Vaccine (2008) 26, 24332442

available at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/vaccine

Livestock vaccine adoption among poor farmers in Bolivia: Remembering innovation diffusion theory
Claire Heffernan , Kim Thomson, Louise Nielsen
Livestock Development Group, School of Agriculture, Policy and Development, University of Reading, Reading RG6 6AT, UK Received 25 July 2007; received in revised form 4 February 2008; accepted 4 February 2008 Available online 18 March 2008

KEYWORDS
Diffusion of innovation; Vaccination adoption; Bolivia

Summary The paper explores the low uptake of livestock vaccination among poor farming communities in Bolivia utilising core elements of the original innovation diffusion theory. Contrary to the recent literature, we found that vaccination behaviour was strongly linked to social and cultural, rather than economic, drivers. While membership in a group increased uptake, the hot and cold distinctions which dictate health versus illness within Andean cosmology also played a role, with vaccination viewed as a means of addressing underlying imbalances. We concluded that uptake of livestock vaccination was unlikely to improve without knowledge transfer that acknowledges local epistemologies for livestock disease. 2008 Elsevier Ltd. All rights reserved.

Introduction
Within the literature, the adoption of livestock-related technologies such as vaccines among the global poor has been considered in relation to delivery [7,11] or by disaggregating key characteristics of adopters, including perceptions and/or awareness of the technology in question [12,2630]. Nevertheless, it may be argued that this division is both articial and unhelpful. For example, Heffernan and Misturelli [7] dened three key parameters important to the uptake of animal health interventions among the poor: access, affordability and acceptability. Where access relates to both the physical distance and delivery channel, affordability mea-

Corresponding author. Tel.: +44 118 931 8213. E-mail addresses: c.l.heffernan@reading.ac.uk, c.heffernan@reading.ac.uk (C. Heffernan).

sures the actual ability of the poor to pay and acceptability relates to the preferences of the poor as consumers [7]. Each of these uptake parameters, however, clearly has a component reliant on the motivation and the attendant perceptions and/or attitudes, of the individual involved [10]. For example, access to a technology also depends upon awareness or perceptions of the technology by the individual [12,30]. Equally, affordability is inuenced by the other nancial obligations that a household may or may not have. Finally, a person may have the intention to adopt a technology but this may not be translated into action [10,19,22]. However, while understanding individual behaviour is important, the goal of most vaccination campaigns is wide-scale adoption at the community, national and even global-levels [24,25]. In this manner, collective behaviour is vitally important. During the 1960s, the diffusion of innovation theory was offered by a sociologist to explain the inuence/uptake of particular technologies on social groups [1517]. While the theory has been subjected to a number

0264-410X/$ see front matter 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2008.02.045

2434 of criticisms and alterations over the years [2,5,15,17,21], within the wider literature on consumer behaviour, much of the later work still draws heavily upon the original thinking [5]. Nevertheless, with regard to livestock technologies, while many authors draw heavily on the discourse of innovation, i.e., innovation, diffusion, adopters, etc. [26,29,30] few studies actually apply core elements of the original theory. To explore the continuing relevance (or indeed, irrelevance) of the theory to the adoption of livestock vaccination adoption among the poor, we decided to frame our analysis around the original approach. In the late 1960s, Rogers [16] described the innovation decision process as taking place in the following sequence: Knowledge (exposure to a technology, and understanding its use). Persuasion (the creation of a positive/negative perceptions). Decision (deciding/not deciding to adopt). Implementation (actual use of the product). Conrmation (corroboration or rejection based on a use outcome). According to Rogers [16], technology adoption occurs via an S shaped curve beginning with the innovators and early adopters with the laggards adopting last.1 The speed of adoption relates to the slope of the curve [21] with persuasion the force that drives adoption up the slope. Rogers [16] noted that interpersonal channels are much more effective at persuading an individual to accept a new idea. As such, the author argues that mass communication media such as the radio, television and the internet are less important during the persuasion stage than direct word of mouth [16]. Within the context of vaccination campaigns, mass media traditionally has been an important tool. Therefore, the study utilised the above framework to explore the factors important to livestock vaccination uptake across a range of poor livestock keeping communities in Bolivia. From the outset, there are a variety of elements that may hamper the uptake of livestock vaccines among the poor. First, vaccination has a low degree of observability, i.e., in the absence of a disease, the benets of vaccinating animals cannot be easily viewed by farmers [16]. Second, preventive technologies, which decrease the incidence of some negative future event [16] tend to have much slower adoption rates. Clearly livestock vaccines meet both of these criteria for slow adoption or uptake. However, depending upon the incidence or prevalence of any particular disease the observability of vaccination is likely to vary over time. Hence, the question remains, what is the role of observability within the context of livestock vaccination uptake by the poor? Further, according to Rogers [16], technologies can often undergo signicant reinvention or adaptation by the population involved.2 As such, within the diffusion process,

