Outputs and Impacts: Antibiotics and Activity spaces

Our project set out to interrogate the policy emphasis on education and awareness raising that had permeated global health policy responses to seemingly “irrational” behaviour of populations that accelerates the development of drug resistant microbes. Our project has contributed to this area empirically, conceptually, and methodologically.

Empirically, our research in rural Thailand and Lao PDR has challenged global education and awareness campaigns. We found that biomedical information is not only extremely difficult to communicate across cultural contexts. If successful, increased awareness of the problem of drug resistance is unlikely to fundamentally alter the behaviours at least of rural populations in Thailand and Lao PDR, and it can entail unintended behavioural consequences like increased antibiotic use or even people starting to sell antibiotics informally if they feel more confident about their medical knowledge. At the same time, we found that people’s health behaviour changes irrespective of their knowledge about drug resistance. When circumstance change, for example when people use a mobile phone during an illness or have a supporting family member around them, then their behaviour starts to fall in line with recommendations of the World Health Organisations to consult public healthcare professionals during an illness. Our research therefore provides a solid foundation for context-sensitive health behaviour change approaches.

Conceptually, we have developed analytical frameworks to conceptualise the relationship between people and the health system, and how factors in their social environment can influence their choices. This is particularly important for non-Western contexts, where healthcare systems are often fragmented and obscure, where rapid socio-economic transitions are taking place, and where external interventions into local health systems are common.

Methodologically, our study has contributed new ways of analysing people’s health behaviours as a sequence of steps (rather than as a one-off decision) embedded in a social network, and even analysing the sequences themselves as a network of actions. Our mixed methods research design has also provided new perspectives on the limitations and opportunities of cognitive interviewing as a survey testing technique in cross-cultural and social network surveys.

Haenssgen, MJ (2020). Interdisciplinary Qualitative Research in Global Development: A Concise Guide. Bingley: Emerald. doi: 10.1108/9781839092299

Haenssgen, MJ. (2019). New impulses from international development for more comprehensive and balanced public engagement evaluation. Global Health Action, 12(Suppl. 1), 1680067. doi: 10.1080/16549716.2019.1680067

Haenssgen, MJ, Charoenboon, N, Zanello, G, Mayxay, M, Reed-Tsochas, F, Lubell, Y et al. (2019). Antibiotic knowledge, attitudes, and practices: new insights from cross-sectional rural health behaviour surveys in low- and middle-income Southeast Asia. BMJ Open, 9:e028224. doi: 10.1136/bmjopen-2018-028224

Charoenboon, N, Haenssgen, MJ, Warapikuptanun, P, Xayavong, T & Khine Zaw, Y (2019). Translating AMR: A case study of context and consequences of antibiotic-related communication in three northern Thai villages. Palgrave Communications, 5(23). doi: 10.1057/s41599-019-0226-9

Haenssgen, MJ, Xayavong, T, Charoenboon, N, Warapikuptanun, P & Khine Zaw, Y (2018). The consequences of AMR education and awareness raising: outputs, outcomes, and behavioural impacts of an antibiotic-related educational activity in Lao PDR. Antibiotics, 7(4), 95. doi: 10.3390/antibiotics7040095

Haenssgen, MJ, Charoenboon, N, Zanello, G, Mayxay, M, Reed-Tsochas, F, Jones, COH et al. (2018). Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation, and knowledge diffusion. BMJ Global Health, 3(e000621). doi: 10.1136/bmjgh-2017-000621