Preventing zoonotic influenza H5N1 in human: Pictorial versus literal health communication methods

Abstract

Outbreaks of avian influenza H5N1 in poultry occurred in Africa’s poultry and 16 countries have reported human infections globally. Intensified human-animal interactions necessitate correct communication of health messages to reduce zoonotic infection. This work was done to determine differences between pictorial and literal health education communication. Cross-sectional survey using literal and pictorial questionnaires in LBMs and poultry farms was carried out among respondents based on matching criteria. Responses were scored and analysed with probability of independence using Chi square test and pairwise correlation. The degree of knowledge of clinical signs in birds, species affected, communication means and biosecurity were good, that of the post-mortem signs was poor with increasing potentials of human exposure to virus-rich visceral tissues from slaughtered sick birds. Marked differences exist for the various items listed within each knowledge field, the odds of having correct responses from pictorial were better than with literal respondents. Risky practices were still practised in the LBMs despite the good degree of knowledge of hygiene and biosecurity. Knowledge and implementation does not always correlate and pictorial representation out surpasses literal method in communicating potential zoonotic H5N1 influenza A infection to the undiscerning public.

Full text

87
Introduction
Global food needs, current food insecurity, rapid
urbanisation and the increasing human populations
have fostered industrial agriculture (Graham et al.
2008, Keusch etal. 2009, Alexandratos and Bruinsma
2012) with increased human‑animal interactions,
animal density per unit space and animal disease
occurrence. The surge of animal populations has
accelerated the risk of zoonotic diseases (Herfst
et al. 2012, Gebreyes et al. 2014). Such diseases
have also been associated with wild and domestic
animal populations due to intense human‑animal
interfaces (Cleaveland et al. 2001, Keesing et al.
2010). Because of this complicated but inseparable
interplay between humans and animals, health
policy plans and implementation cannot be carried
out in isolation. Because humans are intricately
involved in the implementation of animal health, the
understanding of the behavioural and emotional
well‑being, knowledge, attitudes and perceptions
of humans (stakeholders in the animal industry) is
important to reduce the burden of diseases (Decker
etal. 2010, Liverani etal. 2013).
1Department of Production Animal Studies, Faculty of Veterinary Science,
University of Pretoria, South, Africa
2Department of Animal Health, Federal College of Animal Health and Production Technology,
Ibadan, Nigeria.
3Department of Epidemiology & Public Health, Faculty of Veterinary & Animal Science,
Sylhet Agricultural University, Sylhet, Bangladesh.
4Department of Farm Animal Health, Utrecht University
5Department of Theriogenology and Animal Production, Faculty of Veterinary Medicine,
Usmanu Danfodiyo University, Sokoto, Nigeria.
6Department of Veterinary Tropical Diseases, University of Pretoria, Onderstepoort 0110, South Africa
7Emergency Centre for Transboundary Animal Diseases-Food and Agriculture Organisation, Gigiri Kenya.
*Corresponding author at: Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria,
Postal Bag X04, Onderstepoort 0110, South Africa.
E-mail: daydupe2003@yahoo.co.uk .
Keywords
Zoonotic inuenza
H5N1,
Communication,
Human health,
Education,
Outbreak.
Summary
Outbreaks of avian inuenza H5N1 occurred in Africa’s poultry and 16 countries have
reported human infections globally. Intensied human‑animal interactions necessitate
correct communication of health messages to reduce zoonotic infection. This work was done
to determine dierences between pictorial and literal health education communication.
Cross‑sectional survey using literal and pictorial questionnaires in live bird markets and
poultry farms was carried out among respondents based on matching criteria. Responses
were scored and analysed with probability of independence using Chi square test and
pairwise correlation. The degree of knowledge of clinical signs in birds, aected species,
communication means and biosecurity were good, that of the post‑mortem signs was poor
with increasing potentials of human exposure to virus‑rich visceral tissues from slaughtered
sick birds. Marked dierences existed for the various items listed within each knowledge eld,
the odds of having correct responses from pictorial were better than with literal respondents.
Risky practices were still practised in the LBMs despite the good degree of knowledge of
hygiene and biosecurity. Knowledge and implementation does not always correlate and
pictorial representation out surpasses literal method in communicating potential zoonotic
H5N1 inuenza A infection to the undiscerning public.
Olubunmi Gabriel Fasanmi1,2, Olumide John Okuneye2, Syed Sayeem Uddin Ahmed3,
Aminu Shittu4,5 and Folorunso Oludayo Fasina6,7*
Preventing zoonotic inuenza H5N1 in human:
pictorial versus literal health communication methods
Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Accepted: 15.02.2017 | Available on line: 31.12.2020