C. Heffernan et al. understanding or use of the technology can often evolve from the original intention or application. Given the importance of customary knowledge regarding the emic and etic of livestock disease among poor communities in the South it is reasonable to assume that a certain amount of reinvention will take place. However, the degree and role of reinvention in the adoption of livestock vaccines is largely unknown. Therefore, to explore these issues, we collected data from over 400 poor livestock keeping households in Bolivia. We begin by applying our data to the sequence of steps involved in innovation diffusion described above.

Methods
Data collection
Non-probabilistic, purposive sampling was utilised to identify poor livestock keeping households. Multi-stage sample selection took place at the community and individual level. The study focused on urban and peri-urban communities in La Paz and Cochabamba Departments. Urban livestock production systems were largely based on pig, poultry and guinea pig production. In total, 257 urban and 212 peri-urban livestock keepers involved in the research. The majority of these latter households were involved in small-scale dairying. To fully represent the livestock production systems important to the poor, an additional subset of 45 Llama and Alpaca rearers located in rural communities in Oruro department were included in the study.

Questionnaire development and outcome

Open-ended, semi-structured interviews were performed in which study participants were asked the following core questions regarding vaccination behaviour and the understanding of disease processes. The questions were formulated to generate descriptive narratives while lowering the possibility of enumerator input or bias. Section I: vaccination behaviour (implementation, persuasion and conrmation and knowledge) Do you vaccinate your animals? If yes, which species, against which diseases? If no, why not? How often do you vaccinate? Why? Are you a member of a group (i.e. producers group, milk co-operative, community group, etc.)? How do vaccinations work? Section II: understanding disease processes (knowledge) Who is your primary source of animal health information? What disease are you most afraid of your animals being infected by? Why? What causes the disease? How can the disease be treated? How can the disease be prevented?

The characterization of adopters appears to be the most prominent remnant of the original theory across the livestock development discourse. 2 Within the diffusion of innovation literature, delity is commonly utilised as an antonym to reinvention [4,23]. Studies of

delity (and thereby reinvention) tend to explore how core versions of events, innovations and/or programmes derived from implementers differ from those of adopters [4].

Livestock vaccine adoption among poor farmers in Bolivia The questionnaire was pre-tested among a peri-urban community on the Bolivian Altiplano. Minor changes were made to the ordering of the questions and translation from English to Spanish. Respondents took, on average, 3035 min to complete the above questions.
Table 1 Vaccination behaviour Production system Peri-urban Total livestock keepers 212 Rural 45 Urban 257

2435

Total 514

Training of enumerators
Prior to commencing data collection activities, all enumerators underwent a 5-days training course in qualitative data collection techniques. Individuals were provided training in three key areas of a quality interview: accuracy, richness or depth of responses and internal consistency both within and between responses [8,9]. Further issues addressed included the difference between probing and prompting responses. Interviews were assessed on a daily basis for quality, descriptive detail, and internal coherence. Specic issues were brought to the attention of the individual enumerator involved.
Vaccination use Reported uptake Actual uptake 182 157 38 20 134 45 354 222

Vaccination key diseases Anthrax 14 Foot and mouth 117 Swine fever 11 Newcastle 1 Rabies 14 Total 157

20

7 12 6 21 60

14 143 23 7 35 222

20

Data analysis
The data was analysed from two perspectives. First, responses were coded and a content analysis performed to explore the intention and frequency of factors important to the uptake of vaccination. A content analysis is dened as a quantitatively oriented technique by which standardized measurements are applied to metrically dened units and these are used to characterize and compare documents [20]. Second, a cluster analysis was utilised to explore the strength of participant associations with the multiple variables under study. Cluster analysis is a descriptive statistical tool that measures the closeness of associations or distance between individual cases or variables. As such, a 2 measure was used to calculate the distance between clusters. SPSS software package was utilised to perform a joining or tree clustering algorithm to explore the commonalities between farmers with regard to vaccination. The results are presented in the form of horizontal hierarchical tree plots (or dendrograms). A logistical regression analysis was performed to further explore the factors important to vaccination uptake outlined in the study approach.

Results
To explore the diffusion of a new technology, Rogers [16] analysis began with knowledge. Conversely, to explore the uptake of an existing technology, which has been available to farmers for many years, we begin at the implementation stage.

