DSpace at VNU: An Exploration of How Perceptions of the Risk of Avian Influenza in Poultry Relate to Urbanization in Vietnam

EcoHealth
DOI: 10.1007/s10393-014-0906-2

Ó 2014 International Association for Ecology and Health

Original Contribution

An Exploration of How Perceptions of the Risk of Avian
Influenza in Poultry Relate to Urbanization in Vietnam
Melissa L. Finucane,1,2 Tuyen Nghiem,3 Sumeet Saksena,1 Lam Nguyen,4 Jefferson Fox,1
James H. Spencer,5 and Trinh Dinh Thau4
1

East-West Center, 1601 East-West Rd, Honolulu, HI 96848
RAND Corporation, 4570 Fifth Ave, Pittsburgh, PA 15213
3
Vietnam National University, Hanoi, Vietnam
4
Hanoi University of Agriculture, Hanoi, Vietnam
5
Clemson University, Clemson, SC 29634
2

Abstract: This research examined how perceptions of outbreaks of highly pathogenic avian influenza (HPAI)
subtype H5N1 in poultry are related to urbanization. Via in-depth interviews with village leaders, household
farmers, and large farm operators in modern, transitional, and traditional communes in the north of Vietnam,
we explored behaviors, attitudes, cultural values, and traditions that might amplify or attenuate HPAI outbreaks. We also explored conceptualizations of urbanization and its impacts on animal husbandry and disease
outbreaks. Qualitative theme analyses identified the key impacts, factors related to HPAI outbreaks, and disease
prevention and management strategies. The analyses also highlighted how urbanization improves some aspects
of life (e.g., food security, family wealth and health, more employment opportunities, and improved infrastructure), but simultaneously poses significant challenges for poultry farming and disease management.
Awareness of qualitative aspects of HPAI risk perceptions and behaviors and how they vary with urbanization

processes may help to improve the prevention and management of emerging infectious diseases.
Keywords: risk perception, urbanization, avian influenza, HPAI, poultry, Vietnam

INTRODUCTION
Highly pathogenic avian influenza (HPAI) subtype H5N1
emerged in Southeast Asia in 2003, with repeated outbreaks
causing poultry and economic losses on a large scale.
Anthropogenic and ecological studies suggest that the spread
of HPAI may be related to the ongoing process of replacing
traditional farming methods (e.g., multispecies livestock
husbandry) with industrial, mass-production-oriented

Correspondence to: Melissa L. Finucane, e-mail: Melissa.Finucane@EastWestCenter.
org

operations (e.g., Mallin and Cahoon 2003); especially when
the number of poultry houses and other connected establishments increases without proper planning (Capua and
Marangon 2000). Opportunities for disease transmission
increase with industrial poultry production because of increases in livestock pools, intensive rearing of multiple species, and semi-vertical integration systems where, for instance
feed trucks, abattoir delivery, and other vehicles, may visit
several farms daily (Dent et al. 2008). Gilbert et al. (2008)
demonstrated that a few key factors, such as human population density, rice cropping intensity, and poultry density,
explain a large proportion of the spatial variation in HPAI


Melissa L. Finucane et al.

disease risk. The same study also highlighted that a considerable variation remains unexplained and factors, such as
poultry production, marketing systems, or other dimensions
of human behavior, should be considered.

Only a few studies have examined the perceived risk of
HPAI in poultry. Studies in Thailand (Takeuchi 2006), Laos
(Barennes et al. 2007), and Cambodia (Ly et al. 2007) suggest
that few people are aware of HPAI symptoms in poultry and
that many think it is unlikely to occur in their flocks. Few
people report that they would notify authorities of poultry
deaths, despite believing that it is important to report the
deaths. The most common reasons for non-reporting include
lack of knowledge about or inaccessibility of the reporting
procedure, fears of culling, and fears of being unable to sell the
remaining poultry. The above studies were sampled from
areas reflecting different levels of urbanization but did not
report differences among urban, semi-urban, and rural subsamples, even though the level of urbanization may be related
to avian influenza outbreaks (Spencer 2013). Thus, we do not
know (1) whether perceived risk varies with levels of urbanization and (2) how people conceptualize urbanization and its
impacts on animal husbandry and disease outbreaks.
Vietnam provides an excellent site for this research because
as a result of its rapidly growing economy (5% GDP real growth
rate for 2012; Central Intelligence Agency 2013) it is experiencing rapid environmental transformations. Urbanization in
Vietnam has substantially changed farmers’ interactions with
natural systems. For example, transportation has become
motorized, increasing the potential for disease to spread further
and more easily from one farm or commune to another via
feces on moped or truck tires. Understanding perceptions of
urbanization and its relationship with HPAI outbreaks in
poultry is important because urbanization and the resulting
infrastructure create a filter which distances people from the
environment and affects their ability to perceive changes in
natural resources (Lilian et al. 2007). Failing to perceive change
potentially threatens a community’s ability to respond appropriately. To fill the gap in knowledge about whether and how

