Effects of a Specific Workshop on the Beliefs and Perceptions on Zoonosis of the Veterinary Students: A First Pilot Longitudinal Study

Zoonoses represent 60% of the diseases affecting humans and 75% of emerging diseases [1]. They represent a major threat in public health and their socio-economic impact are important as illustrated by the 2020 pandemic of COVID-19 which has severely affected the economy and the social lives of the population worldwide. Zoonoses prevention relies mainly on biosecurity measures which should be emphasized at the interface of animals, humans and environment. The veterinary professionals are more likely to be exposed to these pathogen agents [2] and the veterinary students appear to be exposed early in their education [3,4]. Despite these findings, different studies reported a generally low level of implementation of the biosecurity measures (BSM) by the veterinary professionals [5,6]. According to the Health Belief Model (HBM), the intention to implement a given behaviour is determined by 5 mental constructs:


Survey Design and Implementation
In order to raise awareness of the veterinary students on the zoonotic risks and the biosecurity measures to implement, a specific workshop on zoonosis was developed. It was designed as case studies to be presented by the student on different zoonotic diseases affecting different species in order to promote self-reflection and exchanges among small groups of 10 to 16 students from end of September 2019 to April 2020. A longitudinal study was carried on and the data was collected by an on-line survey developed with Lime Survey, an open-source web application. The questionnaire was directed to veterinary students in Master two or three (Appendix A) registered for the paraclinics seminars under which the workshop on zoonoses was to be delivered. The students' survey was conducted twice: once before the workshops (from September 2019 up to end of May 2020) and a second time at the end of the academic year (from June up to end of July 2020). The invitations to fill in the first survey were sent on a monthly basis to the students through the mailing lists of the Students' Office after approval of the Dean of the Faculty of Veterinary Medicine. Specific reminders were also sent to the different student groups about 10 days before their workshop on the zoonosis in order to increase the answer rate for the first survey. For the second survey, the invitations were sent in May, June and July (just after the examination session).
In the first survey, different questions were asked to assess the different components of the different HBM constructs and the level of implementation of the BSMs by the respondent [8]. Existing HBM guidelines [9,10] and questionnaires [11][12][13][14][15] were used in order to develop the different questions related to the HBM constructs which were mainly assessed indirectly by asking the respondents their degree of agreement (0: fully disagree and 100: fully agree) with different statements at the exception of the perceived benefits of the different BSMs which were assessed by a direct question [8]. The second survey included only the questions related to the HBM constructs as well as some questions related to the eventual practical experience acquired in between ( perception was therefore expected. The student's identification number was used to pair the data and to control that the student did benefits from the workshop on zoonosis between the 2 surveys and to analyze whether the training workshops that they attended did change their beliefs and perceptions regarding the zoonotic risks and the ways to prevent them. Table 1: List of statements used to assess the different Health Belief Model constructs by asking the respondent their degree of agreement through a visual analogue scale [8].

Susceptibility
According to me, veterinary practitioners are very frequently exposed to zoonotic infectious diseases According to me, zoonotic infectious diseases represent a major risk for veterinary practitioners

Statistical Analysis
The data originating from completed questionnaires were

Results
The longitudinal study was implemented as planned in order to capture the student beliefs and perceptions before the workshop.     It would have been interesting to monitor the changes of perceptions and behaviors throughout the year instead of running only two surveys (one at the beginning and one at the end) in order to better capture the eventual changes over time, their duration and the events which could have determined these changes (e.g. internships). It also appear that a 2 hours workshop although judged really interesting and bringing a real added value (unpublished data on the students' feed-back) might be insufficient and that additional training activities on the topic should be integrated to the veterinary training in the future. As the analysis of the outcomes of the first survey, showed that the BS score was mainly influenced by the zoonoses susceptibility and BSM benefits, the communication materials should emphasize on these two aspects [8]. In addition, the information provided to the students and veterinary professionals should rely on evidence based studies as it appears that most of the time, the decision of the veterinary professionals to either implement or not a BSM is based on the case specific perception of the risks related to the intervention to be performed [8].

Conclusion
The level of implementation of the BSMs aiming at preventing zoonotic diseases by the veterinary practitioners in Belgium should be increased. One of the main strategies identified relies on a better training of the veterinary student on theses aspects. Nevertheless, a 2 hours workshop on the topic did not seem to have any significant influence and was proven inefficient even on a short-term basis. As for most interventional activities aiming at a long-term behaviour change, it is therefore recommended to increase the training sessions on this topic throughout the course as well as to pursue such communications towards the veterinary professionals in the future.

Funding
This research received no external funding.

Informed Consent Statement
Informed consent was obtained from all subjects involved in the study. The data was collected, stored and used in accordance with the GDPR (EU) 2016/679.