected.
Are there Risks or Benefits if I Participate?
There are no foreseeable risks to you as a result of your participation in this research. We expect
that this work will be of direct benefit to the dairy farming community in Alberta. Through this
interview, we will work to understand the veterinarians’ perceptions, interests, and concerns
related to antibiotic use and antibiotic use interventions. By doing so, we can obtain a locallyspecific understanding of how best to work for and in collaboration with the farmers and
veterinarians on topics related to antibiotic use. This interview will serve as a means to empower
farmers and veterinarians in future initiatives to improve antibiotic use. It will do so by providing
107
them an opportunity to share their unique experiences and insights. It will also allow them to
share their wishes and expectations for future dairy research interventions related to this topic.
We hope that via this project we can begin to redistribute decision-making power as it pertains to
ongoing research in the community.
What Happens to the Information I Provide?
A transcript, or written record, will be made of your interview. This transcript will not contain
any information that links the interview with you. Your name and the names of any people or
organizations you mention will be replaced with fake names in the transcript.
Only the interviewer (the student researcher), the supervisor, and one collaborator will have
access to the interview recording and the transcript made of the interview. The de-identified
transcripts and encrypted audio-recordings will be retained indefinitely for possible future
research purposes. However, identifiable data will be retained until completion of the thesis and
corresponding publications/presentations.
Quotes from your interview transcript will be used in the writing the student researcher does
based on this project. The student will make every effort to present the data in a way that
conceals your identity. You are free to withdraw from this research project up until four weeks
after the interview. If you decide to terminate the interview, the information you have provided
will not be used for thesis purposes.
***********
The pseudonym (fake name) I suggest for myself is:
______________________________________
Signatures (written consent)
Your signature on this form indicates that you 1) understand to your satisfaction the information
provided to you about your participation in this research project, and 2) agree to participate as a
research subject.
In no way does this waive your legal rights nor release the investigators, sponsors, or involved
institutions from their legal and professional responsibilities. You should feel free to ask for
clarification or new information throughout your participation.
Please note: If you are participating in both the interviews and the on-farm observation, you will
be asked to sign two separate consent forms.
Participant’s Name: (please print) ______________________________________________
Participant’s Signature:
______________________________________________
Date: _______________
Researcher’s Name: (please print) ______________________________________________
108
Researcher’s Signature:
______________________________________________
Date: ________________
Questions/Concerns
If you have any further questions or want clarification regarding this research and/or your
participation, please contact:
Jennifer Ida
Faculty of Veterinary Medicine
University of Calgary
1(403) 542-3098
Jennifer.ida1@ucalgary.ca
and
Dr. Herman Barkema
Faculty of Veterinary Medicine
University of Calgary
1(403) 220 2659
barkema@ucalgary.ca
If you have any concerns about the way you have been treated as a participant, please contact
the Research Ethics Analyst, Research Services, University of Calgary at 403.220.6289 or
403.220.8640; e-mail cfreb@ucalgary.ca.
A copy of this consent form has been given to you to keep for your records and reference. The
investigator has kept a copy of the consent form.
**The University of Calgary Conjoint Faculties Research Ethics Board has approved this
research study (REB18-0795). **
109
APPENDIX D. Consent Form: Participant observation
Jennifer Ida, Faculty of Veterinary Medicine, Department of Production Animal Health,
Telephone & Email: (403) 542-3098, Jennifer.ida1@ucalgary.ca
Supervisor:
Dr. Herman Barkema, Faculty of Veterinary Medicine
Title of Project:
The biosocial complexity of antimicrobial use in the dairy farming community in Alberta
This consent form, a copy of which has been given to you, is only part of the process of informed
consent. If you want more details about something mentioned here, or information not included
here, you should feel free to ask. Please take the time to read this carefully and to understand any
accompanying information.
Purpose of the Study:
The focus of this project is to gather information in order to lay the groundwork for the
development of a sustainable and effective community-driven program to improve antibiotic use
in dairy farming and veterinary medicine.