HPAI outbreaks are related to urbanization, we conducted two
exploratory studies with village leaders, household farmers, and
large farm operators in the north of Vietnam.

METHODS
Research Design
A qualitative research design was used to allow participants
to describe beliefs and experiences about HPAI in poultry

and urbanization in their own words, rather than as a
choice between the predetermined survey responses
(Morgan 1998; O’Brien 1993; Pope and Mays 1995). We
established sampling frames (see below) that included traditional settings (customary agricultural practices, housing,
and water sources), modern settings (agricultural modernization, industrial cities, and modern water sources),
and transitional settings (a mix of traditional and modern
agricultural practices, housing, and water sources). The
variables we used to identify these settings were reported
previously as metrics of urbanization potentially associated
with outbreaks of HPAI in poultry (e.g., Spencer 2013;
Pfieffer et al. 2007; Fang et al. 2008; Gilbert et al. 2008).

Participants
For both Studies 1 and 2, a research assistant from Hanoi
University of Agriculture arranged permissions and
scheduled people to attend the interviews. Individuals were
recruited using a purposive sampling technique with the
goal of obtaining diverse samples regarding age, gender,
and farming activities. Participants were informed about
the purpose of the study, the nature of the questions, and
that they could refuse to answer questions or withdraw

from the study at any time. Each participant was paid
30,000–200,000 VND (approximately $1.44–$9.60 USD) to
compensate for their time and travel expenses.
The sample for Study 1 included 43 people recruited
from four communes1 in Bac Ninh Province, Vietnam. The
communes were selected as representative of different levels
of urbanization based on an index of water source coherence (Spencer 2013) calculated from variables in the 1999
Vietnam census. The index reflects the amount of ‘‘mixing’’
of different types of household-level water supply (well,
rain, bottled, or surface water). Table 1 shows the demographics and other characteristics of the sample.
To identify participants for Study 2, we created a
sampling frame using the 2006 Vietnam agricultural census
following the methods developed by Saksena et al. (2013).
All the communes were classified into three groups
reflecting different levels of urbanization (traditional,
transitional, or modern) using hierarchical cluster analysis
with the following criteria: (1) percent of houses whose
main income is from agricultural, fishing, or forestry
activities and (2) percent of houses that have a modern
1

The smallest administrative unit in Vietnam is usually the commune, but in more

urban areas they may be called a ward or town.


Perceived Risk of AI in Poultry and Urbanization in Vietnam

Table 1. Study 1 Participant Characteristics (n = 43).

Table 1. continued

Commune, Province (urbanization level), n (%)
Thai Bao, Bac Ninh (modern)
14 (32.6)
Quang Pho Thanh, Bac Ninh (transitional)
15 (34.9)
Ninh Xa, Bac Ninh (transitional)
10 (23.3)
Dai Dong, Bac Ninh (traditional)
4 (9.3)
Participant type, n (%)
Village leader
15 (34.9)
Household farmer
13 (30.2)
Large farm operator
15 (34.9)
Gender, n (%)
Male
32 (74.4)
Female
11 (25.6)
Age, years, range (mean)
29–61 (46.57)
Ethnicity, n (%)
Kinh
43 (100)
Education, n (%)
High school or less

27 (62.8)
Vocational school or some college
11 (25.6)
Completed 4-year college or more
5 (11.6)
No response
2 (4.7)
Primary profession, n (%)
Manager/Deputy Manager
3 (7.0)
Professional (e.g., lawyer, doctor, teacher)
1 (2.3)
Industrial worker
1 (2.3)
Agricultural laborer
31 (72.1)
Retired
2 (4.7)
Other (Head of Village
2 (4.7)
and Agricultural Extension Officer)
No response
3 (7.0)
Annual household income,
150,000–
VND, range (mean)
300,000,000
(49,335,135)
Housing, n (%)
Solid (concrete walled)