Implementation
Across the study set, when farmers were asked if they had vaccinated any of their animals during the past 12 months, 68% replied yes. However, when asked to detail the illness or disease against which they were vaccinating, only 46% of farmers named a livestock disease for which a vaccine exists, i.e., anthrax, foot and mouth disease (FMD), Newcastle disease, rabies or swine fever. Thus, the decision to

vaccinate was not clear cut, as any form of treatment was often confused with vaccination by the farmers involved. Indeed, incorrect responses ranged from cold or hot weather to external and internal parasites. A further 6% of those individuals who reported vaccinating against a specic disease, did not own an appropriate species that could be infected by the disease in question. Overall, of those farmers who did vaccinate, vaccination against FMD accounted for the overwhelming majority of responses (74%) with peri-urban residents displaying the highest adoption rates (Table 1). To explore the potential relationships between demographic and economic variables with the decision to vaccinate, a cluster analysis was performed. The analysis explores the relationship between use of the ve vaccines detailed above with two disparate demographic groups: married, educated men, >40 years old with >5 years in formal education versus single women, <40 years old with less than 5 years in formal education. Fig. 1 explores these factors in relation to wealthier, male subset of study participants. As Fig. 1 displays, while vaccination uptake was closely associated, i.e., individuals who vaccinated their animals tended to uptake all of the available technologies (with the exception of FMD), there was little association with the demographic features under study: gender, age or indeed position on the poverty line. A similar nding was noted when the alternate demographic group (less well-off women) were explored. Therefore, contrary to ndings from other studies [27], wealth did not appear to be a factor in adoption. Thus, from the ndings from the cluster analysis two broad groups of consumers could be identied; those that vaccinate for FMD and those that utilise vaccination to address a range of other diseases.The logistical regression analysis further revealed the differences between the two groups of respondents. Vaccination for FMD had a signicant relationship (p < .05) with being male, residing in a periurban environment, having a more than 5 years of formal education level and holding positive views toward vaccination, in general. Conversely, those individuals who reported vaccinating for the other diseases, i.e., swine Fever, New-

2436

C. Heffernan et al.

Figure 1 Vaccination vs. demographics I: age, gender, marital status and poverty line. AnthraxY = vaccinated for anthrax; NewcastleY = vaccinated for Newcastle disease; SwineFevY = vaccinated for swine fever; RabiesY = vaccinated for rabies; MaleY = male farmer; FMDY = vaccinated for FMD; AbovePov = above poverty line (disaggregated by rural and urban location); EdMore5Y = more than 5 years in formal education; Greater40y = greater than 40 years old; MarriedY = married individual.

castle, rabies and anthrax resided in urban areas (p < .05) and had less than 5 years of formal education (p < .05). The signicance of location between the two groups was not particularly surprising as many cattle producers resided in peri-urban areas while swine fever, rabies and Newcastle disease were problems for urban pig and poultry producers. More interesting, however, was the relationship between the number of years of education and the adoption of particular livestock vaccines.The next portion of the analysis explored factors relating to persuasion.

Persuasion
According to Rogers [16], farmer to farmer communication, on its own, rarely sparks the diffusion process. As the author claries: . . .when two individuals are identical regarding their technical grasp of an innovation, diffusion cannot occur as there is no new information to exchange. The nature of diffusion demands that at least some degree of heterophily be present between the two participants in a communication process. As such, within the context of livestock vaccination, there are a variety of animal health actors at the community level, who full the requirements for heterophily. Use of these actors, however, remains rare. Across the study set, 60% of respondents noted that their primary source of animal health advice was close social contacts, i.e., friends/family/neighbours. A large proportion of individuals claimed that they depended on their own experience (27.5%) and did not seek advice when an animal was ill. Not surprisingly, members of the milk co-operative tended to seek advice from the afliated vet and animal health technician, while rural households reported utilising NGOsponsored community animal health workers. Overall, 12.5% of the study group reported utilising formal service providers as a source of advice. However, for the source of advice to be a source of persuasion, a variety of factors must be accounted for. First, the proximity of the source to the individual may have a

