Antibiotics and Activity Spaces: An Exploratory Study of Behaviour, Marginalisation, and Knowledge Diffusion

Lead Research Organisation: University of Oxford
Department Name: Tropical Medicine

Abstract

Antimicrobial resistance (AMR) is a global health threat that endangers the achievement of the Sustainable Development Goals, especially Goal 3 on "Good Health and Well-Being." Leading UK and global strategy papers aiming at improving people's antibiotic usage to fight and prevent AMR thereby focus exclusively on awareness-raising campaigns, but this narrow approach suffers from conceptual, methodological, and empirical weaknesses. In response, our study intends to improve the understanding of patients' antibiotic-related health behaviour to inspire more targeted and unconventional interventions in low- and middle-income countries (LMICs). Speaking to the themes of "awareness and engagement" and "informal markets and access to antibiotics," we will investigate three research questions:
RQ1. What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways?
RQ2. Will people's exposure to a behavioural health systems intervention diffuse or dissipate within a network of competing healthcare practices?
RQ3. Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?
Our interdisciplinary approach frames behaviour within a shared activity space. By drawing on theories and tools from public health, medical anthropology, sociology, and development economics, and by focusing on vulnerable rural dwellers in the DAC countries Thailand and Laos, we will be able to generate innovative and unprecedentedly detailed open-access survey data on antibiotic-related behaviour and its social, economic, and spatial determinants. We aim to maximise complementarities with other ongoing projects in the region that (1) implement biomarker testing and education campaigns in clinical settings, (2) generate mixed-method evidence on cross-cultural patterns of antibiotic use, and (3) engage with the general public to improve global health awareness.
We will apply a rigorous three-stage stratified cluster random sampling design to produce district-level representative survey data of the antibiotic use of 2,400 villagers; and we will carry out social network censuses in four communities with a total of 2,400 villagers. Using satellite imagery and digital data collection tools, we can realise these sample sizes at 75% of the cost of conventional survey approaches. Pursuant to our research questions, we will generate novel insights into the nature and variability of Thai and Lao antibiotic usage and health behaviours using the following methods: We will (1) use event sequence analysis and multilevel regression to investigate the impact of technology and digital media as well as economic, social, and spatial characteristics of patients on adverse antibiotic usage, (2) apply social network analysis to understand how knowledge and practice diffuse from clinical interventions into village communities, and (3) use latent class analysis to detect problematic conditions for antibiotic use through easy-to-collect proxy indicators.
Under the umbrella of the Oxford Tropical Network-an inspiring and enabling research environment-this project will be made possible through collaboration across world-leading researchers and groups in health behaviour research (KEMRI Wellcome Trust Research Programme; Kenya), health economics and public engagement (Mahidol Oxford Tropical Medicine Research Unit in Thailand; LOMWRU in Laos), evidence-based antibiotic policy (Oxford University Clinical Research Unit; Viet Nam), social network analysis (CABDyN Complexity Centre; Oxford), development economics (Technology and Management Centre for Development; Oxford), and global health training (Centre for Tropical Medicine and Global Health; Oxford). ODA relevance follows from our partnerships, capacity building activities, and research interest in vulnerable groups in LMICs. We apply for £249,804 from 1 January 2017 - 31 October 2018 for this pump-priming research.

