Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion

Haenssgen, Marco Johannes; Charoenboon, Nutcha; Zanello, Giacomo; Mayxay, Mayfong; Reed‐Tsochas, Felix; Jones, Caroline; Kosaikanont, Romyen; Praphattong, Pollavat; Manohan, Pathompong; Lubell, Yoel; Newton, Paul N.; Keomany, Sommay; Wertheim, Heiman; Lienert, Jeffrey; Xayavong, Thipphaphone; Warapikuptanun, Penporn; Zaw, Yuzana Khine; U-Thong, Patchapoom; Benjaroon, Patipat; Sangkham, Narinnira; Wibunjak, Kanokporn; Chai-in, Poowadon; Chailert, Sirirat; Thavethanutthanawin, Patthanan; Promsutt, Krittanon; Thepkhamkong, Amphayvone; Sithongdeng, Nicksan; Keovilayvanh, Maipheth; Khamsoukthavong, Nid; Phanthasomchit, Phaengnitta; Phanthavong, Chanthasone; Boualaiseng, Somsanith; Vongsavang, Souksakhone; Greer, Rachel; Althaus, Thomas; Nedsuwan, Supalert; Intralawan, Daranee; Wangrangsimakul, Tri; Limmathurotsakul, Direk; Ariana, Proochista

doi:10.1136/bmjgh-2017-000621

Cited by 22 publications

(31 citation statements)

References 43 publications

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“…The public engagement activity Development and design. The educational activity was part of the public engagement portfolio of a social survey on antibiotics, medicine, and treatment-seeking behaviour in Chiang Rai, Thailand, and Salavan, Lao PDR (Haenssgen et al 2018b). Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The overall study was designed as an interdisciplinary project led by a social scientist and situated in the field of development studies with contributions from medical anthropology, economics, sociology, tropical medicine, and clinical research. It was designed to explore the role of marginalisation and knowledge in rural treatment seeking and antibiotic use, drawing on a framework that problematises behaviour at the interface between patients and the health system (Haenssgen et al 2018b). The disciplinary orientation of the educational activity followed the direction of the project, namely social sciences (development studies) rather than medical sciences.…”

Section: Social Network Strengthened By Acɵvitymentioning

confidence: 99%

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Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages

et al. 2019

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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 antibioticrelated 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-indifference 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 twodirectional knowledge exchange components, and alternative behaviour change approaches that respond to contextual constraints like precarity rather than alleged knowledge deficits.

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Section: Methodsmentioning

confidence: 99%

Section: Social Network Strengthened By Acɵvitymentioning

confidence: 99%

Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages

et al. 2019

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“…Our study was part of a research project to study rural medicine use in the context of marginalisation in Thailand (Chiang Rai) and Lao PDR (Salavan) [16]. In the present study, we assessed a half-day educational activity that interspersed two rounds of complete census surveys in two peri-urban villages near a district capital city in Salavan, Lao PDR's poorest province (see Figure 1 for a map and timeline of research activities) [17].…”

Section: Study Sitementioning

confidence: 99%

“…3 We developed the activity simultaneously for rural Thailand and rural Lao PDR as part of the larger project. Because of the cultural context and varying logistical constraints, the specific sessions in the two countries varied slightly [16,23]. For example, the Thai activity included traditional song and a poster-making exercise.…”

Section: Intervention (Public Engagement Activity)mentioning

confidence: 99%

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Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR

Haenssgen¹,

Xayavong²,

Charoenboon³

et al. 2018

Preprint

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Education and awareness raising are the primary tools of global health policy to change public behaviour. Considering the limitations of awareness agenda and the lack of social research to inform alternative approaches, our objective was to generate new empirical evidence on the consequences of antibiotic-related awareness raising in a low-income country context. We implemented an educational activity in two Lao villages to share general antibiotic-related messages, but also to learn about people’s conceptions and health behaviours. Two rounds of census survey data enabled us to assess the activity’s outputs, its knowledge outcomes, and its immediate behavioural impacts in a difference-in-difference design. Our panel data covered 1,130 adults over two rounds, including 58 activity participants and 208 villagers exposed indirectly via conversations in the village. We found that activity-related communication circulated among more privileged groups, which limited its indirect effects. Among participants, the activity influenced the awareness and understanding of “drug resistance,” while effects on attitudes were minor. Evidence on behavioural impacts was sparse and mixed, but the range of possible consequences included a disproportionate uptake of antibiotics from formal healthcare providers. Our study casts doubt on the continued dominance of awareness raising as a behavioural tool to address antibiotic resistance.

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Aligning global health policy and research with sustainable development: A strategic market approach

Haenssgen

2023

Sustainable Development

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Attaining Sustainable Development Goal 3 (SDG 3: Health and Well‐Being) faces a dual challenge of diminishing returns of established intervention designs, and a threat to future gains from complex inter‐connected global health challenges like antimicrobial resistance and global biodiversity loss. The growing movement of context‐sensitive approaches could help realise yet untapped potential for intervention designs, but contemporary global health policy and research still remain dominated by a model of individual market style choices. This paper therefore aims to support the development of global health planning processes that are more grounded and integrative across the SDGs. Reiterating calls for disruptive policy change is unlikely to impact the modus operandi of global health policy and research. This paper therefore builds on a logic that already finds widespread and intuitive application in their underlying planning processes: ‘the market’. However, it challenges the dominant supply‐and‐demand approach to healthcare markets and redefines them from a strategic marketing perspective. Translated to the interface of populations and health systems, the strategic market is a site for solving problems that are defined by people with multidimensional health needs. This framework offers four guiding questions to define the strategic market and six premises as a simple intellectual starting point and checklist for more grounded and inter‐sectorial action across the SDGs. The analysis of data from one of the largest behavioural survey data sets, covering 6683 villagers across China, India, Lao PDR and Thailand, demonstrates the relevance of the premises empirically.

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Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion

Cited by 22 publications

References 43 publications

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

Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR

Aligning global health policy and research with sustainable development: A strategic market approach

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