19 (44.2)
Semisolid (bamboo or concrete)
6 (14.0)
Wood frame with cottage roof
11 (25.6)
(bamboo, thatch)
Temporary one-floor house
5 (11.6)
Two- or three-floor strong house
2 (4.7)
Type of latrine, n (%)
Household septic latrine
31 (72.1)
Pour-flush filtered latrine
2 (4.7)
Eco-latrine
1 (2.3)
Ventilated improved pit latrine
8 (18.6)
Other latrine
0 (0)
No latrine
0 (0)

No response
1 (2.3)
Main source of fresh water, n (%)
Tap water
3 (7.0)
Purchased water (tank, jar, bottle, etc.)

0 (0)
Rain water
16 (37.2)
Drilled well water
24 (55.8)
Constructed well water
0 (0)
Other well water
0 (0)
River, lake, pond water
0 (0)
Spring water
0 (0)
Other sources
0 (0)
Animals farmed in the previous 12 months,
(n participants raising animal),
livestock count range (mean)
Chicken (n = 36)
5–10,000 (972.6)
Duck (n = 17)
4–2,000 (181.6)
Other bird (n = 3)
10–1,200 (28.6)
Pigs (n = 33)
2–200 (33)
Fish (n = 13)
300–30,000 (1757.9)
Other animals (e.g., dog, goose) (n = 4)
1–50 (2.6)

Crops, n farming crop (percent)
Rice
40 (47.1)
Other cereals (e.g., corn)
18 (21.2)
Fruits
7 (8.2)
Vegetables
14 (16.5)
Industrial trees
2 (2.4)
Other crops
4 (4.7)

toilet system. The resulting characteristics of these three
groups are shown in Table 2.
The Study 2 sample included a total of 33 participants
from communes at all the three levels of urbanization, but
with an emphasis on transitional areas because of our
interest in understanding perceptions of change. Table 3
shows the demographics and other characteristics of the
sample.

Materials and Procedures
For both studies, individual and small-group interviews
followed a semi-structured protocol. Study 1 participants
were asked first to comment on their experience of avian
influenza in poultry (e.g., ‘‘Tell me what you know about
avian influenza in birds and how it affects you, your family,

Melissa L. Finucane et al.

Table 2. Characteristics of three groups (traditional, transitional, and modern) of communes.
Type of
commune

Traditional
Transitional
Modern

Percent of houses
whose main income
is from agricultural,
fishing, or forestry
activities

Percent of
houses with
modern toilets

81
53
12

11
56
90

and your community?’’). Then more specific probes asked

about their understanding of risk exposure processes, HPAI
effects, risk assessment and management, and Vietnamese
values and traditions relevant to animal husbandry and
disease management (e.g., ‘‘What role do spiritual beliefs
play in preventing or managing disease outbreaks among
your animals?’’). Study 2 participants were asked to comment on their understanding of ‘‘rural’’ and ‘‘urban’’ (e.g.,
‘‘What does rural mean to you?’’) and how urbanization
affects: the built and natural landscapes, farming practices,
livelihoods, quality of life, waste management systems, and
HPAI in poultry.
The interviews were facilitated jointly by the first author (asking questions in English) and the second author
(translating questions and responses). During individual
and small-group interviews, the facilitators and two assistants recorded by hand the information about participants’
remarks and nonverbal responses. Audio recordings were
not made because the topic was deemed too sensitive. Each
interview took 1–2 h.
For Study 1, nine small-group interviews (with 3–6
individuals per group) were held with 43 participants over
3 days (May 25–27, 2010) in meeting rooms at the commune headquarters of each of the three communes in Bac
Ninh Province: Thai Bao (Day 1), Quang Pho Thanh (Day
2), and Ninh Xa (Day 3). Three groups were interviewed
each day. One group comprised village leaders, one group
comprised household farmers, and one group comprised
large farm operators.
For Study 2, three small-group interviews (with 5–12
individuals per group) were held with 23 participants over
3 days (July 25–27, 2011) at each of the three communes in
Quang Ninh Province: Viet Hung (Day 1), Bang Ca (Day
2), and Cam Tay (Day 3). Two groups were held in meeting

rooms at the commune headquarters and one was held at a
farmer’s house. Individual interviews were held with ten
participants.