Planned Impact

We expect our project to have impacts on antimicrobial resistance (AMR) in 3 main ways: (1) We strengthen social research capacity in AMR and public health in our research team and at the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Bangkok and its sub-units across Thailand and Laos. (2) We contribute conceptually to AMR policy and interventions in Thailand, Laos, and low- and middle-income countries (LMICs) more broadly. (3) The general public in rural Thailand and Laos can benefit from our research directly through public engagement and indirectly in medical and economical terms.
1: We will build capacity for social research in AMR and public health through (1) four research internships at MORU; (2) two research assistants (RAs), one of which will be an 18-month position at MORU; and (3) provision of research training courses for RAs and early-career research team members. Through the locally recruited RA and interns, mentoring, and research methods training, we aim to fill a gap in local social research capacity at MORU over the medium term. In addition, we offer valuable learning opportunities for placement students, interns, and the RAs through supervision by the team and through including them into knowledge exchange activities such as conferences, local public engagement, interaction with policy stakeholders, and academic publishing. These activities are also open to early-career researchers in our team in order to support them in developing international collaborative research capacity and an interdisciplinary AMR research profile.
2: We will influence AMR policy and dialogue conceptually by interacting with policy makers and intervention designers, and through four 8-week student placements with the MSc International Health and Tropical Medicine (IHTM; a global health degree at the University of Oxford). Policy workshops and meetings will be held at project beginning and end to discuss existing AMR policies and interventions, gather inputs on priority policy actions, and share our research findings to broaden the presently narrow and awareness-centred approach to antibiotic-related patient behaviour in national and global policies. We aim to involve ministries of public health in Thailand and Laos; aid organisations working in AMR awareness; and representations of the World Health Organization. The placement projects for MSc IHTM students open another route to contributing to global AMR policy by helping to build a new generation of global health leaders. The MSc IHTM offers interdisciplinary global health training primarily for students with a medical background from LMICs; our placement projects will thereby enable students to appreciate the complexity of treatment-seeking behaviour, the relationship between clinical interventions and popular practice, and the trade-offs in AMR health policy making.
3: Our research impact on the general public in Thailand and Laos arises directly from public engagement, and indirectly from our impact on AMR policies. We will address the public directly through infographic summaries of our research and interact with them in local engagement activities such as science cafés in Thailand and Laos. These activities aim to improve the understanding of AMR and the factors that affect people's behaviour, utilising the existing public engagement infrastructure at MORU in Bangkok. Our placement projects and internships can focus specifically on such public engagement activities. Indirect impact will arise from new AMR policies that help to limit problematic antibiotic use and thus one of the factors underlying AMR and its associated disease burden and economic consequences. Novel policy responses based on our research may also address contextual factors that limit people's healthcare decisions, for example cash transfer programmes to improve the well-being of disadvantaged groups with a coinciding reduction of antibiotic overuse.

Publications

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Haenssgen MJ (2018) It is time to give social research a voice to tackle antimicrobial resistance? in The Journal of antimicrobial chemotherapy

 
Title Tales of Treatment Photo Exhibition 
Description We hosted a photo exhibition series entitled "Tales of Treatment" in Bangkok (Art Gallery 23), Chiang Rai (Tai tea shop and bar), Oxford University, and the Warwick Arts Centre. The exhibition arose directly from our field research in Southeast Asia, in which we wanted to understand rural health behaviour and medicine use to inform this subject. More than 15 different ethnic groups participated in our research as we travelled through 72 villages in northern Thailand. But there was much that our questionnaires and interviews could not capture. As our local survey teams shared experiences of herbalists curing broken bones and spiritual healers summoning ghosts, we wondered, "What was the meaning and significance of these practices?" Our research participants permitted us to share their stories, which were documented by the talented members of our survey team. "Tales of Treatment" narrated 16 photographic stories of traditional healing as a dying craft among ethnic minority groups in northern Thailand. Stories of herbal medicine, ghost doctors, sacred books of chants, and ceremonial posts highlight that healing maintains firm though waning links to local knowledge and belief systems even in an economy and society transitioning as rapidly as Thailand's. However, the exhibition also highlighted subtle contradictions and tensions in global health policy and research - for instance in the field of antimicrobial resistance, which is regarded a global health priority and a threat to achieving the 2030 Sustainable Development Goals. The stories demonstrate that seemingly modern policy tools to find herbal and non-medicinal alternatives for antibiotic treatment had been practised for centuries. This also invites reflection on critiques of the "pharmaceuticalisation" of traditional medicine (where herbal medicine is administered in capsules), seeing that traditional herbalists have used capsules, too, and for very pragmatic reasons. The exhibition attracted a wide range of visitors, including medical doctors, NGO staff, United Nations staff, research institutes, Thai government departments and schools, university students, researchers and other university staff, and general members of the public interested in photography and medicine. The exhibition was joint work between research project leader Mr Marco J Haenssgen, research officer Ms Nutcha (Ern) Charoenboon, and research interns Ms Patthanan (Mind) Thavethanutthanawin, Ms Kanokporn (Joobjang) Wibunjak, and Ms Penporn (Yok) Warapikuptanun. The event at the Warwick Arts Centre was supported by the University of Warwick's Humanities Research Fund, the Global Research Priority on Connecting Cultures, and the Department of Global Sustainable Development at the University of Warwick. 
Type Of Art Artistic/Creative Exhibition 
Year Produced 2018 
Impact The overall more than 500 visitors across our four venues engaged enthusiastically with the exhibits, the stories, and the exhibition hosts, typically spending 45-60 minutes at the exhibition. The feedback from these visitors has been overwhelmingly positive. For example, of the 23 feedback forms received during the latest exhibition at the Warwick Arts Centre, 100% of the feedback stated that the exhibition was worth visiting, and 96% "learned something new" at the exhibition. For the project itself, this was an opportunity to cultivate and benefit from the talent of our team, and to learn from the knowledge or our participants, enabling us to explore a perspective of healing and treatment that we could not have witnessed otherwise. The latest exhibition at the Warwick Arts Centre has also paved the way for closer collaboration with artists and visual media in future research projects. 
URL http://warwick.ac.uk/mjhaenssgen/talesoftreatment
 
