The use of creative arts to engage Nepali schools with antimicrobial-resistance and create positive behaviour change on health-seeking behaviours.

该项目将把AH/R005869/1的方法和知识应用于尼泊尔学校9-11岁的儿童。在我们最初的项目中，这一群体成为寻求健康行为（包括购买非处方抗微生物药物）的关键行为者，因此所有合作伙伴都希望修改最初的项目，以覆盖这一群体。这将涉及基于现有社区参与方法的社区合作制作一个教育方案，使尼泊尔社区能够通过参与式电影制作探索其与抗菌素耐药性问题的关系。抗菌素耐药性是“一种健康”的主要威胁，在尼泊尔等发展中国家尤其严重，因为这些国家人口不断增长，卫生基础设施有限，而且在没有医疗建议或处方的情况下可获得抗微生物药物。虽然以前的项目有成年人参与，但我们最初的研究项目强调了尼泊尔儿童在与抗微生物药物耐药性相关的求医行为中发挥的关键作用。他们经常是被派去购买非处方抗菌素的家庭成员。这些药物的滥用加剧了抗菌素耐药性，但公众对这种风险的认识很低。特别是儿童对抗菌素耐药性的知识或改变有害行为的能力有限，因为关于抗菌素耐药性的对话主要在部长级举行，而且目前学校没有教授抗菌素耐药性的风险。我们联合制作的教育节目将使用参与式艺术，鼓励儿童分享他们的行为如何与抗微生物药物耐药性相互作用。这将大大扩大之前项目在社区层面的覆盖范围，使尼泊尔的儿童能够发展知识和信心，以促进他们自己的抗菌素耐药性行为的改变，并在他们的社区传播这一信息。为筹备这一教育方案，该项目将大力投资培训社区志愿人员担任促进者。这将涉及AH/R005869/1参与者的重新参与和使用他们的原始产出（参与性影片），两者都是我们教育计划中社区参与方面的组成部分。它们使现有社区资源的价值最大化，确保全球南方对项目的所有权，并提供地方背景，以帮助年轻人理解这一复杂的“同一个健康”问题。现有的AH/R005869/1影片将被用作教育资源，AH/R005869/1参与者将被培训为社区抗菌素耐药性冠军，以促进教育计划。培训将增强他们的AMR知识和信心，同时培养他们在公共演讲、与儿童合作（包括保护和无意识偏见）方面的技能，以及他们对参与式艺术方法的理解。然后，培训方案将延伸到学校，让校长、学校护士和专门学科的教师参加同样的培训方案。在社区抗微生物药物耐药性冠军的支持下，这些参与者将共同制作抗微生物药物耐药性教育项目的最终内容，并在他们的学校交付。这个项目被设计成可扩展的。定期与参与者进行汇报，对教育计划和促进者培训包进行强有力的评估，将提供丰富的数据集，以评估社区参与和参与式艺术方法对在AMR方面创造行为改变的影响。这将允许创建最佳实践资源（手册），允许其他从业者重复此干预。此外，它将使原来的研究小组在尼泊尔卫生和人口部制定其国家抗菌素耐药性行动计划时继续与之接触。

This project will apply the methodology and learnings from AH/R005869/1 to a new audience, children aged 9-11 in Nepali schools. This group emerged as key actors within health seeking behaviours including the purchasing of non-prescription antimicrobials in our original project, hence all partners wish to modify the initial project to reach this group. This will involve community co-production of an education programme based upon existing community engagement methodology which allowed Nepali communities to explore their relationship with the issue of antimicrobial resistance (AMR) through participatory filmmaking. AMR is a major One Health threat, particularly acute in developing countries such as Nepal due to growing populations, limited health infrastructure and the accessibility of antimicrobials without medical advice or prescription. While the previous project engaged adult participants, our original research project highlighted the key role that Children in Nepal play in AMR-related health-seeking behaviour. They are frequently the member of the family sent to purchase non-prescription antimicrobials. The misuse of these drugs exacerbates AMR, but public understanding of this risk is low. Children especially have limited AMR knowledge or empowerment to change harmful behaviours because conversations regarding AMR are mainly held at Ministerial level and the risks of AMR are not currently taught in schools. Our co-produced education programme will use participatory arts to encourage children to share how their behaviours interact with AMR. This will significantly extend the community-level reach of the previous project, allowing children in Nepal to develop knowledge and confidence to facilitate changes in their own AMR behaviour, and spread this message through their communities. In preparation for this education programme, the project will invest heavily in training community volunteers as facilitators. This will involve the re-engagement of AH/R005869/1 participants and the use of their original outputs (participatory films), both are integral to the community engagement aspect of our educational programme. They maximise the value of existing community resources, ensure Global-South ownership of the project, and provide local-contextualisation to help young people understand this complex 'One Health' issue. Existing AH/R005869/1 films will be used as educational resources and AH/R005869/1 participants will be trained as Community AMR Champions to facilitate the educational programme. Training will enhance their AMR knowledge and confidence whilst at the same time developing their skills in public speaking, working with children (including safeguarding and unconscious bias) and their understanding of participatory arts methodology. The training programme will then reach out to schools engaging head teachers, school nurses and subject specific teachers with the same training programme. Supported by Community AMR Champions, these participants will then co-produce the final content of the AMR education programme to be delivered in their school. This project is designed to be scalable. Regular debriefing sessions with participants, robust evaluations of the both the education programme and facilitator training package will provide a rich dataset to assess the impact of community engagement and participatory arts methodology for creating behaviour change with regard to AMR. This will allow the creation of best-practice resources (manuals), allowing other practitioners to repeat this intervention. It will, moreover, allow the original research team to continue to engage the Nepali Ministry of Health and Population as it develops its national AMR action plan.