Data Analysis
For Study 1, qualitative theme analysis (Bernard and Ryan
1998; Crabtree and Miller 1999) using ATLAS.ti (version 5)
was used to distinguish the salient constructs and to
identify words commonly used to describe attitudes and
experiences. Following the guidelines presented by Fereday
and Muir-Cochrane (2006), the coding template was
developed using a hybrid of the data-driven inductive approach of Boyatzis (1998) and the deductive a priori template of codes approach outlined by Crabtree and Miller
(1999). Core themes that repeatedly appeared in notes of
the interview discussions were identified by the lead author
and confirmed by a research assistant. Consensus was
achieved via discussion. For Study 2, the key-words-incontext technique (Tesch 1990) was used to find instances
of key words in field notes. Themes were then identified by
sorting the examples into groups of similar meaning,
retaining information about the sources of the examples.
Given that this research focused largely on identifying
perceptions that do not necessarily have a correct answer,
respondents’ trustworthiness was assessed by asking
knowledgeable locals (e.g., village veterinarian) or members
of the local research team to corroborate the plausibility of
responses. Confirmability was assessed, where possible, by
asking respondents to verify some statements (e.g., that
there is no place to take dead animals) via a tour of their
vicinity. Credibility was assessed frequently during interviews by checking respondents’ agreement with paraphrasings of their comments.

FINDINGS

Study 1: HPAI Risk Perceptions
Key Impacts
Overall, participants were very concerned about HPAI
outbreaks, referring to the disease as an ‘‘epidemic,’’ ‘‘a
scary disease,’’ ‘‘a big worry,’’ and ‘‘very dangerous,’’ particularly because of the relatively high fatality rate of HPAI
in poultry. One participant described the death of chickens
from HPAI as ‘‘equal to robbing because it takes away our


Perceived Risk of AI in Poultry and Urbanization in Vietnam

Table 3. Study 2 Participant Characteristics (n = 33)
Commune, Province (urbanization level), n (%)
Mo Lao, Ha Dong (modern)
1 (3.0)
Cam Tay, Quang Ninh (modern)
8 (24.2)
Viet Hung, Quang Ninh (transitional)
13 (39.4)
Phu Luong, Ha Dong (transitional)
1 (3.0)
Quoc Oai, Ha Tay (transitional)
1 (3.0)
Phung Xa, Thach That (transitional)
2 (6.1)
Bang Ca, Quang Ninh (traditional)
7 (21.2)
Participant type, n (%)
Village leader
3 (9.1)

Household farmer
30 (90.9)
Gender, n (%)
Male
11 (33.3)
Female
22 (66.7)
Age, years, range (mean) (n = 29)
25–69 (47.9)
Ethnicity, n (%)
Kinh
23 (69.7)
Dao
7 (21.2)
No response
3 (9.1)
Education, n (%)
High school or less
26 (78.8)
Vocational school or some college
3 (9.1)
Completed 4-year college or more
0 (0)
No response
4 (12.1)
Primary profession, n (%)
Agricultural laborer
14 (42.4)
Non-agricultural wage laborer
3 (9.1)

Manager/Deputy Manager
1 (3.0)
Professional (e.g., lawyer, doctor, teacher)
0 (0)
Retired
1 (3.0)
Other (e.g., student, homemaker)
8 (24.2)
No response
6 (18.2)
Annual household income,
10,000,000–
VND, range (mean) (n = 22)
168,000,000
(49,154,545)

livelihood with no warning or reason.’’ Participants from
all the communes agreed that the most worrisome aspect of
HPAI was at the household level when substantial investments and their main income source were lost.

Factors Related to HPAI Outbreaks
Modernization and Pollution Participants varied in the
factors they emphasized as important in the spread of
HPAI in poultry, but many focused on the process of

modernization and associated increase in pollution problems. Participants from all the communes observed that
rapid population increase and economic development had
a detrimental impact on their environment. The increased
volume of waste from livestock and household garbage,
which was perceived to be poorly managed and hard to