Description 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.
Exploitation Route Academic impact has materialised from our project through first follow-up studies that investigate the role of contextual change e.g. in the area of precarious employment on people's treatment-seeking behaviour and antibiotic use. This is also the basis for the current development of a large funding proposal for the GCRF call on "Health in Context," which speaks directly to the new questions raised by our project. The immense extent and detail of our quantitative and qualitative data that we collected in this pump-priming project also enables an active publication pipeline in high-ranking development studies and global health journals for the coming three years.
As mentioned in the narrative impact statement, we are confident that our extensive communication of our research insights and project outcomes through academic channels, social and mass media, and stakeholder consultations have contributed to a more nuanced policy narrative around awareness campaigns and behaviour change in AMR. Non-academic impacts have also materialised from our capacity building activities with local Southeast Asian research talent and Oxford University students in the MSc International Health and Tropical Medicine, for whom new research and training opportunities arose after participating in our project. Our arts-based public engagement has also been the starting point for further collaboration between our research team and the Warwick Arts Centre.
Sectors Education,Healthcare,Culture, Heritage, Museums and Collections

URL https://doi.org/10.13140/RG.2.2.15567.33448
 
Description The findings from this research challenge the emphasis on education and awareness raising as the primary means to change population behaviour in the context of antimicrobial resistance. The non-academic impacts of this project have materialised as follows: 1) We aimed to build socio-medical research capacity in Southeast Asia and beyond - Training and skill development for junior team members: We trained our research team members in survey research and offered them volunteering opportunities, which has resulted in follow-on employment e.g. for our Lao team members in WHO survey research projects. Our junior research team members have also participated in skills training through the NCRM and could present their contributions to the 6th ESRC NCRM Research Methods Festival in Bath (Jeffrey Lienert: Social network analysis; Nutcha Charoenboon: cognitive interviewing in cross-cultural contexts). Jeffrey Lienert is now working as a postdoctoral health economist; Nutcha Charoenboon is intending to pursue an academic career in the behavioural sciences. We further hosted research student placements and research internships. Our 2 placement students completed MSc theses on antimicrobial resistance in Southeast Asia and are now pursuing PhD programmes; our 4 research interns are now pursuing master's degrees and work in research organisations and the creative industry. We are confident that the experiences gained through our project have been instrumental in enabling these career trajectories. 2) We aimed to influence policy and practice around antimicrobial resistance From the early stages of our project, we have actively communicated our ongoing research insights through expert commentaries, blogs, and social media. As findings from our research have materialised, our communication strategy has also included traditional media such as the Times of India. Throughout the process, we have also liaised with local stakeholders from Thailand and Lao PDR to feed back our findings. As of 8 March 2019, we have presented our research on 20 occasions, targeting practitioners and researchers in public health and tropical medicine (e.g. International Health Conference in Oxford; Joint International Tropical Medicine Meeting in Bangkok), development studies (Development Studies Association Annual Conference in Manchester), as well as development practitioners (e.g. the Aid and International Development Forum 4th Asia Summit in Bangkok). Our communication work has also involved participation in public consultations by the UN Interagency Coordination Group on Antimicrobial Resistance and by the Joint Programming Initiative on Antimicrobial Resistance as well as contributions at the Wellcome Trust AMR First Call to Action. While the definitive impact of these activities cannot be ascertained, we are confident that we have contributed to a small but growing movement of social researchers who question the suitability of conventional public health tools to tackle drug resistance. We are now beginning to see changes and increasing nuance in the policy narrative, as for instance the Wellcome Trust report to the Second Call to Action states that, "knowledge transfer is not always sufficient to create real change. It goes beyond initiatives to simply raise awareness and comprehension of the problem. Instead, these interventions focus on moving people towards specific actions to reduce AMR, working with users to understand why they behave the way they do and the potential routes to facilitate change" (p. 6). This is very much the message of our research, which we have positioned vocally since 2017, and we therefore believe that we have contributed alongside other social scientists in the field to changes in the policy narrative. We also continue to pursue a longer-term strategy towards policy change, namely through academic training. We have successfully hosted student internships and placements involving students from the MSc International Health and Tropical Medicine at the University of Oxford, who have continued onto PhD programmes. In addition, we are developing teaching case studies on antimicrobial resistance based on our work, first parts of which have already been deployed in research methods teaching at the BASc in Global Sustainable Development at the University of Warwick. 