A focus group study exploring necessary competencies and contextual factors for effective antimicrobial stewardship...

There is a need for improved antimicrobial stewardship on dairy farms, and changes will be largely enacted by the farm workers who are responsible for carrying out farm procedures. For this reason, efforts directed at educating and enabling farm workers in antimicrobial stewardship are necessary for compliance with farm-level antimicrobial usage policies. Therefore, the objectives of this research were (1) to determine the competencies needed by dairy farm workers to implement antimicrobial stewardship and to inform educational resource development and (2) explore the farm contexts that influence farm worker antimicrobial stewardship capabilities. Initially, focus group discussions were conducted in person with 6 groups of veterinarians at 3 independent conferences held in the United States. To gain additional perspectives, 2 focus groups were conducted via video link with dairy producers from the midwestern United States. The focus groups had 4 to 8 participants and 2 to 4 facilitators each, and were audio recorded and transcribed for analysis. Discussions were audio recorded, transcribed, and evaluated using inductive thematic analysis, with 9 key themes identified. Participants emphasized that farm workers needed to be willing to learn, to be responsible, and to be consistent in their execution of tasks. Furthermore, farm workers needed knowledge about the rationale behind antimicrobial use strategies and disease mitigation practices. General skills needed by farm workers included good communication, excellent observation, and the ability to follow protocols and keep records. Technical skills required by farm workers related to the handling of animals, attention to cleanliness, ability to properly administer pharmaceutical products, and farm equipment maintenance. The skills and knowledge required differed among farm workers depending on their responsibilities and experience, with greater expectations for herd managers compared with employees who specialized in a specific task such as milking. Farm contexts that affected antimicrobial stewardship included the farm size, which had an impact on the 3 other themes: workplace culture, leadership, and tools. Workplace culture encompassed having an approachable environment and clear responsibilities, and leadership encompassed managerial capacity and veterinary support. Important tools for effective antimicrobial stewardship included relevant and up-to-date protocols, technology, equipment, and a proficient workforce. The evidence provided through these focus groups is useful for informing competency-based educational efforts aimed at improving antimicrobial stewardship on dairy farms.