control, was viewed as a key source of air, land, and water
pollution (e.g., dead chickens are thrown onto the street or
into fish ponds). Many participants noted the importance
of keeping a clean farm to prevent disease. One participant
(from a transitional commune) indicated that he kept his
farm clean; but that he could not control the whole system,
which he observed to be increasingly interdependent. Participants from the traditional commune emphasized the
role of transportation in spreading the virus (e.g., trucks
spread disease via their tires when transporting feed and
international movement of livestock).
Farming Practices The trade-offs of new versus old
farming practices were emphasized. For instance, some
participants (modern commune) commented that the new,
industrial way is good because ‘‘the feed is more relaxing’’
(i.e., farmers do not have to collect or prepare the feed) and
the livestock have more economic value. However, they
also noted that the industrial feed may use too many
chemicals, be moldy, or cause chickens to put on weight
too fast, causing the livestock to be more prone to disease.
Farm Size Participants had differing opinions on the role
of the farm size. Some participants (modern and transitional communes) tended to believe that small and large
operations were equally likely to experience an outbreak of
disease. Some participants in transitional communes,
however, emphasized that the high-volume farming operations caused environmental problems because the chicken
density was too high and that small-scale operations posed
fewer problems. Others noted that large operators were
more cautious and thus more likely to vaccinate their
livestock, but that small-scale farmers were more able to
check each chicken and to detect a problem early.
Poultry Varieties Most participants agreed that traditional

Vietnamese chickens have a higher resistance (and do not
require much care) than industrial broiler or layer chickens,
but that the latter were more profitable. Some noted that
compared with broiler chickens, layer chickens were
probably less vulnerable because they were kept on a high
floor (for easy egg retrieval).


Melissa L. Finucane et al.

Seasonal Variation Most participants noted that outbreaks were more likely around Teˆt, the Vietnamese New
Year, which usually falls in the western calendar months of
January or February and is a period when more chickens
are raised and exposure is more likely. One participant
noted that the powder of xoan (Melia azedarach) flower
(which flowers in spring) causes HPAI.
Wild Birds When asked about the role of wild birds, some
said that they had heard about this issue in the media, but
thought it was unlikely to be an important factor because of
a lack of wild birds in their area (in part because villagers
shoot them). Others suggested that wild birds may play a
role in disease outbreaks.
Disease Management Strategies
Vaccination Vaccination was generally thought to be
effective, though problematic when poultry are already sick.
Some participants from the traditional commune indicated
that they might not buy the vaccine until their poultry was
sick because it was too expensive. Both the household
farmers and large operators in transitional and traditional
communes expressed reservations about vaccine effectiveness. Some participants stressed the problems in obtaining

high-quality vaccines (e.g., distributors might dilute it, not
keep it cool during transportation, or sell expired bottles)
and that the availability of too many brands of unknown
quality was confusing.
Waste and Disease Management Systems Participants discussed the need for better waste and disease management
systems. Several noted that there was no place to take dead
animals (so they were buried in the paddy fields near the
communes with lime) and there was little systematic guidance about how to deal with waste or disease. One participant
in a transitional commune stressed that there was noone to
identify and quarantine the source of an outbreak and that
sometimes quarantine restrictions were implemented too
late. One participant (modern commune) observed that
people do not always report poultry deaths. Another participant (transitional commune) stressed that reporting
deaths brought little extra support. Some participants indicated that they were not willing to make reports because they
did not want to precipitate in new culling campaigns.
Uncertainty, Knowledge, and Training In general, participants expressed a desire for more knowledge and training

about disease management options and more consultation
opportunities (e.g., about which vaccine to use). One
participant (transitional commune) suggested that an early
warning system would be helpful (e.g., providing forecasts
about when each province will be most likely to experience
an outbreak). Others reflected on the importance of mass
media (television and newspapers) as a source of information about HPAI origins and impacts.
Support Systems Key sources of support for understanding and managing HPAI included village veterinarians,
village leaders, and faculty at the Hanoi University of
Agriculture. When asked about the role of spirituality,
some participants said it did not play an important role in
disease management, but others noted that they thought it
was important to put food on their altars or to pray

internally to ask their ancestors for good health and production.
Figure 1 schematically depicts these qualitative themes
and their relationships as described in the interview discussions.