role, i.e., the closer the source, the higher the potential use and therefore, the greater the inuence. Second, the views of the individual involved must be amenable to the advice provided by any such source. For example, if the overall perception of a technology is negative, it may be presumed that despite external pressure or advice, the uptake will be low. Therefore, to explore the possible factors relating to persuasion a cluster analysis was performed which examined the relationship between vaccination uptake, the primary source of information regarding animal health, distance to healthcare provider, and overall perceptions regarding vaccination (negative vs. positive). Where negative views regarding vaccination included perceptions such as adverse impacts on milk production and/or animal health, i.e., postvaccination ill-health/lameness, etc. As Fig. 2 illustrates, use of formal sources of advice were most closely associated with the uptake of Newcastle, swine fever and anthrax vaccination. Interestingly, however, it appears that farmers were vaccinating despite negative perceptions regarding the effects of vaccination on individual animals. Equally, distance to the healthcare provider did not appear to be a factor in uptake behaviour. Finally, formal sources of advice had a stronger association to specic kinds of vaccines. To explore the possible effect of other community members on persuasion, Table 2 compares group membership with vaccination behaviour. Overall, 45% of the study set (n = 232) reported being part of a group. As Table 2 reveals, the highest frequency of those individuals who reported vaccinating their animals belonged to a milk co-operative followed by community and church groups. Not surprisingly, particular vaccines were found to be related to membership in specic groups. For example, vaccination for FMD had a signicant relationship to membership in a milk co-operative (p < .01) or an NGO-sponsored group (p < .01). Thus, while overall membership in a group appeared to enhance vaccination uptake, particular social networks were linked to the uptake of specic vaccines. However, in the case of FMD it may be argued that adoption was likely to have been driven by group regulations or membership norms rather than the strength of individual social relationships involved. And indeed, farmers noted that the

Livestock vaccine adoption among poor farmers in Bolivia

2437

Figure 2 Vaccination use vs. distance to provider, information sources and perceptions (Neg). NewcastleY = vaccinated for Newcastle disease; FormalAd = primary source of advice formal service providers; SwineFev = vaccinated for swine fever; AnthraxY = vaccinated for anthrax; VaccNegV = holds negative views of vaccination; RabiesY = vaccinated for rabies; Distance = distance to animal healthcare provider; Informal = primary source of advice friends and family; FMDY = vaccinated for FMD; PrivateS = primary source of advice private sector providers.

milk co-operative demanded that their members vaccinate for FMD (despite the edict 10% of milk co-operative members were among the non-vaccinating group). Thus, compliance even under these conditions was not uniform. Nevertheless, the nding can help explain why FMD vaccination was not clustered with the other vaccine use across the analysis. While it would be tempting to conclude that vaccination adoption relies on regulation and high levels of compliance can be obtained when there are signicant economic incentives involved, a different perspective was obtained when the factors relating to conrmation or the use of the technology over time was explored.

Conrmation
To explore conrmation, the rst step of the analysis was to examine the reported frequency of vaccine use. Overall, 61% of the study set stated that they vaccinated on a yearly basis. Next, reports of disease outbreaks were compared to vaccination use over a 5-year period. The number of specic disease reports offered by farmers from 1999 to 2003 is detailed in Fig. 3. From Fig. 3, two outbreaks can be identied. First a number of farmers reported being impacted by FMD in April 2002, with a Newcastle disease outbreak among urban producers in early 2003. While some farmers reported large losses from Swine Fever, upon hearing of the outbreak other individuals reported that they had slaughtered out their herds possibly explaining the lower numbers of farmers reporting cases. Vaccination for the above diseases over the time period is as follows. As Fig. 4 illustrates, despite initially reporting a high level of consistent uptake, in reality vaccination uptake appears to be largely utilised in response to disease outbreaks and not as a preventative strategy. Newcastle disease, however, was an exception. Indeed, farmers appear largely willing to accept the losses from Newcastle disease on their poultry ocks with few farmers reporting vaccination use. Thus,

Table 2

Group membership and vaccination Type of group Church Group Community Group Food for Work Health Group Milk Co-operative NGO Producers Group Womens Group Workers Group Total 15 31 16 1 3 3 5 8 12 94 Church Group Community Group Food for Work Milk Co-operative NGO Producers Group Womens Group Workers Group 12 33 18 39 8 11 12 5 138

Do you vaccinate? No

Total Yes

Total

Figure 3

Number of reports of key diseases.

