Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam.
Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam.
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DOI：
10.3389/fpubh.2022.822873
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发表时间：
2022
影响因子：
5.2
通讯作者：
Lewycka, Sonia
中科院分区：
文献类型：
--
作者：
Cai, Huong Thien Ngoc;Tran, Hang Thi;Nguyen, Yen Hong Thi;Vu, Giao Quynh Thi;Tran, Thao Phuong;Bui, Phuong Bich;Nguyen, Huong Thi Thu;Pham, Thai Quang;Lai, Anh Tuan;Van Nuil, Jennifer Ilo;Lewycka, Sonia
由于容易获得非处方药以及对抗生素的作用了解甚少，越南社区中人类和动物的抗生素使用率很高。这导致抗生素耐药性水平达到世界最高水平。为了解决这个问题，我们开发了一种参与式学习和行动（PLA）干预措施。在这里，我们描述了在开发和测试这一干预措施以准备在越南北部进行大规模 One Health 试验时遇到的挑战和经验教训。我们使用社区主导的摄影测试了 PLA 方法，然后反思了这种方法在实践中的运作方式。我们审查和讨论了实施文件，并制定和完善了主题。确定了与挑战和经验教训相关的五个主题：了解当地情况、利益相关者关系发展、参与者招募、建立信任和动力以及参与抗生素和抗菌素耐药性 (AMR) 主题。与国家和地方当局的伙伴关系为与社区建立关系提供了重要基础，并提高了活动的知名度和可信度。合作伙伴关系的发展需要管理关系、明确角色并适应不同的管理风格。在招募参与者时，我们必须平衡自上而下和自下而上方法的偏好。建立信任和动力需要时间，并且由于社区中研究团队的存在有限而受到挑战。在整个过程中，我们重新讨论了围绕期望和适当激励措施的公开讨论。经济激励提供了参与的最初动力，而集体知识、社会关系、帮助社区的愿望和新技能等无形的好处则维持了长期动力。由于缺乏对抗菌素耐药性问题的认识和重要性，影响了最初的动机。在讨论这个话题的复杂性时，通过使用通用和简化的语言来增进相互理解是有帮助的。随着研究的进展，参与者对抗菌素耐药性有了更多的了解，了解它与自己的担忧有何关系，并将自己的想法融入到活动中，从而产生了一种主人翁意识。 PLA 可以成为刺激社区行动并将人们聚集在一起解决共同问题的有力方式。了解当地权力结构的细微差别，并留出时间发展利益相关者关系和建立共识，是设计参与项目时的重要考虑因素。
Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects.
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影响因子：
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DOI：
10.1016/s2214-109x(21)00024-3
发表时间：
2021-05
期刊：
The Lancet. Global health
影响因子：
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