What Will I Be Asked To Do?
This aspect of the study will involve on-farm observation so that the researcher may learn about
dairy farm management, life, and culture. The researcher will participate in and observe routine
activities on the farm (i.e. milking, feeding, herd health exams) and assist with chores in the
home when welcomed. Your participation is voluntary. You do not need to answer any questions
you do not wish to answer, nor do you need to interact with the researcher at all times. You may
terminate your interactions with the researcher at any time. The observations will be recorded as
fieldnotes and used to contextualize the interviews.
You and the researcher can decide how often and for how long she will assist on the farm. It
would be ideal if she could assist with on-farm activities for approximately three days and for a
duration of 4-8 hours each day. The researcher has been trained in various on-farm activities (i.e.
milking) by a local farmer and has previously worked as a veterinary technician assistant.
However, it is important to make sure she is aware of specific protocols that pertain to your farm.
Together you and the researcher will decide how best to explain her presence on the farm to
those who may drop by. If you are okay with her identifying as a researcher, please be aware that
this disrupts confidentiality. That is, your participation in the study will no longer be private. The
researcher can also identify as a volunteer in an effort to secure confidentiality.
110
Local veterinarians and other farmers will serve as a means of introduction, but the researcher
will not make them aware of your participation in the observational part of the study. However,
if given the opportunity, the researcher would like to observe herd health exams. If you agree to
her observation of the herd health exams, this will disrupt confidentiality as your veterinarian
would then know you are participating in the study.
What Type of Personal Information Will Be Collected?
We will collect information regarding herd size, somatic cell count, milking parlor procedures,
and veterinary medical treatments (i.e. use of antibiotics). Also, some information about your
values, perceptions, and on-farm relationships will be gathered.
Are there Risks or Benefits if I Participate?
There are no foreseeable risks to you as a result of your participation in this research. We expect
that this work will be of direct benefit to the farmers and dairy farming community. By
participating in and observing on-farm activities, we hope to learn about routine on-farm
activities and chores, daily life of a dairy farmer, and decision-making processes surrounding
medical treatment of dairy cattle. By doing so, we can obtain a locally-specific understanding of
how best to work for and in collaboration with the farmers on topics related to antibiotic use. The
information gathered through participant observation will be used to provide a context for the
interviews. We hope that in combination with the interviews, it will serve as a means to empower
farmers to make their voices heard in future initiatives to improve antibiotic use. It will do so by
providing them an opportunity to share their unique experiences and insights as they relate to
antibiotic use. It will also allow them to share their wishes and expectations for future dairy
research interventions related to this topic. We hope that via this project we can begin to
redistribute decision-making power as it pertains to ongoing research in the community.
Additionally, we hope that the researcher’s unpaid participation in on-farm chores and activities
will be helpful.
What Happens to the Information I Provide?
The information collected while the researcher is participating in on-farm activities will become
fieldnotes. Your name and the names of any people or organizations you mention will be
replaced with fake names in the fieldnotes.
Only the observer (the student researcher), the supervisor, and one collaborator will have access
to the fieldnotes. The de-identified fieldnotes will be encrypted and retained indefinitely for
possible future research purposes. However, identifiable data will be retained until completion of
the thesis and corresponding publications/presentations.
Information from the fieldnotes will be used in the writing the student researcher does based on
this project. The student will make every effort to present the data in a way that conceals your
identity. You are free to withdraw from this research project up until four weeks after the student
researcher has begun participating in on-farm activities. If you decide to terminate your
interactions with the researcher, the information you have provided will not be used for thesis
purposes. In the event that only one participant on the farm would like to withdraw while others
would like to continue participation, the researcher will only record observations pertaining to
those interested in continuing to participate. She will also keep interactions between the nonparticipant and herself to a minimum.
111
***********
The pseudonym (fake name) I suggest for myself is:
______________________________________
Signatures (written consent)
Your signature on this form indicates that you 1) understand to your satisfaction the information
provided to you about your participation in this research project, and 2) agree to participate as a
research subject.