3) We aimed to realise wider non-academic impact through public engagement activities Part of our public engagement portfolio involved bi-directional educational activities with villagers in the project sites in rural Thailand and Lao PDR. The objective of the activities was not to change behaviour, nor to convince villagers that their current behaviour was wrong. The activity rather aimed at sharing information and ideas about antibiotics and drug resistance in line with messages from the World Health Organization, but also at the team learning from the participating villagers about their antibiotic-related behaviour and conceptions as well as how they received the messages from the activity. Approximately 150 villagers participated in the half-day activities, which took place in between two rounds of complete census survey data collection in the same villages (involving more than 2,000 villagers in total). As a result, we were also in a privileged position to assess the outcomes of our public engagement on the village level. For example, the awareness of the words "drug resistance" increased from 56% to 86% (+30%) among the participants three months after the activity, compared to an improvement from 46% to 63% (+17%) in the villages more generally. However, our methodology also enabled us to detect unintended consequences of information sharing, which has challenged global public awareness campaigns more generally. For instance, one villager felt so much more confident about her antibiotic knowledge after the activity that she started selling antibiotics informally in her shop. Our research design is therefore also a good practice example to detect unintended consequences in public engagement with science more generally - which we are now in the process of feeding back to the public engagement community in academia. Our public engagement activities also involved the international photo exhibition series "Tales of Treatment," which showcased traditional healing in northern Thailand and its relationship to modernity and global health crisis. The exhibition was developed and curated by our Thai research team members, thereby building local capacity by offering opportunities for creative engagement with academic research. Altogether more than 500 visitors attended the exhibitions in Bangkok, Chiang Rai, Oxford, and Coventry (Warwick Arts Centre), and the feedback has been exceedingly positive. Testimonies included, for example, "So enlightening and so inspiring - who knew medicine was so fun!," "Incredibly interesting photo exhibition on the variety of medical treatments used in Asia," "Inspiring story!," and "Enchanting photography." But the exhibition was not only inspiring and thought-provoking for the visitors. The co-production of content together with villagers also enabled the research team to reflect on global health narratives and anthropological critiques. One of the seemingly modern policy responses in Thailand is to offer herbal and non-medicinal alternatives for antibiotic treatment, for example when people have a sore throat. Tales of Treatment documented that this herbal treatment for sore throats had been practised for centuries, but was increasingly marginalised by the expansion of modern Western medicine in Thailand. One wonders, does the survival of modern medicine then depend on the traditional treatment that it had crowded out over the years? At the same time, the prescription of capsules of herbal medicine as an alternative to antibiotics is considered problematic among some anthropologists. Their argument is that the "pharmaceuticalisation" - meaning the prescription of capsules of herbal medicine - reduces more comprehensive traditional treatment to an impersonal transaction. However, we learned from our stories that traditional herbalists themselves use capsules, too, and for very pragmatic reasons - without being agents of Western medical agendas. We continue to build on the artistic material produced by the team and are now in the process of developing a research publication on the co-production of knowledge in global health.
First Year Of Impact 2017
Sector Education,Healthcare,Culture, Heritage, Museums and Collections
Impact Types Cultural,Policy & public services

 
Description AMR Calls for Action and Public Consultations
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a national consultation
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/6637...
 
