title: Understanding the failure of a behavior change intervention to reduce risk behaviors for avian influenza transmission among backyard poultry raisers in rural Bangladesh: a focused ethnography.
abstract: The spread of the highly pathogenic avian influenza (HPAI) H5N1 virus among poultry and humans has raised global concerns and has motivated government and public health organizations to initiate interventions to prevent the transmission of HPAI. In Bangladesh, H5N1 became endemic in poultry and seven human H5N1 cases have been reported since 2007, including one fatality. This study piloted messages to increase awareness about avian influenza and its prevention in two rural communities, and explored change in villagers' awareness and behaviors attributable to the intervention.
  
  
  
  During 2009-10, a research team implemented the study in two rural villages in two districts of Bangladesh. The team used a focused ethnographic approach for data collection, including informal interviews and observations to provide detailed contextual information about community response to a newly emerging disease. They collected pre-intervention qualitative data for one month. Then another team disseminated preventive messages focused on safe slaughtering methods, through courtyard meetings and affixed posters in every household. After dissemination, the research team collected post-intervention data for one month.
  
  
  
  More villagers reported hearing about 'bird flu' after the intervention compared to before the intervention. After the intervention, villagers commonly recalled changes in the color of combs and shanks of poultry as signs of avian influenza, and perceived zoonotic transmission of avian influenza through direct contact and through inhalation. Consequently the villagers valued covering the nose and mouth while handling sick and dead poultry as a preventive measure. Nevertheless, the team did not observe noticeable change in villagers' behavior after the intervention. Villagers reported not following the recommended behaviors because of the perceived absence of avian influenza in their flocks, low risk of avian influenza, cost, inconvenience, personal discomfort, fear of being rebuked or ridiculed, and doubt about the necessity of the intervention.
  
  
  
  The villagers' awareness about avian influenza improved after the intervention, however, the intervention did not result in any measurable improvement in preventive behaviors. Low cost approaches that promote financial benefits and minimize personal discomfort should be developed and piloted.
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. nadiarimi@icddrb.org.
authors.forename: Nadia Ali
authors.initials: NA
authors.lastname: Rimi
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Sultana
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Kazi
authors.initials: K
authors.lastname: Ishtiak-Ahmed
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Md Zahidur
authors.initials: MZ
authors.lastname: Rahman
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Marufa
authors.initials: M
authors.lastname: Hasin
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: M Saiful
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.|Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Nazmun
authors.initials: N
authors.lastname: Nahar
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.affiliation: Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.|Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.|Stanford University, Stanford, CA, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D000884:Anthropology, Cultural; D001364:Awareness; D001459:Bangladesh / Q000453:epidemiology; D003142:Communication; D004644:Emotions; D019353:Endemic Diseases; D005260:Female; D015438:Health Behavior; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D005585:Influenza in Birds / Q000635:transmission* / Q000821:virology; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D008297:Male; D009042:Motivation; D011200:Poultry / Q000821:virology*; D015980:Public Health Practice; D012306:Risk; D012309:Risk-Taking; D012424:Rural Population
keywords: Avian influenza; Backyard poultry; Bangladesh; Behavior change intervention; Focused ethnography