2438

C. Heffernan et al. milk co-operatives and/or local colleges on animal health or production. Nevertheless, with regard to vaccination behaviour, nearly 30% of this group did not vaccinate their animals. As Table 3 illustrates, for those individuals who had participated in a training course, 37% could not correctly identify that vaccination had a preventative role in herd health. Indeed, half of those farmers who participated in a general course on animal health were unsure how vaccinations actually worked. Thus, it is clear that while training was related to uptake, contrary to the literature on the topic [26], it was not due to any particular knowledge imparted regarding vaccination itself. Nevertheless, it may be argued that vaccination could have been discussed in relation to specic diseases. Therefore, the dendrogram below explores the associations between reported vaccination for FMD and an understanding of the disease and the role of vaccination. As Fig. 5 illustrates, training was clustered with all of the various causal factors of FMD, as a contagious disease (FMDCause1) due contaminated food/water and/or environment (FMDCause2) or inclement weather (FMDCause3). Thus, the nding demonstrates that despite training, customary knowledge was a major factor in forging perceptions and attitudes toward the disease. Psychologists argue that individuals via a process known as selective exposure tend to uptake messages that are in line with their attitudes and values and avoid or disregard those which are not [31]. Therefore, it is possible that messages delivered by trainers, which opposed more traditional explanations of the disease, were ignored. Overall, however, the causal factors were not closely associated with vaccination uptake (FMD Yes). The nding was conrmed in the regression analysis. Vaccination for FMD had a signicant relationship to learning about the disease via the media (as opposed to those individuals who declared that they had learned about the disease in a training course) (p < .01). Other signicant factors included holding the view of FMD as a priority disease (p < .01). Thus, the media appeared to be a key driver of FMD vaccination behaviour. While it would be tempting to conclude that media campaigns enhance uptake, it is clear that the behaviour was not driven by an accurate understanding of the disease. Equally, as the previous analysis demonstrated, vaccination was occurring on a short-term basis during outbreaks rather than as a longer-term means

Figure 4

Reported vaccination.

repeated uptake of the technology appeared to be largely driven by specic events and not by continuous social interaction and/or group membership norms. Finally, the factors relating to knowledge were explored.

Knowledge
When asked how vaccines worked, the question elicited a wide variety of responses. Replies ranged from descriptions of negative impacts such as lameness and/or ill health, to views of the technology as curative to correct notions of vaccination as preventing disease outbreaks. Nevertheless, the majority of farmers (both those who reported utilising the technology and those who did not) were unsure. Interestingly, group membership appeared to foster greater levels of participant opinions regarding vaccination. Indeed, a higher proportion of group members were able to offer an opinion, i.e., preventative, curative, harmful in response to the question, as opposed to simply an answer, i.e., unsure. Nevertheless, many milk co-operative members were unclear about their participation in vaccination campaigns as the following farmer noted: (ID 95) PIL (the milk co-operative) obligates us to vaccinate, however, I dont know exactly against what, just that the milk has to be good for selling. Overall, approximately, 10% of the study set reported that they had attended a training course offered by NGOs,
Table 3

Understanding of vaccination and group membership/training How do vaccines work? Curative (%) Preventative (%) 16.2 21.6 21.7 50.0 100.0 22.2 Unsure/Unknown (%) 60.9 45.2 52.2 40.0 50.0 32.3 No impact (%) 1.6 1.4 0.0 20.0 50.0 33.1 Harmful (%) 5.9 6.7 4.3 10.0

Group membership No group (n = 253) Yes group (n = 208) Attended training course (n = 51) Livestock health (n = 24) Livestock management (n = 15) Traditional medicine (n = 1) Nutrition (n = 2) Technician training (n = 9)

15.4 25.0 21.7 30.0

22.2

Livestock vaccine adoption among poor farmers in Bolivia

2439

Figure 5

Understanding of FMD and vaccination behaviour.

of disease prevention. Further ndings related FMD vaccination to membership in a group, i.e., milk co-operative or NGO. Consequently, it is likely that the media was simply forging a perceived correct answer to questions regarding FMD vaccination and in relation to the importance of the disease. The nding may help explain the high levels of false reporting initially found. However, it appeared that a considerable amount of reinvention was taking place with regard to FMD vaccination. Indeed, notions of vaccination for FMD as a treatment for the disease had a signicant relationship to learning about the disease from both the media and formal sources (p < .01). As it is unlikely that either the media or formal service providers propagated notions of vaccination as a treatment, another explanation is required. The use of vaccines in this manner did not contradict customary notions of FMD as caused by the weather and/or dirty feed. Indeed, within the indigenous populations of the Andes, illness and well-being is often associated to notions of hot and cold inuences within the body, more specically the blood/lymphatic system [13]. According to Bastien [1] within the ethno-physiology of the Andes, traditional healers view the blood as being hot, cold, wet or dry or combinations thereof [6]. Particular items such as food, water, medicines, natural and supernatural forces all have intrinsic properties that can impact these states of ill-being or imbalance [6,13,18]. As Logan [13] notes: The terms hot and cold . . . refer to a symbolic power contained in most substances. To insure health, one must maintain the bodys internal temperature . . . by attempting to avoid extreme or prolonged exposure to one quality or another. When one is ill, however, the attempt is made to restore health by re-establishing the temperature balance. The nding was conrmed in study participants descriptions of livestock disease aetiologies. For example, 41% of farmers attributed FMD to too much heat. Interestingly, mastitis was largely considered by farmers to be a cold disease. Within this paradigm, treatment must redress the specic imbalance involved, as Foster [6] notes: . . . therapy is based upon . . . the principle of opposites: a Hot remedy for an illness caused by . . . an excess of cold, and a Cold remedy for illness caused by . . . an excess of heat. Vaccination was perceived as a means of addressing particular internal imbalances. For example, as the following