88 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
preventive health in humans. Pictorial translations
of all questions were designed from the literal
document. Pictures were used with permission or
downloaded with appropriate citation for use in
the pictorial questionnaire (Annex 1). Prior to the
administration of questionnaire, relevant clinicians,
pathologist and avian medicine professionals viewed
and cleared the questions and associated pictures.
Pretesting of the questionnaire was conducted
among ten selected pre‑degree non‑veterinary,
medical, biological or agricultural sciences’ students
to assess for clarity, similar meaning, and to check
whether matching criteria was appropriate in the
poultry farms and LBMs. It was believed that such
students’ knowledge cannot bias their responses
(because they have not been exposed to curriculated
veterinary sciences (2nd to 6th years) as was expected
among the general populace.
Recruitment of respondents
Twenty‑ve states and the Federal Capital Territory,
Abuja, have reported previous or current outbreaks
of avian inuenza H5N1 in Nigeria and 11 states
have never experienced or reported outbreaks.
Following these outbreaks, repeated messages of
avian inuenza have been disseminated in poultry
farms, live bird markets, town hall meetings, print
and electronic media. For this survey, a total of
1,692 identied LBMs with a combined daily
capacity of 198,700 birds were recruited as target
population. Using the formula for sample size n
= [DEFF*Np(1‑p)]/ [(d2/Z21‑α/2*(N‑1)+p*(1‑p)],
314 respondents were needed for the survey. We
interviewed 210 farmers and 140 poultry marketers
(total = 350) from seven states in the southern
part of Nigeria using face‑to‑face interviews. All
respondents were matched by level of education
(up to secondary versus post‑secondary; 1:1.5),
size of the farm (≤500, 501‑2000 and ≥ 2001; 1:1)
and volume of sale per day in the LBM (≤100 birds
per day and ≥100 birds per day; 1:1). For purposes
of classication and irrespective of the level of
education, we classied “biomedically semi‑literate”
individuals as persons who may have had some
years of formal education but not in the biomedical
(veterinary, medical, biological and agricultural)
eld. Each respondent was only allowed to ll a
pictorial or literal questionnaire and not both at any
time during the study.
Data coding and statistics
Following the administration and retrieval of
questionnaires from the farms and live bird
markets, all data and information were entered
into Microsoft Excel spreadsheet. Data were
categorised, ltered and coded appropriately for
Since 1997, the majority of human cases have
been conrmed to be linked to direct or indirect
contact with infected live birds in poultry farms or
in live bird markets (Horimoto and Kawaoka 2001,
Wan et al. 2011, Herfst et al. 2012, Bridges et al.
2002, Okoye etal. 2013, Okoye etal. 2014, Mounts
etal. 1999, Nuttal et al. 2012). To date, no evidence
of virus reassortment exists to conrm sustained
human‑human infection (Ungchusak et al. 2005,
Kandun et al. 2006, Wang et al. 2008). However
between 2003 and 2015, the overall case fatality
rate (CFR) for A H5N1 human infections was 62.3%
globally (Fasanmi etal. 2016).
Since the beginning of avian inuenza H5N1
pandemics in poultry, communication has been
intensied in Asia, Europe and African countries
and calls for intense inter‑sectoral communications
have been made to reduce spread (Breiman et al.
2007). Many international organizations and donor
agencies have been involved and millions of dollars
have been spent in communication and targeted
socio‑behavioural change (OIE/FAO 2016, UNICEF
2007, AU‑IBAR 2009).
To assess the eectiveness of any communication
system, regular reviews of intended and unintended
outcomes are necessary (UNICEF 2011, UNICEF
2012). For example, recent evidence has indicated
that human inuenza vaccine health messages
may sometimes be viewed with scepticism due to
miscommunication and only brief but balanced
evidence‑based transparent information may be
useful for communication (UNICEF 2011, UNICEF
2012, Mowbray et al. 2016). To date, no empirical
evaluation and review of highly pathogenic avian
inuenza (HPAI) H5N1 communication campaigns
have been conducted as advocated (AU‑IBAR 2009,
FAO 2008). The authors carried out a survey among
poultry farmers and live‑bird marketers (LBMs)
to assess whether avian inuenza health‑related
messages are correctly communicated, and
whether communications using pictures and words
will produce an improvement in the passage of
biosecurity and health messages.
Methods
Questionnaire design and testing
A literal questionnaire was designed to test
subjects’ syndromic clinical signs in birds, species
aected, knowledge of post‑mortem signs in
opened carcasses, knowledge and preference
for communication methods, knowledge of
biosecurity to reduce infection in man and animal,
and knowledge of risky practices at sales point, all
serving as early warning measure to precautionary