In no way does this waive your legal rights nor release the investigators, sponsors, or involved
institutions from their legal and professional responsibilities. You should feel free to ask for
clarification or new information throughout your participation.
Please note: If you are participating in both the interviews and the on-farm observation, you will
be asked to sign two separate consent forms.
Participant’s Name: (please print) ______________________________________________
Participant’s Signature:
______________________________________________
Date: _______________
Researcher’s Name: (please print) ______________________________________________
Researcher’s Signature:
______________________________________________
Date: ________________
112
Questions/Concerns
If you have any further questions or want clarification regarding this research and/or your
participation, please contact:
Jennifer Ida
Faculty of Veterinary Medicine
University of Calgary
1(403) 542 3098
Jennifer.ida1@ucalgary.ca
and
Dr. Herman Barkema
Faculty of Veterinary Medicine
University of Calgary
1(403) 220 2659
barkema@ucalgary.ca
If you have any concerns about the way you have been treated as a participant, please
contact the Research Ethics Analyst, Research Services, University of Calgary at
403.220.6289 or 403.220.8640; e-mail cfreb@ucalgary.ca.
A copy of this consent form has been given to you to keep for your records and reference.
The investigator has kept a copy of the consent form.
**The University of Calgary Conjoint Faculties Research Ethics Board has approved this
research study (REB18-0795). **
113
APPENDIX E. Interview template: Dairy farmers
Open-ended, semi-structured interview guide
Two interviews (60-90 minutes each)
Population: Dairy farming community in central Alberta (Ponoka, Lacombe)
Research Questions:
1. What are current local practices related to use of antibiotics and what influences
decision-making surrounding use?
2. What are the barriers and negative implications to absolute reduction in use?
What are local perceptions and concerns surrounding the external pressure to
reduce use?
3. How can farmers and veterinarians collaborate to promote antibiotic stewardship
and create a sustainable community-driven initiative?
4. What is the personal life history of the farmer?
Interview 1
Farm profile
Breed:
Number of milking cows:
Style of milking parlor:
Does your milking system have a backflush?
Bedding:
Milking shifts/day:
Average somatic cell count:
Average daily milk yield:
Stocking rates for each lactation period:
Time on pasture, if any?
Number of employees:
What do the employees do on-farm?
Do you participate in any disease control programs? If so, which ones?
Which vaccines do your cows receive?
Personal background
Name:
Date of birth:
Date of interview:
Gender:
Level of education:
Number of years farming:
Number of years in Canada:
Do you come from a dairy farming background? If so, how many generations back can it
be traced? Is this part of a cultural context?
114
If not, how did you get involved?
Number of immediate family members involved in the farm:
Current practices
1. Which antibiotics do you use most often?
a. How do you determine which one to use?
b. To treat which illnesses/symptoms?
c. In which age group (i.e. most often calves? Transition cows?)?
2. Which illnesses/symptoms do you treat most often?
3. Which age group do you treat most often?
4. Do you keep a supply on-farm?
a. Which ones?
b. From where do you purchase them?
c. Have you or other farmers you know purchased antibiotics from
people/places other than your veterinarian/veterinary clinic?
5. Do you ever combine antibiotics?
a. In which cases?
b. What is the benefit of doing so?
6. Do you ever use antibiotics or other treatments in ways that are based on your
own experience, rather than based on a vet’s instructions?
7. How do you treat mastitis?
8. Do you practice blanket or selective dry cow treatment?
a. How did you come to that decision?
b. If you practice blanket, would you consider selective? Why or why not?
9. Do you practice blanket medical treatment for any other reason (i.e. calves prone
to pneumonia during season transition)?
10. How do you treat metritis?
11. How do you treat respiratory illness?
12. How do you treat scours in calves?
13. How do you treat foot rot?
14. How do you treat pneumonia in calves?
15. Who determines antibiotics are needed for a particular case?
16. How do you make decisions with regard to which drug to purchase?
a. How important is your vet’s opinion or recommendation when
considering which antimicrobial to purchase?
