We worked collaboratively to design our research questions over a period of several months. This process ensured projects considering different AMR challenges, and utilising different CE approaches, were confident that the questions would appropriately capture their experiences and learnings.
Our working definition of Community Engagement: We understand community engagement (CE) to be a participatory process through which equitable partnerships are developed with community stakeholders, who are enabled to identify, develop and implement community-led sustainable interventions to issues that are of concern to them and to the wider global community. This approach can result in bespoke local solutions to addressing the drivers of AMR, which align with the priorities and needs of communities.
- What constitutes the ‘community’ that we are engaging with?
- What do we mean by ‘community’ in practice?
- How do definitions of ‘community’ engage, or ignore, complex issues around, for example, gender and intersectionality?
- How do social, cultural, political, geographic and other contexts impact CE activities?
- What lessons can we learn from the Cluster’s experience in a wide range of settings?
- What (CE) strategies have been utilised to understand the context in which AMR develops in LMICs and what are the advantages/disadvantages of these?We will discuss, identify, collate and evaluate implementation materials that have been developed to address AMR through community engagement. These will be made available on the cluster website.
- Which One Health drivers (including behaviours) have we focused on when addressing AMR within specific LMIC communities?
On reflection does our work;
- Clearly address these behaviours and drivers?
- Create change on these behaviours and drivers?
- Miss certain behaviours or divers?
- Consider the context around these behaviours and drivers?
We are committed to equitable partnerships between policy makers, providers, academic researchers, communities and other relevant stakeholders when developing and implementing community engagement approaches. However, it is imperative that our approaches are framed by technical expertise i.e. that they are informed by scientific knowledge on appropriate strategies to address AMR. Our team of experts will identify key behavioural objectives (specific practices that individuals and communities implement that will impact on AMR) that have already been addressed within the constituent projects, as well as those that we recognise as gaps in our current practice.
- What are the best ways to make CE scalable and/orsustainable when tackling One Health AMR challenges?
Here we are referring to both the mode or model of engagement and the outputs developed from it. We understand that for some projects, discussions of feasibility and accessibility may be more appropriate at this stage. We would like to understand how the project eco-system facilitates feasibility, acceptability, scalability and sustainability.
- How do we identify the community needs?
- How can we build capacity within communities to align the One Health AMR agenda with their needs?
- (How) can we embed CE within existing systems?
We recognise that CE has been critiqued because those that have impacted on health outcomes are often time intensive and require high levels of financial and human resources. They can be difficult to sustain and replicate in low resource settings. Some of our constituent projects have focused on particular systems (e.g. the health system) within which CE can be embedded. These systems are valuable and potentially sustainable entry points that would allow for scale-up. However, in other contexts there may not be functioning systems within which we can embed CE. In that case, how can we identify community needs, build capacities, and align an AMR agenda with people’s felt needs? We will synthesise best practice on how to scale or sustain CE which may include embedding CE within existing systems.
- What are the most effective ways to engage with national and international stakeholders, beyond the community?We will build on the preliminary work undertaken in Kathmandu on raising CE as a strategy to address AMR on national and global policy agendas by identifying best practice with regards to networking within, between and beyond the Cluster projects.
- How do we define success, measure effectiveness, and learn from failures, when applying CE methods to the One Health AMR context?
- What metrics/indicators do we use to define success and failure?
- How can we learn from failures in our current contexts?
- What contextual factors appear to underpin success/failure?
- How to we share successes and failures?
We will consider processes and methods of evaluating CE activities which address AMR specifically in LMIC settings. We recognise that alongside health outcomes, methods of engagement must also be evaluated in order to understand the advantages and disadvantages of the CE approach used. We want failure to become a positive term, allowing for learning and refinement. Measures of success and failure can be qualitative, quantitative or impact based for example engaging with changes in community confidence, number of people engaged in an activity, policy making decisions relating to an activity etc.