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Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
the sales of wild birds and other animals alongside
farmed poultry. Pictorial representation was poorly
correlated with post‑secondary education but
positively correlated with the knowledge of clinical
signs (P < 0.001), species aected (P < 0.001) and
post‑mortem signs in opened carcases (P < 0.001)
(TableIII).
Discussion
We have shown evidence that communicating
the health and disease prevention messages is
dependent on using the appropriate means, and
pictorial representations outperformed literal
presentations in health information communication
to generate the intended outcomes. Porter (Porter
2012, Porter 2013) has earlier highlighted the
importance of using ethnographic details and
images to communicate avian inuenza information.
The farming and livestock marketing populations
were grossly semi‑literate biomedically and appear
to be aging with over 78% of the respondents older
than 45 years; Mokoele and colleagues (Mokoele
et al. 2014), have obtained similar ndings in
smallholder pig production in South Africa. Whether
the aging trend of the formally educated individuals
is a matter of increasing unemployment that forced
ease of statistical analysis. All binary data were
categorised as ‘0’ for ‘No’ and ‘1’ for ‘Yes’ responses.
Knowledge score was accepted as correct (1) if the
total score in a knowledge category was at least
75%, and incorrect (0) if the score is less than 75%.
Using the Intercooled Stata v9.0 (StataCorp, Texas,
USA), we test the probability of independence for
categorical data using Pearson’s Chi square test.
The association between two variables and odds of
correct responses were conducted and tested using
the 2 × 2 table. Pairwise correlation analysis was
used to correlate knowledge scores with pictorial
representation. Other descriptive analyses were
performed to summarise the respondents’ inputs.
Results
The majority of the poultry farming and live‑bird
market respondents were older than 45 years
(P<0.001), and many have obtained post‑secondary
education. In addition, a greater proportion operated
in the rural and peri‑urban areas (P<0.001, Table1).
The degrees of knowledge of clinical signs in birds,
aected species, preference for communication,
biosecurity to reduce infection in man and animal,
and risky practices at sales points were good to very
good but the degree of knowledge of post‑mortem
signs in opened carcasses was relatively poor
(P<0.001, TableI).
Specically, signicant dierence exists between
responses to pictorial and literal representations
of the specic questions in each knowledge
eld. For the knowledge of clinical signs in birds,
torticollis (twisting of neck, OR = 3.46, P < 0.001),
malformed eggs (OR=1.52, P<0.001) and swollen
head (OR = 3.27, P < 0.001) got a signicantly
higher number of correct responses in the pictorial
respondents (TableII). There was no dierence in the
responses to depression (OR= 0.71, P = 0.48) and
coloured shank (feet, OR=1.24, P = 0.51). Whereas
most respondents (literal and pictorial) were aware
that chickens are aected by avian inuenza H5N1
(OR= 1.00, P = 1.00), there were signicantly more
positive responses with regards to the other species
of birds among pictorial respondents for ostrich
infection (OR = 224) (TableII).
Although the knowledge of post‑mortem signs
was generally poor, they were signicantly better
(OR=8.59 to 24.28, P < 0.001) among respondents
who answered the pictorial questions (Table II). There
was no dierence in the preference and method
of reporting outbreaks between respondents to
pictorial and literal means. A great disparity was
however observed between good knowledge of
biosecurity measures and implementation in the
farms and live bird markets (Table II). Finally, risky
practices continue to exist in the LBMs through
Table I. Descriptive statistics of the respondents and knowledge scores.
Variables Categories (n) Proportion
± SE (%) P-value
Age
≤ 45 years (76) 21.7±2.2
< 0.00146-55 years (189) 54.0±2.7
> 55 years (85) 24.3±2.3
Education level
Up to secondary
(148) 42.3±2.6
< 0.001
Higher than
secondary (202) 57.7±2.6
Location Rural (206) 58.9±2.6 < 0.001
Urban (144) 41.1±2.6
Knowledge of clinical
signs in birds
Yes (1173) 67.0±1.1 < 0.001
No (577) 33.0±1.1
Knowledge of aected
species
Yes (1986) 81.1±0.8 < 0.001
No (464) 18.9±0.8
Knowledge of
post-mortem signs in
opened carcasses
Yes (522) 37.3±1.3
< 0.001
No (878) 62.7±1.3
Knowledge and
preference for reporting
outbreaks
Yes (1318) 75.3±1.0
< 0.001
No (432) 24.7±1.0
Knowledge of biosecurity
to reduce infection in
man and animal
Yes (1723) 82.0±0.8
< 0.001
No (377) 18.0±0.8
Knowledge of risky
practices at sales point
Yes (591) 84.4±1.4 < 0.001
No (109) 15.6±1.4

