Engaging communities to address antimicrobial resistance: Identifying contextualised and sustainable community-led solutions in low resource settings

This study will make a significant contribution to addressing antimicrobial resistance (AMR). AMR is a major challenge to global health, food sustainability and security, and socio-economic development. If we do not address AMR, in the future we will be less able to prevent and treat common infectious diseases, and major surgery, cancer chemotherapy and organ transplants will become much more dangerous in the absence of effective antibiotics. The quantity of antimicrobials used in food production internationally is at least the same as that in humans, and in some places is higher. Some last-resort antibiotics for humans are being used extensively in animals, and there are currently no replacements. There is a huge global effort to address AMR. One area that is emphasised in global guidance is the importance of raising public awareness on the issue. However, it is important to go beyond raising awareness and actively engage with individuals and communities, by enabling them to identify, develop and implement community-led sustainable solutions. To the best of our knowledge, community engagement approaches to address AMR have not been evaluated anywhere in the world. In order to address this gap, we have established a world-leading research group, which builds partnerships between six research organisations and project partners in Bangladesh, Nepal and the United Kingdom. Members of this team have already developed two approaches to using community engagement to address AMR. The Community Dialogue Approach (CDA) has previously been used in several countries to address other health issues and we adapted it to address the misuse of antibiotics by humans in Bangladesh. Participatory Video (PV) is an approach whereby community members are supported to make short films about issues that concern them and these films are used to demonstrate to policy makers how people interact with the issue. We adapted this approach to explore the misuse of antibiotics in Nepal. In this study, we plan to combine these two approaches: The PV will help us to identify critical themes to address through the CDA, and it will help to raise the profile of community engagement on national and international policy agendas. At the start of this study, we will use PV (and other methods) to help us develop materials that are needed to deliver the CDA in Bangladesh and in Nepal. We will ensure that these materials address different issues that impact on AMR in rural communities - these include the ways that humans use antimicrobials, the way they are used for animals, and the way they enter into soil and water. We will implement the CDA across the district of Comilla in Bangladesh to see whether it changes people's knowledge, attitudes and reported behaviour in relation to AMR. We also want to find out how much it would cost to implement it on a national scale and to see whether it is equitable i.e. that it reaches and is used by different population groups, such as males and females, and the poorest in society. We will also introduce our approach into a hill region in Nepal so that we can find out how easy or difficult it is to deliver it in different types of settings. Finally, we will use the outputs from the PV methods - especially films that have been made by community members - to help us to increase awareness of the importance of community engagement in Nepal, Bangladesh, the UK and beyond. This study will make a major contribution to our understanding of how to address AMR by working with individuals and communities to enable them to identify, develop and implement solutions. It will also help us to understand how our approach to community engagement can be implemented on a large scale and in different settings. Ultimately, we aim to ensure that this study influences policy makers internationally to include community engagement approaches as one of the key strategies for addressing AMR.