Knowledge and attitudes of veterinarians with regard to pain and welfare in cats: an educational intervention
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Date
17/12/2021Author
Zaini, Syamira Syazuana binti
Metadata
Abstract
Freedom from pain is a key component of animal welfare, and treatment
depends on its effective recognition. Since veterinarians play an important role
in alleviating animal pain, they must be equipped with the knowledge and
ability to recognise and treat painful conditions. In addition, it has been
suggested that individuals’ attitudes and knowledge may influence how they
manage and treat pain in animals. In this work, knowledge is defined as (i)
knowing what, (ii) knowing how and (iii) knowing when and why to do a certain
action. Attitudes involve beliefs or ideas associated with a particular
psychological object. In this thesis, I aimed (i) to survey veterinarians’ attitudes
and knowledge with regard to cat pain and welfare (i.e. using a set of
questionnaires), (ii) to explore barriers experienced by veterinarians when
trying to achieve good post-operative cat management in practices, (iii) to use
findings from (i) and (ii) to develop an educational intervention, and (iv) to test
the efficacy of that educational intervention among veterinarians. In order to
gather data relating to attitudes and knowledge of veterinarians with regard to
cat pain and welfare, a set of quantitative questionnaires were designed and
distributed to the UK and Malaysian veterinarians. To validate the results
gathered from the questionnaire in Malaysia, data from direct observation in
practices was collected. Although Malaysian veterinarians’ attitudes towards
pain in cats were good, the behaviours in practice raised welfare concerns.
Results from both the questionnaire and direct observation then suggested a
follow-up study aimed to explore barriers experienced by Malaysian
veterinarians to use good post-operative management in their practice. Basic
barrier types were assessed by quantitative questionnaire, with more data
richness being gathered using qualitative semi-structured interviews. Findings
from quantitative surveys, the natural data collection and the qualitative
interviews were used to inform the choice of behavioural theory that aimed to
develop a behaviour change intervention study, the Health Action Process
Approach (HAPA) based questionnaire and video intervention. Further testing
of the efficacy of the video intervention which aimed to understand the process
of human behaviour change were performed using a HAPA-based quantitative
questionnaire plus direct observation in practice (i.e. to validate the
respondents’ responses).
In Chapter 2, a questionnaire showed that Malaysian and UK veterinarians
demonstrate similar levels of concern about pain management in cats. In both
countries, there is good awareness of the impact of pain on cats’ welfare and
the possible treatment options. 98.2% UK and 87.1% Malaysian veterinarians
agreed or strongly agreed with the statement ‘Pain compromises the quality of
a cat’s life’. However, questionnaire results do not always correspond to what
is happening in practice. Subsequent observations of practice in Malaysia and
the UK demonstrated differences in the levels of care for post-operative cats.
There was a significant gap in the uptake of optimal cat care (i.e. basic
environmental resources provided to cat patients. Cage criteria recommended
by https://catfriendlyclinic.org/) into Malaysian practices even though research
has demonstrated that environmental management in veterinary practices is
crucial for cat welfare. However, this gap could be partly due to the availability
of learning resources which are mainly in English and predominantly
developed in the ‘West’ and partly due to education or awareness not
dispersing from other Asian countries. For example, this research found that
Malaysian cats were often being housed with little comfort post-operatively
(e.g. bedding, litter trays, hiding places), suggesting that cat patients may
experience discomfort due to increase postural changes. This may be
suggestive of stress, and could, in turn, lead to a misinterpretation of
behavioural indicators of pain.
There may be many factors that contribute to poor post-operative
environments. In Chapter 3, a mixed-methods approach (i.e. questionnaire
and semi-structured interview) investigated what barriers Malaysian
veterinarians experienced in providing good post-operative cat care in
practices. Results from the mixed-method study revealed that apart from the
cost constraints experienced by veterinarians, a lack of practice management
skills (i.e. skills dealing with how to have an efficient managerial system that
can be applied in practices, for a practice that had insufficient staff, time and
resources) was the other main reason for not providing better post-operative
recovery environments for cats. They also recognised that comfortable post-operative environments help recovery, but they did not describe the
relationship between reduced stress and pain assessment. Thus suggesting
that participants might hold a lower significance for using or providing
environmental resources for cat patients. This was because participants’
understanding of the use of bedding only focused on the comfort and safety
purposes. Participants did not offer critical awareness relating to the ‘why’ or
the potential relationships between providing comfort and a safe place with
reduced stress in cats. A number of previous studies have indicated positive
correlations between reducing environmental stress and pain assessment
scoring ability - i.e. if the subject is relaxed it is easier to score their pain. The
majority of these studies come from human clinical settings, but due to the
similarity in stress and pain physiology and behaviour seen in mammals, one
would expect to see a similar relationship in cats. In fact, as many of the
behaviours associated with stress in cats could also be used in pain
assessment, it is vital that veterinarians can tell the difference. Therefore,
minimizing the development of negative emotions, for example, through
environmental management should be prioritized in order to reduce the
likelihood that such negative emotions override or modulate the pain
behaviours. Therefore, findings from these studies (Chapter 2 and 3) assisted
in developing an educational intervention which aimed to illustrate cost-effective ways to promote good cat welfare in the clinic.
