This is a letter to the editor published in the July 2006 issue of the Emerging Infectious Diseases journal. It addresses public awareness in Thailand of avian influenza in birds after a Ministry of Health public education campaign. In this letter, the author notes the discrepancy between high levels of awareness and low levels of behaviour change. Based on a study conducted at the end of 2005, the author found that though "[m]ost villagers knew that minimizing contact with birds could reduce their risk for infection...they were not sure how they could minimize contact." In addition, though testing of birds was known to be important in gauging the health of the flock, most poultry owners did not test their birds. And though home poultry producers realised they needed to report signs of avian flu (bird flu) in their poultry, they did not have practical access to the reporting system.

"The findings of this study are similar to those of Olsen et al., who reported that widespread knowledge of avian influenza had not resulted in behavior change. Behavior change is a complex process; both motivators and barriers contribute to change. One participant said that the household chickens were a very important economic source, not only for the household but also for her entire village. Eggs were usually consumed within the household or sold at the local market. This villager also said that government educators told villagers not to directly interact with or slaughter chickens at home. Although she was well aware of the danger of HPAI, she thought the recommendations would be impossible to follow since feeding and egg collection involve direct interaction with chickens. When a chicken is no longer able to produce eggs, the participant slaughters the hen and either eats or sells the meat. No facility that could safely slaughter chickens is available in the village, so she does it at home."

The author identifies a disconnect between risk awareness and risk perception. Many villagers Takeuchi interviewed were aware of the risks, but did not perceive that anything could happen to their chickens, and if it did they did not see how they could address those risks without damaging their livelihoods. One key point the author makes is that in the absence of practical solutions, people have very little motivation to change. Four practical elements of future Thai awareness campaigns are identified to provide practical solutions and motivation:

1. a list of detailed symptoms of bird flu in poultry and humans;
2. guidelines on raising and slaughtering home-raised poultry, with a list of protective equipment such as boots, masks, and goggles, as well as cleaning materials;
3. instructions on how to report sick birds or persons to the Thai Ministry of Health; and
4. a strategy for addressing the economic considerations of the villagers - compensation for culled birds and for necessary protective equipment.