90 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
that may emanate from improperly managed faecal
waste, (2) other greenhouse gases like ammonia
which are irritating and inimical to human health,
and (3) increased possibility of contracting infectious
or zoonotic diseases from poultry (Brautbar 1998,
Snyder etal. 2003).
Although the positive score obtained in response to
the questions on knowledge of biosecurity practice
in the LBMs and poultry farms can be attributed
humans into farming and poultry marketing apart
from oce‑related employments is beyond the
scope of this work. In addition, we observed that
a greater proportion of respondents operated in
the rural and peri‑urban areas; we associated this
observation with the fact that poultry farming,
marketing and abattoir facilities are incompatible
with the highly built‑up urbanised areas due to the
following reasons: (1) associated oensive odour
Table II. Assessment of individual avian inuenza health-related items using pictorial and literal responses. —cont’d
Categories of response
variables Pearson’s χ2OR (95% Conf.
Interval) P-value
Literal Pictorial
Knowledge of clinical signs in
birds
Torticollis Yes 44 94 29.91 3.46 (2.20-5.43) < 0.001
No 131 81
Depression Yes 167 164 0.50 0.71 (0.28-1.82) 0.48
No 8 11
Malformed eggs Yes 67 85 3.77 1.52 (1.00-2.33) 0.05
No 108 90
Coloured shank Yes 152 156 0.43 1.24 (0.65-2.37) 0.51
No 23 19
Swollen head Yes 101 143 23.87 3.27 (2.10-5.33) < 0.001
No 74 32
Knowledge of aected species
Chicken Yes 174 174 0.00 1 (0.06-16.12) 1.00
No 1 1
Guinea fowl Yes 137 170 28.87 9.43 (3.61-24.61) < 0.001
No 38 5
Duck Yes 149 172 19.89 10.00 (2.97-33.72) < 0.001
No 26 3
Turkey Yes 154 174 19.40 23.73 (3.16-178.47) 0.005
No 21 1
Quail Yes 100 166 68.23 13.83 (6.64-28.84) < 0.001
No 75 9
Pigeon Yes 95 164 70.70 12.56 (6.37-24.76) < 0.001
No 80 11
Ostrich Yes 5 152 249.60 224.70 (83.36-605.64) < 0.001
No 170 23
Knowledge of post-mortem
signs in opened carcasses
Ovary Ye s 8 51 37.69 8.59 (3.93-18.74) < 0.001
No 167 124
Intestine Yes 49 154 129.31 18.86 (10.74-33.11) < 0.001
No 126 21
Trachea Yes 28 137 136.23 18.93 (11.02-32.51) < 0.001
No 147 38
Heart, liver, spleen Yes 7 88 94.79 24.28 (10.78-54.68) < 0.001
No 168 87
continued