Description Global Research Priority on Connecting Cultures
Amount £750 (GBP)
Organisation University of Warwick 
Sector Academic/University
Country United Kingdom
Start 01/2019 
End 04/2019
 
Description Global Research Priority on International Development
Amount £1,500 (GBP)
Organisation University of Warwick 
Sector Academic/University
Country United Kingdom
Start 02/2019 
End 07/2019
 
Description Humanities Research Fund
Amount £1,920 (GBP)
Organisation University of Warwick 
Sector Academic/University
Country United Kingdom
Start 02/2019 
End 04/2019
 
Description Institute of Advanced Study Research Award
Amount £4,500 (GBP)
Organisation University of Warwick 
Sector Academic/University
Country United Kingdom
Start 03/2019 
End 07/2019
 
Title Guidance for verbal consent in survey research in low- and middle-income countries 
Description For our extensive rural health behaviour surveys in Thailand and Lao PDR, we received a waiver for written consent requirements in order to not unfairly exclude illiterate population subgroups and to ensure trust between the researcher and the rural respondents. Instead of participant-dated signature, we followed a verbal consent process in which (1) we sought permission from village leaders to carry out our survey in their villages; (2) the survey fieldworker read out (and records on audio tape) an oral consent script to the potential respondent and provides them with a printed copy of the participant information sheet; (3) the survey fieldworker asked the respondent to state her or his consent, name and date on audio record and (4) the survey fieldworker personally signed and dated a written record of oral consent. We provide a detailed justification and explanation of this verbal consent process 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact As methodological guidance, the justification and process description for taking oral consent in survey research has been incorporated into research methods teaching for undergraduate degrees in Global Sustainable Development at the University of Warwick. The associated research protocol reporting this process was published in BMJ Global Health and received 1525 full-text views and 187 pdf downloads by 8 March 2019. 
URL https://gh.bmj.com/content/bmjgh/3/2/e000621/DC1/embed/inline-supplementary-material-1.pdf?download=...
 
Title Recent advances in rural health survey methodology 
Description Our research team (PI, co-I, and two research officers) presented their unique contributions to the development of rural survey methodology at the 6th ESRC NCRM Research Methods Festival in Bath. The researchers presented: - Sampling health-related social networks in cross-country surveys (Nutcha Charoenboon) - Satellite-Aided Household Survey Sampling in Low- and Middle-Income Settings (Marco J Haenssgen) - Analysing healthcare sequences in social networks (Jeffrey P Lienert) - Use of accelerometry devices (e.g. Fitbit) to capture energy expenditure in agricultural and rural livelihoods (Giacomo Zanello) 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact Methodological innovation enables easier, more precise, and new ways of understanding human behaviour. That does not necessarily mean "big data" and algorithms. Innovation also arises from new combinations of conventional methods with other established techniques and new technologies. Combining rural health surveys with satellite imagery and accelerometers, social network surveys with cognitive interviewing, and healthcare access data with social network analysis does not just keep the methodological debates in survey research alive. It also enables new research, new questions, and a new view on human behaviour. We broadened the outreach of our work through a contribution to the Oxford Science Blog (http://www.ox.ac.uk/news/science-blog/overcoming-challenges-rural-surveys-developing-countries), the LSE Impact Impact Blog (http://blogs.lse.ac.uk/impactofsocialsciences/2018/06/18/how-eyes-in-the-sky-can-cut-survey-costs-and-enable-researchers-to-identify-key-but-hard-to-reach-populations/), the NCRM Audio Podcast (https://www.ncrm.ac.uk/resources/podcasts/mp3/NCRM_podcast_Marco_Ern.mp3), the presented tools and techniques are now available open-access on the NCRM website, and we plan to incorporate these advances in future collaborative work. 
URL https://www.ncrm.ac.uk/RMF2018/programme/session.php?id=C3
 