individual expressed, FMD vaccination helped to cool the heat generated by the weather: (ID 111) What things make animals sick, when the weather is hot they may have heat inside the body thats why you need this treatment [FMD vaccination] to make them cool. Hence, it appears that the technology was reinvented to prevent any conict with existing norms regarding the aetiology of disease. Indeed, by adapting the role and functioning of vaccination, it may be argued when face with a disease outbreak, farmers were not vaccinating against the disease threat itself, but rather the imbalances of hot and cold, underlying the disease process.

Discussion
The diffusion of innovation framework proved to be a useful tool to study animal health vaccination behaviour by the poor from a number of perspectives. In relation to the poor as consumers of the technology, the study revealed three different groups of adopters, who were not mutually exclusive. First, there appeared to be a small group of overall adopters or those farmers who vaccinated against multiple disease threats. Equally, apparent, were the forced adopters or those farmers in order to meet the membership criteria in the local milk co-operative had to uptake a specic vaccine (FMD). Finally, there were those farmers who were ostensibly vaccinating in response to a disease threat, or the reactive adopters. The ndings relating the factors of persuasion further conrmed the existence of the adopter groups. Indeed, individuals who claimed that their primary source of animal healthcare advice was a veterinarian or community animal health worker tended to vaccinate for a number of different diseases and as such, formed part of the overall adopter group. Group membership could largely explain the forced adopter category, with members of the milk co-operative the largest subset of FMD vaccinators. However, there was a social aspect to group membership that coincided with Rogers original explanation of group-level persuasion among peers [16]. Indeed, Rogers argues that during persuasion individuals seek evaluative information regarding the impact of an innovation [16]. Membership in a group provides a likely forum for such interaction. Thus, the theory explains why even membership in a non-livestock related group, such as community or womens groups, was linked to higher uptake levels.

2440 Nonetheless, when the drivers to uptake behaviour were assessed, the ndings were somewhat surprising. First, there was a high level of false reporting when vaccination behaviour was explored, particularly among urban dwellers. The nding may be due to high level of awareness of the FMD vaccination campaigns which were advertised on the radio and television. As such, there was a perceived correct answer to questions regarding vaccination, particularly regarding FMD, i.e., individuals were aware that they should be vaccinating when in fact they were not. Or equally plausibly, as many were recent urban migrants, the individual may have been keen to display their livestock-owning credentials and were reporting previous behaviour and/or that by friends and relatives in their natal areas. Thus, vaccination was not a neutral topic for the individuals involved. The exploration of the factors related to conrmation further corroborated the nding. Indeed, while the majority of the study set claimed to vaccinate on a yearly basis, when vaccination behaviour was explored over a 5-year period, most individuals were vaccinating in response to disease outbreaks, particularly FMD and swine fever. As such, the majority of individuals fell into the reactive adopter category. Interestingly, however, the cluster analysis revealed vaccination uptake was largely independent of demographic factors such as gender, age and/or economic standing. As such, it was clear from the outset that other drivers were involved. According to the diffusion of innovation theory, knowledge is the platform upon which all the other stages of technology adoption are built [16,17]. And in relation to vaccination uptake, this appeared largely to be the case. The majority of individuals, in both the vaccinating and non-vaccinating groups, were unsure how the technology actually worked or indeed, its role in herd health. As such, at face value, it may be argued that the majority of farmers involved were not fully aware of the benets and therefore, levels of informed decision-making were low. To further justify the claim, the study found that a higher proportion of farmers, who had participated in a training course, vaccinated their animals. Equally, a signicant relationship was found between vaccination for FMD and learning about the disease from formal service providers and the media. Consequently, it would be easy to conclude that the overall low levels of vaccination uptake were simply a function of poor knowledge transfer. Nevertheless, such a conclusion would be too simplistic. Even after training, the study found that a large proportion of respondents did not link vaccination to the prevention of disease. As the regression analysis demonstrated, while training had a positive impact on vaccination, the reason for this uptake was not related to accepted notions of the role of vaccination in disease prevention. For example, in relation to FMD, most farmers did not view the disease as contagious. As it is likely that communication channels such as formal service providers and the media would describe the disease as contagious, some form of selective exposure appears to have taken place. The nding raises two issues consistent with core elements of diffusion theory. First, in order to prevent dissonance between attitudes and behaviour, those individuals who reported vaccinating their animals appeared to be altering notions of the use of the technology itself. Indeed,