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Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
Table II. Assessment of individual avian inuenza health-related items using pictorial and literal responses. —cont’d
Categories of response
variables Pearson’s χ2OR (95% Conf.
Interval) P-value
Literal Pictorial
Knowledge and preference
reporting outbreaks
Report by phone Yes 160 163 0.36 1.27 (0.58-2.81) 0.55
No 15 12
Community discussion Yes 160 156 0.52 0.77 (0.38-1.57) 0.47
No 15 19
I have reported Yes 25 34 1.65 1.45 (0.82-2.55) 0.20
No 150 141
State veterinary
services
Yes 172 172 0.00 1 (0.20-5.02) 1.00
No 3 3
Federal Department of
Livestock (FLD)
Yes 130 146 4.39 1.74 (1.03-2.94) 0.04
No 45 29
Knowledge of biosecurity to
reduce infection in man and
animal
Footbath (know) Ye s 169 171 0.41 1.52 (0.42-5.46) 0.52
No 6 4
Footbath (use) Ye s 118 135 4.12 1.63 (1.02-2.62) 0.04
No 57 40
Hand wash (know) Yes 175 173 2.01 - -
No 0 2
Hand wash (use) Yes 170 172 0.51 1.69 (0.40-7.17) 0.48
No 5 3
Vehicle spray (know) Ye s 153 157 0.45 1.25 (0.65-2.43) 0.50
No 22 18
Vehicle spray (use) Yes 53 77 7.05 1.81 (1.17-2.81) 0.008
No 122 98
Knowledge of risky practices at
sales point
Wild bird, pigeon, egret Yes 160 142 7.82 0.40 (0.21-0.77) 0.01
No 15 33
Grass cutter, antelope Yes 142 147 0.50 1.22 (0.70-2.12) 0.48
No 33 28
Table III. Pairwise correla tion analyses between pictorial representation and knowledge scores.
Pictorial
representation
Education
(post-secondary)
Knowledge of
clinical signs
in birds
Knowledge
of aected
species
Knowledge of
post-mortem signs
in opened carcasses
Knowledge of
biosecurity to
reduce infection in
man and animal
Pictorial representation 1.000
Education
(post-secondary) - 0.012 1.000
Knowledge of clinical
signs in birds 0.333*0.068 1.000
Knowledge of aected
species 0.444*-0.012 0.204*1.000
Knowledge of
post-mortem signs in
opened carcasses
0.567*0.106*0.450*0.252*1.000
Knowledge of biosecurity
to reduce infection in man
and animal
0.017 0.113*0.205*0.123*0.098 1.000
*P value ≤ 0.05