17. Who gives the antimicrobials to the animal?
a. If employees give them, do they need to inform anyone prior to or after
giving the antibiotics?
18. In which cases, if any, will you consult your veterinarian before giving antibiotics
to a cow?
19. What do you do if you have treated an animal and you notice that she is not
recovering?
20. What do you do with the cows when they enter the milking parlor and in what
order?
21. How do you keep track of milking cows who have received antibiotics and
respective withdrawal periods?
a. Do you keep treatment records?
115
22. How do you ensure milk does not enter the bulk tank before the end of
withdrawal period?
Interview 2
Sociopolitical and economic infrastructure that disables good stewardship practices;
Local perceptions and concerns surrounding external pressure to reduce use,
particularly in terms of intervention mechanisms and bans; Implications of absolute
reduction in use
1. What are your thoughts on reducing use of antibiotics in dairy cattle in Alberta?
a. On your farm?
2. Do you feel that antibiotic resistance is an issue in the dairy industry?
a. In Alberta?
b. On your farm?
3. Do you feel that reducing the use of antibiotics in dairy cattle in Alberta is
important? Necessary? Critical? A priority on your farm?
4. What would make it difficult for you to do so? What would be a negative
outcome of doing that?
5. What would be your greatest concern if mandated to reduce use?
6. What do you perceive to be the economic challenges associated with reducing
use?
7. Governments may consider banning the use of some antibiotics that are also used
in human medicine. What do you think about that? How would it affect you?
8. How would increased regulation (i.e. requiring prescriptions for every dose)
affect you?
a. How would it affect your relationship with your veterinarian?
9. How critical are antibiotics to maintaining the health of your herd?
10. Whose responsibility is it to do something about this issue?
11. To what extent would you expect to be supported by the government?
a. By your veterinarian?
12. What do other farmers think about antimicrobial resistance? About reducing use?
a. What do family members think?
b. Employees?
13. How would increased regulation affect your ability to do what you think is right
and act independently?
14. How do you talk about antibiotics and resistance with your family?
a. Employees?
b. Your vet?
15. How critical are antibiotics to maintaining the health of your family?
16. Does your use of antibiotics with the cows influence your use with your kids and
vice versa?
17. Do you think that the use of antibiotics in your cows can influence the overall
health of your family?
a. Yourself?
b. Your employees?
18. To what extent do consumers and the public influence your choices related to
antimicrobials?
a. To what extent does Alberta Milk?
b. Processors?
c. Distributors?
116
d. Others?
19. If the public increased pressure to reduce use, how would you respond?
a. Alberta Milk?
b. Processors?
c. Distributors?
d. Others?
20. Are you familiar with the new policies in Alberta as of December?
21. How have new policies in Alberta affected you? Your farm?
Mechanisms for increasing stewardship
1. How might you be able to practice better use of antibiotics on your farm?
2. What role do you see your vet playing in on-farm use of antibiotics?
3. How might you be able to work with your vet to create on-farm strategies for
using antibiotics in a more sustainable way?
a. How might you be able to work better with employees who are managing
cows?
b. Other family members?
4. How could stakeholders and those invested in better use of antimicrobials track
progress?
a. Should there be a measurable goal?
b. Does reduction constitute success?
c. If no, then what does?
5. An initiative to reduce antibiotics has already been put into action in the
Netherlands. Are you familiar with this system?
a. Do you know any farmers there?
b. What do the farmers in the Netherlands think about it?
c. How has it affected them, their cows, and their farm?
6. What are your thoughts on implementing a similar system here in Alberta?
7. What do you think contributes to successful vet-farmer relationships?
8. Do you feel you have a good relationship with your vet? Why or why not?
9. What will your vet need to do to support you if you choose to reduce use?
10. In light of current pressure, what is your sense about where the issue of
antimicrobial use is going? Do you think this is something that will become more
mandated? How do you imagine continuing to do what you do but complying at
the same time?