Moreover, the mixed-method study in Chapter 3 concluded that attitudes and
knowledge might not fully contribute to behavioural action development without
the contribution of social cognitive variables such as action planning and self-efficacy. In Chapter 4, the Health Action Process Approach (HAPA) theory
used in health psychology, including aspects of both planning and self-efficacy
was applied to understand both the current behaviour and behaviour changes
among Malaysian veterinarians regarding the provision of comfortable bedding
to post-operative cats. HAPA-based questionnaires were developed and used
in three different time frames (i.e. Motivational phase, Pre-action phase and
Actional phase). In Chapter 5, the Behaviour Change Wheel (BCW) framework
was used to guide the development of this video intervention. BCW is a new
2011 behaviour model that comprises the following functions: (i) Capability (C),
(ii) Opportunity (O) and (iii) Motivation (M). These three functions are needed
for developing or influencing Behaviour (B). This framework identifies which of
the possible psychological determinants need to be changed before the
intervention function for the development of an educational intervention can be
selected. The BCW framework was applied to current research findings
(Chapter 2 and 3), to produce guidance for developing a video-based
educational intervention entitled ‘How to have good post-operative cat
management in practices’. In Chapter 6, the HAPA questionnaires identified
three different behavioural stages: Actors (who always provided bedding to
post-operative cats), Intenders (who provided bedding inconsistently) and
Non-intenders (who did not provide bedding). Most Actors completely agreed
with all social cognitive variables statements (e.g. risk assessment, outcome
expectancy, self-efficacy, action planning, and self-monitoring) compared with
Intender and Non-intenders who did not always agree.
Although the HAPA theory was a useful tool for understanding the intention
behaviour gap, HAPA was limited in developing our understanding about the
connection between Pre-action (i.e. after a participant has developed intention
to provide bedding to post-operative cats) to Actional phase (i.e. participants
that already provide bedding to post-operative cats). This suggests that there
is a possible gap in the application of HAPA theory in investigating other
underlying factors such as habit (i.e. the unconscious processes that are
behind the repeating or routine behaviour that normally happens in a situation-specific manner). Although my current research attempted to incorporate the
role of emotion (i.e. an unconscious process involving strong feelings deriving
from one’s circumstances) in predicting the behaviour of providing bedding to
post-operative cats in the HAPA-questionnaire, this was insufficient to show
the involvement of emotions in providing bedding to post-operative cats. One
possible reason could be due to the low sensitivity of the scale to show
increased or significant effects. Although the empathy scale in the present
study was reliable and internally consistent, it was not specific enough to help
predict the behaviour. In addition, it could be that the sample size in the present
study was too small. Thus, reevaluating the usefulness of the empathy scale
using a larger sample size in future research is suggested.
In conclusion, this research study provides a better understanding of the
attitudes and knowledge of Malaysian veterinarians with regard to cat pain and
welfare. Additionally, this research also provides better insights into the
barriers that contribute to the development of human behavioural issues (e.g.
a lack of post-operative cat care management). All of this information has
facilitated the design and implementation of a video educational intervention.
The intervention shows the feasibility of using behavioural science (i.e. using
any of various disciplines such as sociology, psychology and others in dealing
with the subject of human actions) to improve cat welfare in practices. Future
animal welfare studies could benefit from adapting this approach.
Some limitations were noted in the current study. For example, as mentioned
above, the HAPA framework used in the current study was limited in its ability
to fully explain the unconscious social-cognitive factors (e.g. habit and
emotion). This is because in order to change to the targeted behaviour, one
should consider both conscious and unconscious social-cognitive factors in
order to achieve a successful behaviour change. Future studies should attempt
to gain a thorough understanding of both the original behaviour and the
participants in order to choose the best theory for designing the interventions.
In addition, the current study only managed to test the efficacy of intervention
among veterinarians, thus further, refined and validated the current
measurement scales (i.e. HAPA questionnaires) and video intervention could
be considered to be conducted among other relevant stakeholders (e.g.
veterinary nurses, veterinary students). Plus, using other targetted populations
could potentially reduce the risk of survey fatigue among veterinarians and limit
the over-use of similar target participants in future.