To report or not to report: a psychosocial investigation aimed at improving early detection of avian influenza outbreaks.

The aim of this study was to identify difficulties and barriers to reporting clinically suspect situations, possibly caused by avian influenza (AI), and to explore possible incentives to reporting such situations, with the ultimate aim of facilitating early detection of AI outbreaks. Focus group sessions were held with policy-makers from the competent authority, representatives of veterinary practitioners and poultry farmers. Personal interviews with a group of poultry farmers and practitioners were held to ascertain the difficulties and barriers they perceived and their proposed solutions. An electronic questionnaire was put on the websites of a poultry farmer union and the Royal Dutch Veterinary Association to investigate perceptions and attitudes concerning AI-suspect situations in The Netherlands. Six themes emerged identifying factors that hinder the reporting of a clinically suspect situation: lack of knowledge and uncertainty about clinical signs of AI; guilt, shame and prejudice; negative opinion of control measures; dissatisfaction with post-reporting procedures; lack of trust in veterinary authorities; lack of transparency in reporting procedures and uncertainty about the notification process. Recommendations to facilitate early detection of AI are discussed.