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

让社区参与解决抗菌素耐药性问题：在资源匮乏的环境中确定因地制宜、社区主导的可持续解决方案

• 批准号: MR/T029676/1
• 负责人: Rebecca King
• 金额: $ 281.91万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT029676%2F1
• 关键词: Engaging; communities; address; antimicrobial; resistance

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.

这项研究将为解决抗生素耐药性（AMR）做出重大贡献。抗生素耐药性是对全球健康、粮食可持续性和安全以及社会经济发展的重大挑战。如果我们不解决AMR问题，未来我们将无法预防和治疗常见的传染病，在缺乏有效抗生素的情况下，大手术，癌症化疗和器官移植将变得更加危险。国际上用于食品生产的抗菌剂数量至少与人类相同，在某些地方更高。一些人类最后使用的抗生素正在动物身上广泛使用，目前还没有替代品。全球都在努力解决AMR问题。全球指南强调的一个领域是提高公众对这一问题的认识的重要性。然而，重要的是要超越提高认识，积极与个人和社区接触，使他们能够确定、制定和实施社区主导的可持续解决方案。据我们所知，世界上任何地方都没有对社区参与解决AMR的方法进行过评估。为了弥补这一差距，我们成立了一个世界领先的研究小组，该小组与孟加拉国、尼泊尔和英国的六个研究机构和项目合作伙伴建立了伙伴关系。该小组的成员已经开发了两种利用社区参与解决AMR的方法。社区对话方法（CDA）以前曾在几个国家用于解决其他健康问题，我们对其进行了调整，以解决孟加拉国人类滥用抗生素的问题。宣传视频是一种支持社区成员制作与他们有关的问题的短片的方法，这些短片被用来向决策者展示人们如何与问题互动。我们采用这种方法来探索尼泊尔滥用抗生素的情况。在本研究中，我们计划将这两种方法联合收割机结合起来：PV将帮助我们确定通过CDA解决的关键主题，并将有助于提高社区参与国家和国际政策议程的形象。在本研究开始时，我们将使用PV（和其他方法）来帮助我们开发在孟加拉国和尼泊尔交付CDA所需的材料。我们将确保这些材料能够解决影响农村社区抗生素耐药性的不同问题，包括人类使用抗生素的方式，用于动物的方式，以及它们进入土壤和水的方式。我们将在孟加拉国的科米拉地区实施CDA，看看它是否会改变人们对AMR的认识、态度和报告的行为。我们还想了解在全国范围内实施该计划的成本，并了解该计划是否公平，即是否惠及不同的人口群体，如男性和女性以及社会最贫困者。我们还将把我们的方法介绍到尼泊尔的一个山区，以便我们可以发现在不同类型的环境中提供它的容易程度或困难程度。最后，我们将利用PV方法的成果，特别是社区成员制作的电影，帮助我们提高尼泊尔、孟加拉国、英国等国对社区参与重要性的认识。这项研究将通过与个人和社区合作，帮助他们识别、制定和实施解决方案，为我们理解如何应对AMR做出重大贡献。它还将帮助我们了解如何在不同环境中大规模实施我们的社区参与方法。最终，我们的目标是确保这项研究影响国际政策制定者，将社区参与方法作为解决AMR的关键战略之一。

项目成果

Addressing antimicrobial resistance through community engagement: a framework for developing contextually relevant and impactful behaviour change interventions.

• DOI: 10.1093/jacamr/dlad124
• 发表时间: 2023-12
• 期刊: JAC-antimicrobial resistance
• 影响因子: 3.4

Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study.

• DOI: 10.1186/s12913-023-10470-2
• 发表时间: 2024-01-11
• 期刊: BMC HEALTH SERVICES RESEARCH
• 影响因子: 2.8
• 作者: Parajuli, Ayuska;Garbovan, Lidis;Bhattarai, Basudev;Arjyal, Abriti;Baral, Sushil;Cooke, Paul;Latham, Sophia;Barrington, Dani J.;Mitchell, Jessica;King, Rebecca
• 通讯作者: King, Rebecca