92 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
bird markets to signicant risk of infection as
the adoption of precautionary measures around
other species was likely to be poor (Neupane etal.
2012). Perhaps the display of coloured pictures that
showed the clinical signs, symptoms pathology
or biosecurity items (supplementary material)
aided the outcomes of the pictorial respondents,
and such positive reinforcement should also be
encouraged in communicating health messages to
the undiscerning public (Porter etal. 2013).
Conclusion
We did not observe dierences between the two
methods of reporting outbreaks; hence we call for
a complimentary use of both methods. Due to the
fact that risky practises continue unabated in the
LBMs and farms, continued surveillance and regular
re‑training of all stakeholders are important to
reduce the burden of zoonotic inuenza in humans.
Education was negatively correlated with pictorial
representation but the knowledge of post‑mortem
signs, clinical signs and species aected were
positively correlated with pictures. We concluded
that semi‑literate individuals will benet more from
picture‑oriented messages rather than literal ones
and advocate the adoption of such practices by
government extension and communication ocers.
To ensure that the intended outcomes of public
health and preventive messages are achieved, it is
important to evaluate and pre‑test communication
methods to determine their suitability.
Acknowledgement
We wish to thank the government veterinarians that
participated in the surveyed States and the workers
that facilitated sample collections. We are grateful to
the selected poultry farmers and live‑bird marketers
that willingly participated in the survey. The input of
the Department of Production Animal Studies and
the Department of Veterinary Tropical Diseases is
gratefully acknowledged.
to lessons learnt from reinforced messages from
previous outbreaks of HPAI H5N1 (2006‑2008)
(Pagani etal. 2008), good knowledge of biosecurity
in the farms and live bird markets does not always
correlate with implementation of biosecurity in
facilities and the reinforcement of such messages
using pictorial information may serve a more
usefulpurpose.
The degree of knowledge of post‑mortem lesions
in tissues and organs of dead birds was very poor,
probably due to the fact that previous training did
not focus on making veterinarians out of farmers
and marketers, however farmers live closely with
these potentially infected birds and live bird
sale are often accompanied by small to medium
slaughter facilities (Fasina etal. 2016). In the course
of slaughter and evisceration of such potentially
infected poultry, humans are exposed to virus‑rich
visceral and respiratory organs (Reperant et al.
2012), and the risk of contracting infection is high.
It becomes necessary to demonstrate such risks to
these poultry stakeholders using video or pictorial
representations.
Torticollis and swollen heads in birds have
signicantly higher odds of recognition in the
pictorial representation but not depression and
coloured shanks. These signs may be associated with
low grade infection, low pathogenic avian inuenza
(LPAI) or confused with signs observed in other
infections like Newcastle disease and Salmonellosis.
Because the low pathogenic avian inuenza viruses
may sometimes mutate or undergo re‑assortment
to HPAI virus and infect humans (Peiris et al. 2007,
Lee etal. 2016), we advocated for the development
of panels of clinic‑pathological signs in pictures for
display at LBMs and farms to aid easier recognition
of those signs and symptoms.
The awareness of HPAI H5N1 infection in chickens
is very high among both the literal and pictorial
respondents but most of the literal respondents
found it dicult to accept that this virus may
sometimes aect other species of birds. This lack
of awareness predisposes these farmers and live

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Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
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Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

96 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

97
Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

98 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

99
Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

100 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

101
Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Fasanmi et al. Communication of H5N1: pictorial vs literal health methods
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2
continued

102 Veterinaria Italiana 2020, 56 (2), 87‑102. doi: 10.12834/VetIt.1156.6369.2
Communication of H5N1: pictorial vs literal health methods Fasanmi et al.
Figure 1. Pictorial questionnaire. —cont’d
Annex 1
Publisher: Istituto Zooprolattico Sperimentale dell'Abruzzo e del Molise ‘G. Caporale’ | Journal: Veterinaria
Italiana | Article Type: Reasearch Article | Volume: 56; Issue: 2; Year: 2020; doi: 10.12834/VetIt.1156.6369.2