What is ‘antimicrobial resistance’ and why should anyone make films about it? Using ‘participatory video’ to advocate for community-led change in public health

Abstract

In this article, we discuss the role of participatory video (PV) as a tool for developing community-level solutions to ‘Antimicrobial Resistance’ (AMR) in Nepal. In recent years, PV has become an ever more popular tool in development contexts for supporting communities in low and middle income countries to raise awareness of issues that they do not feel are adequately represented in mainstream media. One area of growing interest in this regard is public health. However, PV has not, to date, been used to address AMR, currently considered to be one of the biggest public health issues we face globally. Placing our project within the wider context of ‘participatory documentary’ practice, we examine the world-view presented in the films this project generated, a dimension of such projects that is, somewhat curiously perhaps, often overlooked, with commentators tending to focus on the process of delivering PV, rather than the final products made. Here we are particularly interested in questions of power and how a close reading of the texts produced highlights the complexity of the power relationships at work in these films, which, in turn, can allow us to reflect in new ways on the processes at work in the project.

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

“…is appropriate, through to dissemination. For example, the film outputs of Case Study 1 [ 28 ] have integral creative and social value as well as being effective AMR resources or tools.…”

“…of Case Study 1 [28] have integral creative and social value as well as being effective AMR resources or tools. Evidence-led: Understanding previous, current and emerging work on AMR was a common theme of co-producer discussions.…”

“…Many co-producers stated that involving the community in project planning was a successful way of ensuring equitable partnerships developed from the offset as the community, research team and wider stakeholders could share existing knowledge and have their assumptions challenged within a safe space. Consideration of social norms in the community is also important with regards to equity, for example, Case Study 1 [28] realised through focus groups that there were gender differences in health-seeking behaviours which may impact on AMR. These findings shaped not only the way this project was evaluated but also allowed a follow-on project to consider gender differences in more detail.…”

High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings

“…Our study is in line with the WHO’s Global action plan on antimicrobial resistance, which calls for improved awareness of the problems arising from antibiotic resistance as stated in one of the five strategic objectives 85 . Indeed, raising awareness can be facilitated, for example, through the making of participatory videos 86 . As expected, in this study, resistance was commonly detected from stool samples collected from healthy volunteers in community settings.…”

Prevalence of multidrug-, extensive drug-, and pandrug-resistant commensal Escherichia coli isolated from healthy humans in community settings in low- and middle-income countries: a systematic review and meta-analysis

“…Some of these interventions targets community settings and some are tailored to contribute to combating the challenges of multidrug-resistance. Based on the WHO antimicrobial control plan strategic objectives [ 47 ], the interventions are classified into the following categories; i) those aimed at improving awareness and understanding of antibiotic resistance, for example, it is recommended that creating participatory videos (participatory documentaries) about antibiotic resistance would be useful in creating awareness in communities [ 65 ]; ii) activities strengthening knowledge through active and routine surveillance and research; iii) those focussing on the reduction of infections for example improvement in sanitation and hygiene, to reduce the demand of antibiotics; iv) those that optimize the use of antibiotics, for example, the formulation and implementation of regulations surrounding the use of antibiotics coupled with strict monitoring of antibiotic use as part of the policy, in addition to the development of new screening and diagnostic tools [ 66 ]; and v) interventions ensuring that there is a sustainable investment in combating antibiotic resistance. A global and interdisciplinary approach will fast track implementation of some of the interventions that may be universal, for example, the development of new screening and diagnostic tools [ 66 ].…”