The use of creative arts to engage Nepali schools with antimicrobial-resistance and create positive behaviour change on health-seeking behaviours.

This project will apply the methodology and learnings from AH/R005869/1 to a new audience, children aged 9-11 in Nepali schools. This group emerged as key actors within health seeking behaviours including the purchasing of non-prescription antimicrobials in our original project, hence all partners wish to modify the initial project to reach this group. This will involve community co-production of an education programme based upon existing community engagement methodology which allowed Nepali communities to explore their relationship with the issue of antimicrobial resistance (AMR) through participatory filmmaking. AMR is a major One Health threat, particularly acute in developing countries such as Nepal due to growing populations, limited health infrastructure and the accessibility of antimicrobials without medical advice or prescription.

While the previous project engaged adult participants, our original research project highlighted the key role that Children in Nepal play in AMR-related health-seeking behaviour. They are frequently the member of the family sent to purchase non-prescription antimicrobials. The misuse of these drugs exacerbates AMR, but public understanding of this risk is low. Children especially have limited AMR knowledge or empowerment to change harmful behaviours because conversations regarding AMR are mainly held at Ministerial level and the risks of AMR are not currently taught in schools. Our co-produced education programme will use participatory arts to encourage children to share how their behaviours interact with AMR. This will significantly extend the community-level reach of the previous project, allowing children in Nepal to develop knowledge and confidence to facilitate changes in their own AMR behaviour, and spread this message through their communities.

In preparation for this education programme, the project will invest heavily in training community volunteers as facilitators. This will involve the re-engagement of AH/R005869/1 participants and the use of their original outputs (participatory films), both are integral to the community engagement aspect of our educational programme. They maximise the value of existing community resources, ensure Global-South ownership of the project, and provide local-contextualisation to help young people understand this complex 'One Health' issue. Existing AH/R005869/1 films will be used as educational resources and AH/R005869/1 participants will be trained as Community AMR Champions to facilitate the educational programme. Training will enhance their AMR knowledge and confidence whilst at the same time developing their skills in public speaking, working with children (including safeguarding and unconscious bias) and their understanding of participatory arts methodology. The training programme will then reach out to schools engaging head teachers, school nurses and subject specific teachers with the same training programme. Supported by Community AMR Champions, these participants will then co-produce the final content of the AMR education programme to be delivered in their school.

This project is designed to be scalable. Regular debriefing sessions with participants, robust evaluations of the both the education programme and facilitator training package will provide a rich dataset to assess the impact of community engagement and participatory arts methodology for creating behaviour change with regard to AMR. This will allow the creation of best-practice resources (manuals), allowing other practitioners to repeat this intervention. It will, moreover, allow the original research team to continue to engage the Nepali Ministry of Health and Population as it develops its national AMR action plan.

The aim of this project is to generate significant impact at Community level (Kathmandu Valley). This, in turn, will have impact at both the National (Nepal) and International levels. We are specifically aiming to change health seeking behaviours of children in the Kathmandu Valley in relation to antimicrobials whilst also producing outputs to continue conversations around AMR within their local communities. We foresee these outputs having a wider reach throughout Nepali communities and being used to influence policymakers as the participatory films produced in the originally funded project have done. Finally, we envisage the scalable nature of this project to have potential international significance in terms of promoting the use of community engagement techniques to tackle major health issues in other international settings.

Community/local level
Children in Nepal will become informed and empowered to make behavioural changes relating to antimicrobial resistance (AMR), particularly in terms of their own health seeking behaviours and the purchasing of antimicrobials.

Community AMR Champions and school stakeholders will increase their AMR knowledge and confidence as well as develop communication skills around this issue. This will ensure AMR conversations can continue within the community beyond the duration of the project, whilst also enhancing the transferable skill set of our Community AMR Champions.

National level
Nepali communities will have a wider pool of resources to draw on when considering AMR and how it relates to their daily lives. This will allow local connection to the often-abstract issue of AMR and facilitate meaningful suggestions for behavioural changes.

AH/R005869/1 films and newly created outputs, developed by children, can be used as tools to engage ministerial and governmental offices, allowing HERDi to continue to engage with Ministry officials and support the development of the Nepali National AMR action plan.

Beyond Nepal
The development of facilitator manuals for both the educational programme and the training package will ensure the local and national impacts of this project can be scaled and similar projects can be run in other countries.

The robust evaluation of both the training and educational programme will allow community engagement and participatory arts methods used within this project to be rigorously evaluated in terms of their scope to address a One Health challenge.

International development
The project will strengthen the credibility of HERDi as a leading authority on AMR within Nepal. Showcasing the film outputs of our previous collaboration to Ministry of Health officials spiked interest in developing this proposed training programme, and we hope that this project will help to continue to build the momentum generated through our previous work, allowing HERDi to influence AMR-related policy in Nepal.