Embedding community and public voices in co-created solutions to mitigate antimicrobial resistance (AMR) in Thailand using the ‘Responsive Dialogues’ public engagement framework

Abstract

The use of antimicrobials in Thailand has been reported as one of the highest in the world in human and animal sectors. Our engagement project aimed to improve our understanding of the issue of antimicrobial use and antimicrobial resistance (AMR) among adult Thai communities, and to co-create locally relevant solutions to AMR, especially those focusing on raising awareness to improve related policies in Thailand.We conducted a series of online and in-person ‘conversations’ according to Wellcome’s ‘Responsive Dialogues’ engagement approach, designed to bring together different voices to solve complex problems such as AMR. This approach enabled key AMR stakeholders and policy makers to hear directly from communities and members of the public, and vice versa. Conversations events took place between 25 November 2020 and 8 July 2022, and we engaged 179 AMR key stakeholders and members of the public across Thailand.The issues we found were: there were quite a lot of misunderstandings around antimicrobials and AMR; participants felt that communications and engagement around antimicrobial resistance had limited reach and impact; asking for and taking antibiotics for self-limiting ailments is a social norm in Thailand; and there appeared to be a wide availability of cheap antimicrobials. To mitigate the spread of AMR, participants suggested that the messages around AMR should be tailored to the target audience, there should be more initiatives to increase general health literacy, there should be increased availability of AMR related information at the local level and there should be increased local leadership of AMR mitigation efforts.Thaiclinicaltrials.org registrationTCTR20210528003 (28/05/2021)KEY MESSAGESWhat is already known on this topic⇒Antimicrobial resistance (AMR) is a complex and systemic problem, which will require collaboration from many sectors. Any policies and interventions to address AMR need to be specific to the local context, ethical, and consider the affected communities.What this study adds⇒The regional spread and the depth of our community ‘conversations’ (e.g. 2.5-3 days for in-person ‘conversations’) enabled us to explore topics and important elements of solutions around AMR, summarise common themes, and compare views across different regions and communities in Thailand.How this study might affect research, practice or policy⇒Our project revealed some important ‘building blocks’ or elements for AMR-related policy, in particular relating to communications and engagement: messages around AMR should be tailored to the target audience, there should be more initiatives to increase general health literacy, there should be increased availability of AMR related information at the local level and there should be increased local leadership of AMR mitigation efforts.