A process for developing a sustainable and scalable approach to community engagement: community dialogue approach for addressing the drivers of antibiotic resistance in Bangladesh

Abstract

Background: Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. Methods: The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household surveywhich drew on the qualitative findings-to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level.

Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users’ Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh

“… 38–40 While promoting appropriate and safe use of antibiotics, increased community engagement through community dialogue is considered to be a promising approach for tackling AMR. 41 Before designing an effective AMS in the community, exploring people’s diverse behaviors, thoughts, and the cultural context is highly recommended, particularly while investigating antibiotic seeking, suboptimal use, and medication adherence. 41–43 However, there is little insight into why and in what context people seek antibiotic medicines, and how they use these medicines in Bangladesh during this pandemic.…”

“… 41 Before designing an effective AMS in the community, exploring people’s diverse behaviors, thoughts, and the cultural context is highly recommended, particularly while investigating antibiotic seeking, suboptimal use, and medication adherence. 41–43 However, there is little insight into why and in what context people seek antibiotic medicines, and how they use these medicines in Bangladesh during this pandemic. Previous studies in the pre-pandemic era explained the non-compliance and self-medication with antibiotics using demographic factors, 44 which often fail to understand from a cultural context the relationships and interlinkages between antibiotic seeking decisions and consumption behaviors, and the diversity of information available.…”

Evaluating the feasibility and acceptability of a community dialogue intervention in the prevention and control of schistosomiasis in Nampula province, Mozambique

“…CDFs could provide useful feedback and community perspectives on MDA and NTDs control issues to programme managers, which could be further integrated into future programming [ 39 ]. A recent paper describing the development of a CDA intervention for addressing the drivers of antibiotic resistance in Bangladesh paid particular attention to embedding the intervention within the existing health system, arguing that this provides a valuable and potentially sustainable entry point for subsequent scale-up [ 45 ].…”

Factors Influencing Antibiotic Consumption in Adult Population of Kazakhstan

“…Being concerned about the growing trend of antibiotic consumption, the WHO developed a global action plan to combat antibiotic resistance which urges all countries to increase public knowledge about antibiotics and antibiotic resistance through effective information and communication campaigns [ 4 ]. Thus, in order to develop effective intervention strategies, it is important to understand the level of awareness, attitudes, and perceptions of the population about antibiotics and antibiotic resistance [ 5 ]. We therefore conducted a cross-sectional study to evaluate awareness about antibiotic use and resistance among the adult population of Kazakhstan.…”