C. Heffernan et al. it appears that many individuals were reinventing the functions of vaccination in order to conform to customary knowledge regarding the aetiology of the diseases involved. As detailed above, within Andean cosmology, disease is considered a function of imbalances of the blood. Thus, rather than preventing the disease, vaccination was perceived as having a role in cooling those diseases related to hot imbalances and warming those diseases caused by cold imbalances. Vaccination, by addressing imbalances, was consistent with community-held norms regarding the nature of disease and therefore, could be justied by the individuals involved. Equally, as vaccination is only one such tool that can perform this function, non-adopters could equally maintain their belief system. Therefore, while the reactive adopters may ostensibly appear to be adopting the technology in the face of an outbreak such behaviour is likely to have a greater relationship with attempts to address the underlying imbalance manifested by the disease in question. Further, while FMD was a function of hot elements, the aetiologies of other diseases also included evil spirits and curses. As such, vaccination was not considered an effective remedy for all of the illnesses involved.

Conclusion
Utilising a diffusion of innovation perspective, three broad conclusions can be offered with regard to the questions posed in the introduction. First, it is clear that the spectrum of adopter groups have a relation to both the specic technology (i.e. FMD vs. the other vaccines) and with some qualities of the individuals themselves such as geographic location and levels of education. Second, these adopter groups, rather than being dened by the speed of uptake, as detailed in the original theory, could be categorised by their levels of opposition to adoption. While overall adopters showed little resistance, the forced adopters were largely responding to external demands from membership groups, whereas, reactive adopters were responding to internal demands forged by customary perceptions of disease aetiologies. The nding counters Rogers [16] notion of technology as a means for uncertainty reduction that is made possible by information about the causeeffect relationships on which the technology is based. Utilising this denition, by necessity, it is the uncertainty over the utility of the technology itself that negatively inuences the decision to adopt. In this study, the adopter groups did not appear to be compelled by uncertainty over the actual technology, but rather by the external and internal demands forged by the threat itself, i.e., livestock disease. In this manner, adopter groups are clearly constrained by these demands rst, and with the utility of vaccination to meet these demands, a secondary consideration. In relation to observability, while among other cultures, this may provide a likely explanation of the low uptake of vaccination in the absence of a disease, it is clear that observability is less important given the customary notions of illness and health. As described above, the dynamism and conict between hot and cold states, is not always a directly observable phenomena. Hence, in this case, it is not likely that high levels of observability would be required

Livestock vaccine adoption among poor farmers in Bolivia for a particular intervention to be deemed a success or failure. Nevertheless, this is not to deny that observability is important or that the relation between wellbeing and vaccination requires further explication for the communities involved. Further, it is clear that reinvention was occurring in which vaccination was perceived as a treatment for underlying imbalances. In this manner, vaccination behaviour conformed to, rather than conicted with, existing notions of disease aetiologies. However, Rogers [16] contends that reinvention is a function of lack of understanding and tends to increase with the complexity of a technology. And indeed, the vast majority of participants were unsure or unable to answer how a vaccine worked. Nevertheless, from the results of the study Rogers contention appears too simplistic and does not adequately reect the complexity of interaction between formal and customary knowledge. The nding is important for the new generation of vaccines currently under development [3,14]. Clearly the wider public good is served by strong, positive, collective behaviour with regard to vaccination adoption. Thus, on a collective level, the aim is to enhance vaccination coverage. But surely to meet this aim, on an individual-level, the goal must be for technology uptake to occur for the right reasons. Thus, for these vaccines to have a role in poverty alleviation there is an urgent need to develop more sophisticated tools for transfer knowledge which acknowledges the role of vaccination in animal health from a local epistemological perspective. Therefore, further research is required to better understand the particular cosmologies underpinning livestock-based livelihoods and the role of new and existing technologies within these systems.

