The values and principles underpinning community engagement approaches to tackling antimicrobial resistance (AMR)

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ABSTRACT

This paper presents seven values underpinning the application of Community Engagement (CE) approaches to the One Health challenge of antimicrobial resistance (AMR) developed during an international workshop in June 2019. We define a value as a quality or standard which a CE project is aiming for, whilst a principle is an objective which underpins the value and facilitates its achievement. The values of Clarity, Creativity, (being) Evidence-led, Equity, Interdisciplinarity, Sustainability and Flexibility were identified by a network of 40 researchers and practitioners who utilise CE approaches to tackle complex One Health challenges including, but not limited to, AMR. We present our understanding of these seven values and their underlying principles as a flexible tool designed to support stakeholders within CE for AMR projects. We include practical guidance on working toward each value, plus case studies of the values in action within existing AMR interventions. Finally, we consider the extent to which CE approaches are appropriate to tackle AMR challenges. We reflect on these in relation to the tool, and current literature for both CE and AMR research. Authors and co-producers anticipate this tool being used to scene-set, road map and trouble shoot the development, implementation, and evaluation of CE projects to address AMR and other One Health challenges. However, the tool is not prescriptive but responsive to the context and needs of the community, opening opportunity to build a truly collaborative and community-centred approach to AMR research.

SPECIAL ISSUE:

• Antimicrobial Resistance

KEYWORDS:

• One health
• participation
• equity
• tool
• antibiotic

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

Authors extend their gratitude to inaugural members of the CE4AMR network including: Abriti Arjyal, Ayako Ebata, Anthony Waterkeyn, Ashim Shrestha, Catherine Stones, Dani Barrington, Deena Dejani, Emmanuel Tsekleves, Fariza Fieroze, Fiona Tomley, Ponnari Gopati, Helen Counihan, Ines Soria-Donlon, Jane Plastow, Jessica Mitchell, Juan Carrique-Mas, Juliet Waterkeyn, Lauran Wray, Lisa Dikomitis, Margaret Charleroy, Miriam Kayendeke, Muhammad Shafique, Naomi Bull, Nichola Jones, Nervo Verdezoto Dias, Nub Rajib, Paul Cooke, Ragu Raghavan, Rebecca King, Romi Giri, Rumanah Huque, Sarah Iqbal, Stuart Taberner and Sushil Baral. All mentioned above contributed to discussions, workshops and networking at the inaugural CE4AMR in Kathmandu, June 2019 where the content of this paper was developed. Authors would also like to thank the Ministry for Health and Population, Nepal, who supported the event in Kathmandu and their officials who contributed to the workshop activities and discussions.

Author contributions

JM, PC, SB, AA, RG, AS, RK planned and delivered the Kathmandu workshop upon which the manuscript is based. RK, PC, SB and JM conceived the scope of the publication, JM lead analysis and wrote the manuscript with support from RK and PC. NB, CS, ET attended the workshop and provided case study interviews for the publication, NV attended the workshop and provided critical feedback on the first iteration of the publication. All authors reviewed, commented on, and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

This publication does not report on original research and therefore is not attached to an ethics application. However, all co-producers attending the Kathmandu workshop did provide free, informed and written consent to take part in the workshop, be filmed and recorded during the event in the knowledge that their discussions would be utilised to inform this manuscript and several other CE4AMR outputs.

Paper context

Community engagement (CE) approaches are used to meaningfully engage people and create positive behaviour change. However, as yet these methods have been under-utilised in the field of AMR. We summarise discussions with a group of experts on the potential for CE to be utilised within AMR. We present key values and principles underpinning CE in a tool designed to guide interventions in the AMR sphere, and exemplify this with recent case studies.

Additional information

Funding

This work was supported by AHRC/MRC GCRF: Sourcing Community Solutions to Antibiotic Resistance in Nepal [AH/R005869/1] and AHRC/GCRF Praxis: Arts and Humanities for Global Development [AH/R005354/1].