11. What will the dairy industry look like in 10-20 years from now with regard to
antimicrobials?
Personal life history
1.
2.
3.
4.
5.
6.
7.
At what age did you decide to become a dairy farmer?
What made you want to be a farmer?
How did you imagine your life to be as a farmer?
What do you value most about being a farmer?
Are your siblings/parents also dairy farmers?
Would you consider yourself to be religious?
Do you feel that you farm in-line with your religious and/or cultural values?
a. How do you think that might affect the health of your cows?
117
b. How might that affect your decisions related to medicine?
Other
1. How much has audio recording affected your responses?
118
APPENDIX F. Interview template: Veterinarians
Open-ended, semi-structured interview guide
Population: Large animal veterinarians practicing in Central Alberta
Name:
Date of interview:
Date of birth:
Gender:
City of residence:
Where did you grow up? Characterized as urban/suburban/rural?
Veterinary school attended:
Year of graduation:
Number of years in practice:
Are you currently or have you ever been a practice owner?
Number/percentage of dairy herd clients:
Research Questions: What are the prescribing practices of veterinarians who treat dairy
cattle in Alberta? What are their perceptions of reducing antimicrobial use, antimicrobial
resistance, and increased regulation? What role do they see themselves playing in
improving antimicrobial stewardship?
Prescribing practices
1. Which antibiotics do you prescribe most often? For which diseases?
2. Which age group gets treated most often?
3. Do you have practice-specific treatment protocols? E.g. Antibiotic of first/second
choice for your practice
a. What do you base your choice of antibiotics on?
b. Do you discuss this among associates?
4. Do you have farm-specific treatment protocols?
a. What do you base this on?
5. Do all of your clients buy their antibiotics from you?
6. What do you prescribe for:
a. Mastitis
i. Do you culture mastitis on farm? Do you encourage farmers to do
so? – based on bacteria on farm and sensitivity of bacteria for
specific antibiotics
b. Metritis
c. Foot rot
d. Pneumonia
e. Scours
f. Dry cow therapy
i. Do you recommend a teat sealant?
7. What are your thoughts on selective versus dry cow therapy?
a. How do you select clients who can use selective DCT?
b. Do you have any clients using selective dry cow therapy?
c. What has their experience been?
8. Are there any cases where it is necessary to prescribe off label?
119
9. At what point in the progression of an illness do your clients seek you out for
advice?
Perceptions of antimicrobial use, resistance and regulation
1. What are your thoughts on reducing use of antibiotics in dairy cattle in Alberta?
2. Do you feel that antibiotic resistance is an issue in the dairy industry?
3. What would make it difficult for farmers to reduce use? What would be a
negative outcome of doing that?
4. What would be your greatest concern if mandated to reduce use?
5. Do you have any concerns about reduced use of antibiotics and its effect on your
income?
6. How would increased regulation affect you and your practice?
7. How have new policies in Alberta affected you? The clinic? Your clients?
8. If governments were to consider banning the use of some antibiotics that are also
used in human medicine. What do you think about that? How would it affect the
way you practice medicine?
9. An initiative to reduce antibiotics has already been put into action in the
Netherlands. Are you familiar with this system? What are your thoughts on
implementing a similar system here in Alberta?
10. How compliant do you think producers will be with new regulations?
11. How could stakeholders and those invested in better use of antimicrobials track
progress?
a. Should there be a measurable goal?
b. Does reduction constitute success?
c. If no, then what does?
12. What is your source of information on use of antibiotics?
13. How would you characterize the difference in training versus practice as it
pertains to use of antimicrobials?
14. Is the veterinarian’s dual role as both a prescriber and a pharmacy a conflict of
interest?
a. If so, how do you manage that conflict?
Mechanisms to improve stewardship
1. What role do you see veterinarians playing in on-farm antimicrobial stewardship?
2. How might you be able to work with your clients to create on-farm strategies for
using antibiotics in a more sustainable way?