Study 2: Perceptions of Urbanization and its
Impacts
Characteristics of Rural and Urban Settings
Participants from all the communes agreed that the key
characteristics of a rural setting include: good or supportive, sharing relationships and emotional ties among residents; a feeling of coolness and clean, pure air; and
agricultural activities (using the land for farming to produce food and raise livestock). They also noted that rural
houses were spacious with old-style (pit) toilets. In contrast, key characteristics of an urban setting include: weaker
emotional ties among residents; large-scale industrial
development; better quality houses with more furniture; a
closed sewage system; piped water for cooking; less space
(e.g., to raise children); and more closed doors and private
spaces. Participants noted that income in urban areas
typically comes from trading and selling services, that there
are a lot of jobs, and that it is easier to make money.
Process of Urbanization
Participants from the traditional commune of Bang Ca said
that the process of urbanization had been mostly worth-


Perceived Risk of AI in Poultry and Urbanization in Vietnam

Figure 1. A mental model of highly pathogenic avian influenza (HPAI) outbreaks as reflected in interview discussions with village leaders,
household farmers, and large farm operators in modern, transitional, and traditional communes in Bac Ninh Province, Vietnam.

while, but that it came with both positive and negative
aspects (e.g., the modernization of agriculture increased the

spraying of chemicals to improve crop productivity but
posed a human health risk). Participants in the traditional
settings noted that there has been no change in the type of
toilets or home gardens, but that forested areas have decreased (the land is being used for roads, houses, and
mines) and environmental pollution has increased. One
man noted that the environment was ‘‘cooler’’ in the past
when their houses were made from wood (rather than cement) and were placed lower in the valley (rather than
higher up the hillside). Residents in the traditional areas
can now take advantage of more and different (nonfarm)
income sources (e.g., making baskets), but some people still
did not have enough money to cover the basic living expenses. They reported that ‘‘civilization is more accessible’’
(e.g., through television, which is available in every house),
but that the traditional customs (praying, ceremonies, and
shamans) remained the same.
Participants in the transitional communes (Viet Hung,
Phu Luong, Quoc Oai, and Phung Xa) noted rapid change
over the past 20 years. They highlighted not only improv-

ing food security and food diversity, but also new environmental and health problems (e.g., pesticides and
diabetes). One female farmer said that urbanization
brought more needs (e.g., her children want to go out for
breakfast instead of staying at home like they used to) and
that it is more difficult to earn money. Another participant
noted that the number and types of houses were changing
(‘‘no more bamboo fences or simple tile roof houses’’) and
that the environment felt ‘‘hotter.’’ Participants described
how land value has decreased because it was rezoned for
industry; but then industries were not developed, leaving
them in ‘‘suspense,’’ not knowing how long they can keep
farming their land. Participants mentioned that there are

more nonfarm income sources and that people now
worked for individuals or households rather than the
cooperative. Despite the negative aspects of transition,
participants generally agreed that transition is worthwhile
because their living standard and well-being has improved
and they have more time to rest.
Participants in the modern communes (Cam Tay and
Ha Dong) thought that in general urbanization is worthwhile, but that sometimes people cannot keep up with a


Melissa L. Finucane et al.

rapid rate or high number of changes. They noted how
urbanization has changed the ‘‘coolness’’ of their environment, primarily by the removal of trees. Other participants reported that the amount and type of housing was
changing in their area (e.g., from thatched or tile roofs to
brick roofs), but not too fast. Every house now has its own
toilet and reliable electricity. Stream flow has decreased so
residents buy trucked water for cooking and use catchment
water for washing. Participants noted that food security has
improved and there is less hardship. Human health is also
better because of improved access to health care and
awareness of disease prevention strategies. Families have
fewer children. Also, relationships among neighbors have
changed, with more private spaces and less visits because
people are spending more time working.

Impact of Urbanization on Poultry and Disease Outbreaks
Participants in the traditional commune reported difficulty
in controlling poultry disease, especially when poultry are
bought from outside the commune and have an unknown

vaccination record. They said that their poultry’s health was
not affected by water pollution or human waste, but was
affected by increasing animal density and chemicals in the
environment. Modern treatments were available to deal
with disease, but there was uncertainty about what is most
effective. One farmer said that they cannot prepare effectively because they do not know what is needed.
In contrast, participants in transitional communes
commented that their ability to raise poultry has improved
because they have more medicines and training from the
government on how to use those medicines and deal with
disease. They reported vaccinating frequently, so their
exposure to disease is less. They felt that it is easier to
quarantine sick animals with the increases in fences and
walls.
Participants in the modern communes noted that
animal and human waste can cause disease, but that it does
not happen in their commune. Air and water pollution
were identified as causing poultry disease. One participant
said that it was easier for poultry to get sick now because
the weather was unstable (changing between extremely hot
to extremely cold) and food is now freely exchanged among
areas (e.g., sickness spreads across the commune easily
when a sick chicken is brought in from another commune).
Animal density was also thought to cause disease because
there was less air for the poultry to breathe.