Title Open access data set 
Description Antibiotics and Activity Spaces is a survey of 5,885 villagers in Chiang Rai (Thailand) and Salavan (Lao PDR) to better understand (1) how people access healthcare and what actually counts as "problematic" antibiotic use, (2) whether antibiotic-related information from educational activities spreads or simply evaporates in village community networks, and (3) whether there are simple "early warning" indicators (e.g. specific symptoms) to detect whether people are likely to have "problematic" antibiotic use. The surveys were implemented by 10-member survey teams in each country between November 2017 and April 2018.The survey data sets are now being processed by the UK Data Service for public release and include a provincial-level representative rural survey of adults in Chiang Rai and Salavan, and a two-round census survey with a three-month interval in five villages across the two sites (3 in Chiang Rai, 2 in Salavan). 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact While the open-access data sets are being processed by the UK Data Service, they are already available to other researchers and to higher education. For instance, the survey data have been used in quantitative and qualitative research methods training in the BASc Global Sustainable Development at the University of Warwick in February and March 2019, offering students real-life data case studies to develop their research skills. The data sets are also currently being used to develop a teaching case study on health behaviour, technological change, and antimicrobial resistance. 
 
Description Antibiotic Awareness Week 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact As part of the Thai Antibiotic Awareness Week, research team member Ms Nutcha Charoenboon was invited to present our research as a poster at a high-profile event in Bangkok in November 2018. The event attracted a large number of medical practitioners, media representatives, health policy makers, and health researchers, all of whom expressed interest in our social research work (alongside medical research posters on antibiotic resistance). We subsequently hosted the poster open-access on social media (Twitter) and Research Gate with approximately 2,000 impressions and 115 poster engagements.
Year(s) Of Engagement Activity 2018
URL https://www.researchgate.net/publication/328389889_yaptichiwnalaeaphunthikickrrm_khwamsamphanthkhxng...
 
Description Blogs and Commentary 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact We produced the following blog contributions and commentaries as part of our research project

Haenssgen, MJ (2019). Antibiotic resistance: public awareness campaigns might not work. The Conversation: https://theconversation.com/antibiotic-resistance-public-awareness-campaigns-might-not-work-111926

Haenssgen, MJ, Zanello, G, Charoenboon, N & Lienert, J (2018). Overcoming the challenges of rural surveys in developing countries. Oxford Science Blog: http://www.ox.ac.uk/news/science-blog/overcoming-challenges-rural-surveys-developing-countries

Charoenboon, N, Haenssgen, MJ, Wibunjak, K, Thavethanutthanawin, P & Warapikuptanun, P (2018). Tales of treatment, of modernity and tradition, and of global health crisis. Oxford Science Blog: http://www.ox.ac.uk/news/science-blog/tales-treatment-modernity-and-tradition-and-global-health-crisis

Haenssgen, MJ & Charoenboon, N (2018). How eyes in the sky can cut survey costs and enable researchers to identify key but hard-to-reach populations. LSE Impact Blog: http://blogs.lse.ac.uk/impactofsocialsciences/2018/06/18/how-eyes-in-the-sky-can-cut-survey-costs-and-enable-researchers-to-identify-key-but-hard-to-reach-populations/

Haenssgen, MJ (2018). Using management thinking to fight the superbug crisis. Oxford Science Blog: http://www.ox.ac.uk/news/science-blog/using-management-thinking-fight-superbug-crisis

Haenssgen, MJ & Charoenboon, N (2018). Markets and pharmaceuticals: hardship, antibiotics, and markets for solutions. Antimicrobials in Society: http://www.antimicrobialsinsociety.org/commentary/markets-and-pharmaceuticals-hardship-antibiotics-and-markets-for-solutions/

Garrington, C & National Centre for Research Methods (2018). Using satellites to slash survey costs (interview with N Charoenboon). NCRM audio podcasts. https://www.ncrm.ac.uk/resources/podcasts/mp3/NCRM_podcast_Marco_Ern.mp3

Green Templeton College (2018). Social superbugs: thinking beyond health policy. Green Templeton College News. http://www.gtc.ox.ac.uk/news/news-articles/2010-social-superbugs-thinking-beyond-health-policy.html

Haenssgen, MJ, Charoenboon, N & Khine Zaw, Y (2018). It is time to give social research a voice to tackle AMR. Journal of Antimicrobial Chemotherapy, 73(4), 1112-1113. doi: 10.1093/jac/dkx533