3. How will you communicate with farmers to reach shared decision-making for the
good of the herd?
a. If things do not go well, what will you do?
Profession
1. What made you decide to become a vet?
2. What do you value/enjoy about being a vet?
3. Where do you see dairy medicine in 15-20 years?
120
Other
1. How much has audio recording affected your responses?
121
APPENDIX G. Participant and direct observation protocol
Protocol adapted from Guidelines for Ethical Conduct in Participant Observation,
University of Toronto, Social Sciences and Humanities Research
1. Methods
Participant observation is a field-based research strategy commonly used in
anthropology. It uses immersive experiences to understand the context of interest.
Through participant observation, the researcher is immersed in the day-to-day
activities of the informants. In this project, participant observation will take place
on a maximum of 25 dairy farms in and around Ponoka and Lacombe, Alberta for
a period of approximately 3 months. The researcher will participate in on-farm
activities including milking, feeding calves, relocating heifers, and treatment of
sick cows. The researcher will also participate in household chores including
cooking, gardening, and retrieving eggs from the chicken coop. When invited, the
researcher will also attend community events including religious services. Direct
observation, a complementary field-based method, will also be used in this study.
Direct observation will be employed by observing on-farm activities. This will
include observing routines related to treatment of sick cows (including calves),
herd health exams, milking procedures for animals previously treated with
antimicrobials, and dry cow treatment. Data will be collected in the form of
fieldnotes and will be recorded at the end of each day. These data will be used to
contextualize the information gleaned through the semi-structured interviews.
2. Participants
While on the dairy farms, it is likely that the researcher will interact with the dairy
farmers, on-farm employees, family members, bulk tank drivers, and the herd
veterinarian. The researcher plans to enter the field by offering free assistance on
the farm (i.e. offering to work 2-3 milking shifts). The researcher plans to conduct
approximately 3 days of observation on each farm. Each day may last between 48 hours depending on the farmer’s schedule and approval. By entering the field as
unpaid help in the milking parlor, it allows participants to become familiar with
the researcher’s presence and the nature of the research. Participants will be
informed of the researcher’s identity and purpose of participating in the activities.
The informants will also be made aware of the overall aim of the project, the
methods involved, and that informal discussion and interactions could be
considered data.
3. Potential Harms
Although overall this research presents limited harm to participants, the presence
of an unfamiliar researcher may cause participants to feel slightly uncomfortable.
4. Privacy and confidentiality
The researcher will make every effort to respect the privacy of individuals
involved. The researcher will assure them that the information collected will be
kept confidential. Only the observer (the student researcher), the supervisor, and
one collaborator will have access to the fieldnotes. The fieldnotes will be
encrypted to protect the privacy of the individuals. Pseudonyms will be used in
publication and in public forums when the researcher provides explicit quotes.
122
5. Informed consent
Informed consent will be obtained from all participants with whom the researcher
will interact. Individuals will be informed that they are free to stop interacting
with the researcher at any time.
123
APPENDIX H. Self-perceived role of veterinarians in antimicrobial stewardship
Introduction
As prescribers of antimicrobials, it is important to understand the position of the
veterinarian and his/her self-perceived role in AMU, AMR, and AMS. Veterinarians are
uniquely positioned as the gatekeepers of antimicrobials (Speksnijder et al., 2015) as they
maintain access and control over distribution of the drugs. They are the intermediate in
the antimicrobial distribution chain – the link between the pharmaceutical company and
the consumer. Therefore, it is critical to assess the context of these actors, the underlying
drivers of prescription, and the implicit values and medical philosophies of the
veterinarian as both the prescriber and the seller of antimicrobials (Cattaneo et al., 2009;
Speksnijder et al., 2015; Wolf, 2015; Higgins et al., 2017; Magalhães-Sant’Ana et al.,
2017; Carmo et al., 2018; Scherpenzeel et al., 2018; Kumar et al., 2019).