2441
[8] Livestock Development Group. The livestock and poverty assessment methodology: A toolkit for practitioners. Reading: The University of Reading, http://www.livestock[development.org]; 2003. [9] Livestock Development Group. Poverty and participation: An analysis of bias in participatory methods. Report for DFID Social Development Fund. Reading: University of Reading, http://www.livestockdevelopment.org; 2003. [10] Livestock Development Group. Receptors, end-users and providers: The deconstruction of demand-led processes and knowledge transfer within animal health research. Report commissioned by the Wellcome Trust. London: Wellcome Trust; 2004. [11] LID. Strategies for improving DFIDs impact on poverty reduction: A review of best practices in the livestock sector. Crewkerne: Livestock in Development; 1998. [12] Fandamu P, Thys E, Duchateau L, Berkvens D. Perception of cattle farmers of the efcacy of east coast fever immunization in Southern Zambia. Trop Anim Health Prod 2006;38(1):916. [13] Logan M. Selected references on the hotcold theory of disease. Med Anthropol Newslett 1975;6(2):814. [14] Makkar H, Viljoen G, editors. Applications of gene-based technologies for improving animal production and health in developing countries. The Netherlands: Springer, Dordrecht; 2005. [15] Ostlund LE. Perceived innovation attributes as predictors of innovativeness. J Consum Res 1974;1(2):239. [16] Rogers E. Diffusion of innovations. 5th ed. New York: The Free Press; 2003. [17] Rogers E, Shoemaker F. Communication of innovations: A crosscultural approach. New York: The Free Press; 1971. [18] Zambrano G, Revilla J, Paucar R. Sharing the fruits of Pachamama. In: Haverkort B, Hiemstra W, editors. Food for thought: Ancient visions and new experiments of rural people. Luesden: ECT/Compass; 1999. [19] Davis F. Perceived usefulness, perceived ease of use and user acceptance of information technology. MIS Quart 1989;13(3):31940. [20] Manning P, Cullum-Swan B. Narrative, content, and semiotic analysis. In: Denzin N, Lincoln Y, editors. Handbook of qualitative research. Thousand Oaks: Sage Publications; 1994. [21] Mahajan V, Peterson R. Models for innovation diffusion. London: Sage Publications; 1985. [22] Kristjanson P, Place F, Franzell S, Thornton PK. Assessing research impact on poverty: the importance of farmers perspectives. Agric Syst 2002:7392, 72. [23] Bauman LJ, Stein REK, Ireys HT. Reinventing delity: the transfer of social technology among settings. Am J Commun Psychol 1991;19:61939. [24] Humair J-P, Rizzi Buchs C, Stalder H. Promoting inuenza vaccination of elderly patients in primary care. Family Pract 2002;19:3839. [25] US Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. DHHS publication no. (PHS)\91-50212. Washington, DC: US Department of Health and Human Services; 1991. [26] Bhattacharyya A, Harris T, Kvasnicka W, Veserat G. Factors inuencing the rates of adoption of trichomoniasis vaccine by Nevada range cattle producers. J Agric Resour Econ 1997;22(1):17490. [27] Homewood K, Trench P, Randall C, Godelieve L, Bishop B. Livestock health and socio-economic impacts of a veterinary intervention in Maasailand: Infection-and-treatment vaccine against East Coast Fever. Agric Syst 2006;89(2/3):24871. [28] Beck R, Gong H. Effect of socio-economic factors on bovine somatotropin adoption choices. J Dairy Sci 1993;77(1): 3337.

Acknowledgement
The author would like to thank DFIDs Animal Health Programme for funding this work.

References
[1] Bastien J. Qollahuaya-Andean body concepts: a topographical-hydraulic model of physiology. Am Anthropol 1985;87(3):595611. [2] Christensen C. The innovators dilemma. Boston: Harvard Business School Press; 1997. [3] Cowan T, Becker G. Biotechnology in animal agriculture: Status and current issues. CRS Report for Congress, http://www.usis.it/pdf/other/RL33334.pdf; March 2006. [4] Dusenbury L, Brannigan R, Falco M, Hansen W. A review of research on delity of implementation: implications for drug abuse prevention in school settings. Health Educ Res Theory Pract 2003;18(2):23756. [5] Engel P. Facilitating innovation: An action-oriented approach and participatory methodology to improve innovative social practice in agriculture. PhD thesis. Wageningen: The University of Wageningen; 1994. [6] Foster G. On the origin of humoral medicine in Latin America. Med Anthropol Quart 1987;1(4):35593. [7] Heffernan C, Misturelli F. The delivery of veterinary services to the poor: Findings from Kenya. A report for DFIDs Animal Health Programme. London: DFID, http://www.lives[tockdevelopment.org]; 2000.

2442
[29] Rezvanfar A. Communication and socio-personal factors inuencing adoption of dairy farming technologies amongst livestock farmers. Livestock Res Rural Dev 2007; 19(3), http://www.cipav.org.co/lrrd/lrrd19/3/rezv19033.htm. [30] Bolorunduro P, Iwuanyanwa I, Aribido S, Adeshinwa A. Effectiveness of extension dissemination approaches and adoption

C. Heffernan et al.
levels of livestock and sheries technologies in Nigeria. Food Agric Environ 2004;2(1):298302. [31] Feiler L, Georee J, Yariv L. An Experimental Study of Selective Exposure. Pasedena, California: California Institute of Technology; 2006, http://www.hss.caltech.edu/ lauren/SelectiveExposure.pdf.