Haenssgen, MJ, Charoenboon, N & Khine Zaw, Y (2017). Standardisation: Curing or obscuring AMR's language problem? Social science research for understanding drug resistant infections: AMR Social Science Champion Blog: http://amrchamp.blogs.ilrt.org/2017/08/12/standardisation-curing-or-obscuring-amrs-language-problem/
Year(s) Of Engagement Activity 2017,2018,2019
 
Description Educational activity 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact Popular antibiotic use is one dimension under the broader domain of antimicrobial (antibiotic) resistance. In low- and middle-income countries, antibiotics can often be easily accessed through informal providers (those without formal training or supervision) such as convenience stores. Consequently, people commonly resort to self-diagnosis and treatment patterns including the purchase and consumption of antibiotics for medically inappropriate reasons (e.g. taking antibiotics for viral infections). Understanding the drivers of antibiotic acquisition and use would therefore help to provide insights into targeting and reducing medically inappropriate antibiotic use which could contribute towards antibiotic resistance. In order to engage with the public about antimicrobial resistance, particularly in the domain of healthcare seeking (medically inappropriate antibiotic use), we carried out a series of bi-directional one-day educational activities for 25-30 participants in three of our survey villages in Chiang Rai (Thailand) and two villages in Salavan (Laos PDR). By engaging with the general adult village population in our field sites, we were able to share basic information about medicine use and healthcare-seeking behaviour, while also being able to learn about villagers' constraints and how they interpret our messages. As part of the survey, we are able to later understand the impact of our engagement activities, for instance whether and how our messages spread in the village communities. The educational activities involved sessions as varied as trading games, poster making, storytelling and role plays. These activities were developed on the basis of year-long qualitative research in Thailand and Laos by an international team of research interns from Thailand (Yok Penporn Warapikuptanun), Lao PDR (Kee Thipphaphone Xayavong), and Myanmar (Yuzana Khine Zaw) under the supervision of research officer Nutcha Charoenboon and Principal Investigator Marco J Haenssgen.
Year(s) Of Engagement Activity 2017,2018
URL https://www.antimicrobialsinsociety.org/commentary/markets-and-pharmaceuticals-hardship-antibiotics-...
 
Description Infographics 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact As part of our public engagement activities, we developed infographics that summarise some of our main research findings. We presented the infographics at our photo exhibitions "Tales of Treatment" in Thailand and UK, and circulated them on social media (esp. Twitter), where they received 29,000 impressions and 500 engagements.
Year(s) Of Engagement Activity 2018,2019
URL https://twitter.com/HaenssgenJ/status/1027060550293811200
 
Description Press release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact With assistance from the University of Warwick Press Office, we issued a press release on our research to inform the broader public as well as policy makers about the limitations of public awareness campaigns as a main health policy tool in tackling antimicrobial resistance. In coordination with the press release, we also issued an article in The Conversation about the same subject. This work was picked up by:
- Daily Nation (Kenya, 6 Mar 2019)
- Times of Malta (28 Feb 2019)
- Asian Scientist Magazine (28 Feb 2019)
- Medical Xpress (27 Feb 2019)
- News Medical (26 Feb 2019)
- Yahoo! News (26 Feb 2019)
- Alpha Galileo (26 Feb 2019)

Our Article in The Conversation, released on 26 February, received 2,900 reads by 8 March and was widely discussed on Twitter, where people commented on the new perspective offered through our challenge of public awareness campaigns. More broadly, our social media work on Twitter and Reddit in connection with the press release attracted approximately 40,000 impressions with 1,200 tweet engagements and a net 32 Reddit upvote score (as of 8 March 2019).

Prior to this press release, the research project leader was also interviewed by South East Asia Globe (2017), and an ESRC press release was issued on "Tackling antibiotic resistance: researchers slash survey costs with satellites" (2017).

