Antibiotics and Activity Spaces: An Exploratory Study of Behaviour, Marginalisation, and Knowledge Diffusion

抗菌素耐药性（AMR）是一个全球性的健康威胁，危及可持续发展目标的实现，特别是关于“良好健康和福祉”的目标3。“英国和全球领先的战略文件旨在改善人们的抗生素使用，以对抗和预防AMR，因此只关注提高认识的运动，但这种狭隘的方法存在概念，方法和经验上的弱点。作为回应，我们的研究旨在提高对患者与艾滋病相关的健康行为的理解，以激励低收入和中等收入国家（LMIC）采取更有针对性的非常规干预措施。谈到“意识和参与”和“非正规市场和获得抗生素”的主题，我们将调查三个研究问题：RQ 1。在患者的就医途径中，有问题的抗生素使用的表现和决定因素是什么？RQ 2.人们对行为健康系统干预的暴露会在相互竞争的医疗保健实践网络中扩散或消散吗？RQ 3.哪些替代指标有助于发现社区之间和社区内的有问题的抗生素行为？我们的跨学科方法框架内的行为共享活动空间。通过借鉴公共卫生，医学人类学，社会学和发展经济学的理论和工具，并通过关注DAC国家泰国和老挝的弱势农村居民，我们将能够生成创新的和前所未有的详细的开放访问调查数据，这些数据涉及与艾滋病相关的行为及其社会，经济和空间决定因素。我们的目标是最大限度地发挥与该地区其他正在进行的项目的互补性，这些项目（1）在临床环境中实施生物标志物检测和教育活动，（2）生成关于抗生素使用的跨文化模式的混合方法证据，及（3）与公众接触，提高全球健康意识。我们会采用严格的三阶段分层整群随机抽样设计，2,400名村民的抗生素使用水平代表性调查数据;在4个社区共2,400名村民中开展社会网络普查。使用卫星图像和数字数据收集工具，我们可以实现这些样本量的75%的成本传统的调查方法。根据我们的研究问题，我们将使用以下方法对泰国和老挝抗生素使用和健康行为的性质和变化产生新的见解：我们将（1）使用事件序列分析和多水平回归来调查技术和数字媒体以及患者的经济，社会和空间特征对抗生素不良使用的影响，（2）应用社会网络分析，了解知识和实践如何从临床干预传播到农村社区，和（3）使用潜在类别分析，通过易于收集的替代指标来检测抗生素使用的问题条件。在牛津热带网络的保护伞下-一个鼓舞人心的和有利的研究环境-该项目将通过世界领先的健康行为研究人员和团体的合作得以实现（KEMRI Wellcome Trust Research Programme; Kenya），卫生经济学和公众参与（泰国Mahidol牛津热带医学研究所;老挝LOMWRU），循证抗生素政策（牛津大学临床研究中心;越南）、社会网络分析（牛津大学CABDyN复杂性中心）、发展经济学（牛津大学发展技术和管理中心）和全球卫生培训（牛津大学热带医学和全球卫生中心）。官方发展援助的相关性来自我们的伙伴关系、能力建设活动以及对中低收入国家弱势群体的研究兴趣。我们从2017年1月1日至2018年10月31日申请249，804英镑用于这项泵启动研究。

Antimicrobial resistance (AMR) is a global health threat that endangers the achievement of the Sustainable Development Goals, especially Goal 3 on "Good Health and Well-Being." Leading UK and global strategy papers aiming at improving people's antibiotic usage to fight and prevent AMR thereby focus exclusively on awareness-raising campaigns, but this narrow approach suffers from conceptual, methodological, and empirical weaknesses. In response, our study intends to improve the understanding of patients' antibiotic-related health behaviour to inspire more targeted and unconventional interventions in low- and middle-income countries (LMICs). Speaking to the themes of "awareness and engagement" and "informal markets and access to antibiotics," we will investigate three research questions:RQ1. What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways?RQ2. Will people's exposure to a behavioural health systems intervention diffuse or dissipate within a network of competing healthcare practices?RQ3. Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?Our interdisciplinary approach frames behaviour within a shared activity space. By drawing on theories and tools from public health, medical anthropology, sociology, and development economics, and by focusing on vulnerable rural dwellers in the DAC countries Thailand and Laos, we will be able to generate innovative and unprecedentedly detailed open-access survey data on antibiotic-related behaviour and its social, economic, and spatial determinants. We aim to maximise complementarities with other ongoing projects in the region that (1) implement biomarker testing and education campaigns in clinical settings, (2) generate mixed-method evidence on cross-cultural patterns of antibiotic use, and (3) engage with the general public to improve global health awareness.We will apply a rigorous three-stage stratified cluster random sampling design to produce district-level representative survey data of the antibiotic use of 2,400 villagers; and we will carry out social network censuses in four communities with a total of 2,400 villagers. Using satellite imagery and digital data collection tools, we can realise these sample sizes at 75% of the cost of conventional survey approaches. Pursuant to our research questions, we will generate novel insights into the nature and variability of Thai and Lao antibiotic usage and health behaviours using the following methods: We will (1) use event sequence analysis and multilevel regression to investigate the impact of technology and digital media as well as economic, social, and spatial characteristics of patients on adverse antibiotic usage, (2) apply social network analysis to understand how knowledge and practice diffuse from clinical interventions into village communities, and (3) use latent class analysis to detect problematic conditions for antibiotic use through easy-to-collect proxy indicators.Under the umbrella of the Oxford Tropical Network-an inspiring and enabling research environment-this project will be made possible through collaboration across world-leading researchers and groups in health behaviour research (KEMRI Wellcome Trust Research Programme; Kenya), health economics and public engagement (Mahidol Oxford Tropical Medicine Research Unit in Thailand; LOMWRU in Laos), evidence-based antibiotic policy (Oxford University Clinical Research Unit; Viet Nam), social network analysis (CABDyN Complexity Centre; Oxford), development economics (Technology and Management Centre for Development; Oxford), and global health training (Centre for Tropical Medicine and Global Health; Oxford). ODA relevance follows from our partnerships, capacity building activities, and research interest in vulnerable groups in LMICs. We apply for £249,804 from 1 January 2017 - 31 October 2018 for this pump-priming research.