DISCUSSION
HPAI is Perceived as Risky and Disease Management is Linked with Urbanization Processes
Across the communes, HPAI in poultry was viewed by the
participants as a dangerous epidemic with worrying economic consequences. The role of change in agriculture in

the spread of HPAI was recognized. Both new and old
farming practices were perceived as having advantages and
disadvantages. Participants were sensitive to the roles of
farm size, type of chicken, seasonal variation, and wild
birds in the spread of HPAI. The most prominent disease
management strategies focused on vaccination, quarantine,
and farm and commune hygiene; with calls for better
information and training programs to assist farmers.
These findings are not only consistent with Fielding
et al.’s (2009) description of lay explanations for the cause
of HPAI in humans, but also extend our understanding of
risk mental models to explain the perceived causes of HPAI
in poultry. The present results are consistent with studies
finding a reluctance to report poultry deaths to authorities
because of fears of culling and economic impacts (Barennes
et al. 2007; Ly et al. 2007; Sultana et al. 2012; Takeuchi
2006). However, participants in our study seemed to express more motivation for improving waste and disease
management practices compared with the previous studies.
The results of the present research support the notion
that urbanization changes people’s ability to respond
appropriately to variations in their environment. The
inability to respond is not necessarily because of an
inability to perceive change (cf. Lilian et al. 2007). Rather,
our participants described a rapid and extensive change
that poses different challenges for poultry management as
communes move from rural to transitional to urban settings.

Limitations
The first limitation of this research is that samples were
drawn from people willing and able to participate in a 2-h

interview and may not represent the general population of
farmers in Vietnam in terms of sociodemographic variables
such as age, education, and income. There is also a gender
imbalance in each study, potentially biasing the perspectives obtained toward issues most relevant to the majority
gender. However, the consistency of the findings from this


Perceived Risk of AI in Poultry and Urbanization in Vietnam

study with those reported elsewhere encourages the confidence that many of the observations are generalizable.
A second limitation concerns the small size of samples
in these studies. It is possible that additional information
would have been obtained with a broader sample of individuals. Within this sample, however, we believe that the
questions posed were thoroughly addressed at least by
modern and transitional commune participants because
little new information was obtained in the final interviews.
This phenomenon is called saturation in qualitative research and indicates that a topic has been adequately
sampled (i.e., enough interviews conducted). Another
limitation of the small sample sizes is that they do not
permit statistical differences to be analyzed and thus conclusions are restricted to the descriptive statements elicited.
Finally, the topic of avian influenza is a sensitive issue
that participants may have been reluctant to discuss openly,
especially in a group setting. Other research suggests that
farmers are reluctant to report cases of animal illness because of fears of culling and loss of income (e.g., Sultana
et al. 2012). This is a limitation of most investigations
relying on self-report, but was minimized in the present
research by building good rapport and selecting a diverse
sample to increase the chance of including some more open
participants. Nonetheless, constrained responses limit our
capacity to draw conclusions.

FUTURE DIRECTIONS
The exploratory nature of this research established preliminary
qualitative information about a topic poorly documented to
date, namely how perceptions of HPAI risk in poultry relate to
urbanization in Vietnam. The research findings offer a first step
toward understanding mental models of disease risk and
urbanization in a developing country context. The findings
raise several interesting questions for future research: What
research methods (e.g., anonymous surveys) are effective at
capturing representative perspectives of a sensitive issue in a
rapidly changing environment? How well do risk perceptions
correspond with the actual outbreaks of disease in poultry and
does the relationship vary with setting (traditional, transitional,
modern)? What analytic methods are needed to identify the
components of urbanization that best predict the perceived risk
and the actual outbreaks of avian influenza in poultry?
Addressing these and other questions will help policymakers be
better informed about the optimal risk prevention and management strategies in diverse settings.

ACKNOWLEDGMENTS
The authors are grateful to colleagues at the Hanoi
University of Agriculture for assistance in conducting
interviews; to Boonyarit Itsara and Charles Nguyen for
assistance in verifying and analyzing data. The authors also
thank Michael DiGregorio, Nancy Lewis, and Bruce Wilcox
for assistance in developing the interview protocol. This
work was funded by the National Science Foundation
Grant # DEB-0909410.

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