Influenza education program increases surveillance capacity among rural, limited-English-speaking agricultural communities

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In Brief

Employees with limited or no English skills who work with swine or birds in rural agricultural areas may have little knowledge about influenza if they lack access to in-language educational programs. The Minnesota Center of Excellence for Influenza Research and Surveillance developed a train-the-trainer program to address such a need. Training materials cover practical, basic knowledge about influenza detection, prevention, and control in people, birds, and swine. The program was designed to educate rural populations in their own language, increase community capacity for influenza surveillance, and build relationships between emergency responders and agricultural employees.


Rural agricultural areas in the United States are key regions for influenza surveillance in wild and domesticated animals such as pigs and birds. Public health and veterinary agencies regularly monitor birds and swine for influenza strains that could cause agricultural harm or potential human illness. Because many immigrants and refugees live near or work at farms and animal processing plants, protecting their health and integrating them into flu surveillance and emergency response is a public health priority.

Specific issues
  • Employees and, in particular, their families living near or working at animal processing facilities may have received limited to no education about influenza in birds and swine, how to recognize infection, and how to prevent the disease in humans.
  • Refugee and immigrant populations working in rural areas may have limited to no understanding of English, making it difficult for them to receive traditional risk communication messages.
  • People living or employed in rural areas may not be connected to the local emergency response system, making it difficult for them to warn authorities about potential problems, receive emergency messages, and convey their needs.
The practice

The Minnesota Center of Excellence for Influenza Research and Surveillance (MCEIRS) and its partners developed a train-the-trainer program for delivering basic influenza information to limited- and non-English-speaking people living and working in rural agricultural areas of the US.

The Avian Influenza Rural Community Education Training is intended to be used by local health agencies or other community organizations as a way to train English-speaking community members to present influenza education in a classroom setting. Trainers can use a customizable presentation to deliver in-language information about influenza to their communities. The in-language presentations may decrease barriers to education about influenza and enhance local capacity for influenza surveillance among people who work most closely with animal vectors.

The topics of the presentation focus on practical information community members need to know about detection, prevention, and control of influenza in birds, swine, and people. The program requires approximately 3 hours to train a community member to deliver the presentation. The community presentation is designed to take only 1 hour and provides plenty of time for questions and other interaction.

Components of the Avian Influenza Rural Community Education Training include:

  • A Train-the-Trainer Course Guide that walks local health agencies through the process of identifying potential community trainers, defines the trainers’ roles and potential compensation, creates an interactive agenda and training environment, and helps trainers deliver community education on influenza. Tools provided in the guidebook include:
    • A sample flyer for recruiting community trainers
    • A sample training agenda
    • A training preparation checklist
    • Evaluation criteria for community trainers
    • Pre- and post-training questionnaires
    • An evaluation form for the training sessions
    • A community presentation preparation checklist to assist the trainers

Customizable presentations and speaker guides in English and Spanish provide practical knowledge about influenza for people who live near farms or animal processing plants. The presentation covers the following topics:

  • Influenza in people, including the time of year it most typically occurs, symptoms of flu, its spread and prevention, facts about influenza pandemics, and information on vaccine
  • Influenza in birds, including types of birds that can get influenza, type and severity of disease, facts about the H5N1 virus and avian flu in people, how avian flu spreads, ways in which to monitor avian health and report outbreaks, the safety of raising birds at home, information about how public health would respond if avian flu became an issue in the US, and potential venues where community members might receive communications about avian flu
  • Influenza in swine, including the difference between swine flu and the 2009 H1N1 pandemic virus, spread of influenza in swine, and issues with transmission of influenza between people and swine
  • Local emergency preparedness information or tips. The final slides cover information about preventing home cooking fires and using smoke detectors and fire extinguishers, but they could also be customized to a community’s particular emergency preparedness needs.
What made this practice possible?
  • Funding from the National Institutes of Health and coordinated development by MCEIRS, the Minnesota Department of Health, Nobles-Rock County Community Health Services, and Kandiyohi County Public Health
  • Community members in the rural towns of Worthington and Willmar, Minnesota, where large swine and turkey operations exist, participated in developing the program content and format. Employees were immigrants and refugees who spoke Amharic, Karen, Oromo, Somali, and Spanish.
  • Newly trained people each delivered at least one in-language presentation to their communities after local partners delivered the training during the project’s development.
  • Establishing a community training and presentation mechanism provides greater opportunities for local health and emergency response agencies to include limited-English-speaking populations in emergency communication efforts. Likewise, limited-English-speaking populations have a venue in which to make their preparedness and response needs and assets known to local authorities.

For more information on other MCEIRS influenza training programs, please visit:

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