Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages
Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages
复制标题
DOI：
10.1057/s41599-019-0226-9
复制
发表时间：
2019-02-26
影响因子：
4
通讯作者：
Zaw, Yuzana Khine
中科院分区：
文献类型：
--
作者：
Charoenboon, Nutcha;Haenssgen, Marco J.;Zaw, Yuzana Khine
到2050年，抗生素耐药性（AMR）每年可能导致1000万人死亡，使其成为全球卫生议程上的首要项目。目前的全球政策反应是多方面的，其中主要通过教育和宣传运动处理人们的用药等行为方面。社会科学文献表明，在全球提高认识运动中跨语境翻译医学知识可能会造成误解和不良行为反应。然而，AMR传播在低收入和中等收入背景下的后果在很大程度上仍然没有记录。为了应对经验知识差距，本研究提出了三个北方泰国村庄的教育活动的案例研究，其目的是促进对后果的理解（及其背景影响）时，在农村中等收入的环境中分享与农业有关的信息。该活动的信息以世界卫生组织提高对抗生素耐药性认识的材料为基础。混合方法的研究设计为分析提供了信息。描述性差异和地理分析的基础上，完整的村庄人口普查调查，3个月的时间间隔（n = 1096）补充定性数据和教育活动的意见。基本的概念框架假设成果是通过以下方式产生的：（a）直接参与和间接接触（海报、对话），取决于转化过程以及物质和卫生系统背景;（B）活动对村庄社交网络的影响。结果表明，参与者将他们与健康有关的态度和行为与活动的建议相一致。除了语言障碍（排除了非泰语人士）之外，分散的当地卫生保健景观限制了村民采取行动的能力，但也为非正式的抗生素销售提供了市场机会，与平行但被误解的公共卫生运动的互动产生了谣言和阻力。社区成员的社会支持也促进了健康行为，但不受活动的影响。作为对公众参与抗生素耐药性的最详细的混合方法评估之一，本研究挑战了目前提高认识运动在改变人口行为方面的主导地位。我们呼吁对未来的运动进行全面的混合方法评估，强制性的双向知识交流组件，以及替代性的行为改变方法，这些方法可以应对诸如不稳定性而不是所谓的知识赤字等背景约束。
Antimicrobial resistance (AMR) threatens to cause ten million deaths annually by 2050, making it a top item on the global health agenda. The current global policy response is multi-faceted, wherein behavioural dimensions like people's medicine use are being predominantly addressed with education and communication campaigns. The social sciences literature suggests that cross-contextual translation of medical knowledge in global awareness campaigns can create misunderstandings and adverse behavioural responses. However, the consequences of AMR communication in low-income and middle-income contexts remain largely undocumented. In response to the empirical knowledge gap, this study presents the case study of educational activity in three northern Thai villages with the objective of contributing to the understanding of the consequences (and their contextual influences) when sharing antibiotic-related information in a rural middle-income setting. The activity's messages were based on World Health Organization AMR awareness-raising material. A mixed-methods research design informed the analysis. Descriptive difference-in-difference and geographical analysis based on complete village census surveys with a 3-month interval (n = 1096) was supplemented by qualitative data and observations from the educational activity. The underlying conceptual framework hypothesised that outcomes arise via (a) direct participation and indirect exposure (posters, conversations), subject to translational processes and physical and health system contexts; and via (b) the activity's influence on village social networks. The outcomes demonstrated that participants aligned their antibiotic-related attitudes and behaviours with the activity's recommendations. Aside from language barriers (which excluded non-Thai speakers), fragmented local healthcare landscapes limited villagers' ability to act on the activity but also provided a market opportunity for informal antibiotics sales, and interactions with parallel yet misunderstood public health campaigns created rumours and resistance. Social support from community members also promoted healthy behaviours but remained unaffected by the activity. As one of the most detailed mixed-method assessments of public engagement in AMR, this study challenges the current dominance of awareness-raising campaigns to change population behaviours. We call for comprehensive mixed-method evaluations of future campaigns, mandatory two-directional knowledge exchange components, and alternative behaviour change approaches that respond to contextual constraints like precarity rather than alleged knowledge deficits.