There is growing competition among veterinary practitioners, particularly practice
owners, for the recruitment of new clients and even in the maintenance of existing
clientele. Therefore, there is an inherent incentive to making prescriptions easy to obtain
(Beemer et al., 2011), particularly when the practice of “shopping around” is common.
Beemer and colleagues (2011) point out that unlike in other professions that serve a
societal good (i.e. human physicians, lawyers, accountants), veterinarians are selfregulating. In most cases, we can argue that this self-regulation is directed by an internal
moral compass. This is because reduction in antimicrobial use (AMU), in theory,
translates to reduction in profit for the practitioner. In this way, it can be seen as a
balancing act on the part of the practitioner - between providing a public good with
optimal integrity and securing one’s own livelihood.
124
We need to unpack the veterinarian’s role on a societal level --- do veterinarians
have an obligation to act in the best interest of the public? To benefit the farmer’s bottom
line? To secure their own net sales? To serve the welfare of the animal? Or are all of
these within the purview of the veterinarian? If so, then how do they prioritize these at
any given moment? As we begin to unpack the role of the veterinary practitioner in
society, we will likely start to see how the position situates the individual in a place of
potential moral conflict.
Research Question
1) What are dairy veterinary practitioners’ perspectives regarding AMU in dairy cattle and
their respective role in AMS?
Objectives
1) Describe the prescribing practices of veterinarians who service dairy farms in Alberta
2) Understand their perceptions of reducing AMU, AMR, and increased regulation
3) Understand the role they see themselves playing in improving AMS
Methodology
Ethnographic methods were employed to address the research questions above
(Hammersley and Atkinson, 2007; Berg, 2009; Green and Thorogood, 2009; Bernard,
2011). Data were triangulated by using direct and participant observation and semistructured interviews. This will aid in validating the findings.
Veterinary participants
The study sample included practicing veterinarians in Central Alberta who service
the dairy farming industry. All individuals who service dairy farms were eligible for the
study. A total of nine veterinarians were recruited.
125
Sampling strategy
Participants were recruited from dairy farms and veterinary clinics in Central
Alberta, primarily in the areas of Ponoka and Lacombe. Snowball and purposive
sampling were used to recruit veterinarians. We aimed to include the veterinarians of the
dairy farmers already participating in the study. The researcher conducted the
observations with veterinarians based out of the Ponoka/Lacombe area. We used referrals
from the dairy farmers and other veterinarians in the area to recruit veterinarians.
Observation methodology
Direct observation was conducted over a period of 3 mo. Observations took place
on the dairy farms. Direct observation was employed by observing on-farm herd health
exams. This included observing farmer-veterinarian interactions, pregnancy checks,
discussions regarding hormonal synchronization protocols, examination of sick cows,
decision-making process for treating sick cows, de-horning of calves, discussions of
mastitis culturing, and dry cow therapy protocols. Each day of observation lasted
between 4-8 h depending on the veterinarian’s schedule and approval. There was
approximately 25 d of observations with the veterinarians. Observations were recorded as
field notes. Pseudonyms were used to ensure the anonymity of the participants.
Semi-structured interviews
We conducted open-ended, semi-structured interviews the nine veterinarians.
Topics included, but were not limited to: current prescription and use of antimicrobials,
perceptions of antimicrobial resistance (AMR) and increased regulation on dairy farms,
and potential mechanisms to improve antimicrobial stewardship (AMS). Interviews
lasted approximately 60 min. Interviews took place either in the veterinarian’s clinic or
126
en route to exam. Interviews were audio-recorded. The veterinarians interviewed were
the same veterinarians asked to participate in the observational part of the study.
127
Keep reading this paper — and 50 million others — with a free Academia account
Used by leading Academics
Garumma T Feyissa
Drexel University
Jeffrey W. Cupchik
York University
James M. Lepkowski
University of Michigan
Werner Soors
Institute of Tropical Medicine, Antwerp