As the project related closely to clinical research in northern Thailand, our external collaborations also provided the backdrop for part of our research student internships. The publications and press releases in this related work therefore also contributed to building the profile of our ESRC-funded research project. More specifically, a press release issued by the University of Warwick (https://warwick.ac.uk/newsandevents/pressreleases/antimicrobial_resistance_interventions) was picked up by the following media outlets:
- Asian Scientist (28 Feb 2019)
- ECN Magazine (14 Feb 2019)
- Med India (13 Feb 2019)
- International Travel and Health Insurance Journal (13 Feb 2019)
- ScienceDaily (12 Feb 2019)
- Times of India (12 Feb 2019)
- Medical Xpress (11 Feb 2019)
- Tekno Scienze Publisher (11 Feb 2019)
- Alpha Galileo (11 Feb 2019)
- Eureka Alert (11 Feb 2019)
Year(s) Of Engagement Activity 2018,2019
URL https://warwick.ac.uk/newsandevents/pressreleases/awareness_campaigns_not
 
Description Social Media 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact As part of our public engagement activities, we explored various social media channels for effective outreach beyond traditional media. Between September 2017 and March 2019, we reached 18,500 users with 6,700 post engagements on Facebook; 323,000 impressions and 6,200 tweet engagements on Twitter; and <10,000 impressions and engagements on LinkedIn and Reddit.
Year(s) Of Engagement Activity 2017,2018,2019
URL https://www.facebook.com/IntDevResearch
 
Description Tales of Treatment Photo Exhibition 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact We hosted a photo exhibition series entitled "Tales of Treatment" in Bangkok (Art Gallery 23), Chiang Rai (Tai tea shop and bar), Oxford University, and the Warwick Arts Centre. The exhibition arose directly from our field research in Southeast Asia, in which we wanted to understand rural health behaviour and medicine use to inform this subject. More than 15 different ethnic groups participated in our research as we travelled through 72 villages in northern Thailand. But there was much that our questionnaires and interviews could not capture. As our local survey teams shared experiences of herbalists curing broken bones and spiritual healers summoning ghosts, we wondered, "What was the meaning and significance of these practices?" Our research participants permitted us to share their stories, which were documented by the talented members of our survey team.

"Tales of Treatment" narrated 16 photographic stories of traditional healing as a dying craft among ethnic minority groups in northern Thailand. Stories of herbal medicine, ghost doctors, sacred books of chants, and ceremonial posts highlight that healing maintains firm though waning links to local knowledge and belief systems even in an economy and society transitioning as rapidly as Thailand's. However, the exhibition also highlighted subtle contradictions and tensions in global health policy and research - for instance in the field of antimicrobial resistance, which is regarded a global health priority and a threat to achieving the 2030 Sustainable Development Goals. The stories demonstrate that seemingly modern policy tools to find herbal and non-medicinal alternatives for antibiotic treatment had been practised for centuries. This also invites reflection on critiques of the "pharmaceuticalisation" of traditional medicine (where herbal medicine is administered in capsules), seeing that traditional herbalists have used capsules, too, and for very pragmatic reasons.

The exhibition attracted a wide range of visitors, including medical doctors, NGO staff, United Nations staff, research institutes, Thai government departments and schools, university students, researchers and other university staff, and general members of the public interested in photography and medicine. The overall more than 500 visitors across our four venues engaged enthusiastically with the exhibits, the stories, and the exhibition hosts, typically spending 45-60 minutes at the exhibition. The feedback from these visitors has been overwhelmingly positive. For example, of the 23 feedback forms received during the latest exhibition at the Warwick Arts Centre, 100% of the feedback stated that the exhibition was worth visiting, and 96% "learned something new" at the exhibition. For the project itself, this was an opportunity to cultivate and benefit from the talent of our team, and to learn from the knowledge or our participants, enabling us to explore a perspective of healing and treatment that we could not have witnessed otherwise. The latest exhibition at the Warwick Arts Centre has also paved the way for closer collaboration with artists and visual media in future research projects.

The exhibition was joint work between research project leader Mr Marco J Haenssgen, research officer Ms Nutcha (Ern) Charoenboon, and research interns Ms Patthanan (Mind) Thavethanutthanawin, Ms Kanokporn (Joobjang) Wibunjak, and Ms Penporn (Yok) Warapikuptanun. The event at the Warwick Arts Centre was supported by the University of Warwick's Humanities Research Fund, the Global Research Priority on Connecting Cultures, and the Department of Global Sustainable Development at the University of Warwick.
Year(s) Of Engagement Activity 2018,2019
URL http://www.ox.ac.uk/news/science-blog/tales-treatment-modernity-and-tradition-and-global-health-cris...