Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion

Marco J Haenssgen; Nutcha Charoenboon; Giacomo Zanello; Mayfong Mayxay; Felix Reed-Tsochas; Caroline O H Jones; Romyen Kosaikanont; Pollavat Praphattong; Pathompong Manohan; Yoel Lubell; Paul N Newton; Sommay Keomany; Heiman F L Wertheim; Jeffrey Lienert; Thipphaphone Xayavong; Penporn Warapikuptanun; Yuzana Khine Zaw; Patchapoom U-Thong; Patipat Benjaroon; Narinnira Sangkham; Kanokporn Wibunjak; Poowadon Chai-In; Sirirat Chailert; Patthanan Thavethanutthanawin; Krittanon Promsutt; Amphayvone Thepkhamkong; Nicksan Sithongdeng; Maipheth Keovilayvanh; Nid Khamsoukthavong; Phaengnitta Phanthasomchit; Chanthasone Phanthavong; Somsanith Boualaiseng; Souksakhone Vongsavang; Rachel C Greer; Thomas Althaus; Supalert Nedsuwan; Daranee Intralawan; Tri Wangrangsimakul; Direk Limmathurotsakul; Proochista Ariana

doi:10.1136/bmjgh-2017-000621

Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion

BMJ Glob Health. 2018 Mar 28;3(2):e000621. doi: 10.1136/bmjgh-2017-000621. eCollection 2018.

Authors

Marco J Haenssgen^{1

2

3

4}, Nutcha Charoenboon⁴, Giacomo Zanello⁵, Mayfong Mayxay^{6

7}, Felix Reed-Tsochas^{2

8

9}, Caroline O H Jones^{1

10}, Romyen Kosaikanont¹¹, Pollavat Praphattong¹², Pathompong Manohan¹¹, Yoel Lubell^{1

4}, Paul N Newton^{1

6}, Sommay Keomany¹³, Heiman F L Wertheim^{14

15}, Jeffrey Lienert^{2

16}, Thipphaphone Xayavong⁴, Penporn Warapikuptanun⁴, Yuzana Khine Zaw^{4

17}, Patchapoom U-Thong⁴, Patipat Benjaroon⁴, Narinnira Sangkham⁴, Kanokporn Wibunjak⁴, Poowadon Chai-In⁴, Sirirat Chailert⁴, Patthanan Thavethanutthanawin⁴, Krittanon Promsutt⁴, Amphayvone Thepkhamkong⁴, Nicksan Sithongdeng⁴, Maipheth Keovilayvanh⁴, Nid Khamsoukthavong⁴, Phaengnitta Phanthasomchit⁴, Chanthasone Phanthavong⁴, Somsanith Boualaiseng⁴, Souksakhone Vongsavang⁴, Rachel C Greer^{1

4}, Thomas Althaus^{1

4}, Supalert Nedsuwan¹⁸, Daranee Intralawan¹⁸, Tri Wangrangsimakul^{1

4}, Direk Limmathurotsakul⁴, Proochista Ariana¹

Affiliations

¹ Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
² CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK.
³ Green Templeton College, University of Oxford, Oxford, UK.
⁴ Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁵ School of Agriculture, Policy and Development, University of Reading, Reading, UK.
⁶ Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
⁷ Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos.
⁸ Institute for New Economic Thinking, Oxford Martin School, University of Oxford, Oxford, UK.
⁹ Department of Sociology, University of Oxford, Oxford, UK.
¹⁰ Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya.
¹¹ School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand.
¹² School of Liberal Arts, Mae Fah Luang University, Chiang Rai, Thailand.
¹³ Salavan Provincial Hospital, Salavan, Laos.
¹⁴ Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam.
¹⁵ Medical Microbiology Department, Radboudumc, Nijmegen, The Netherlands.
¹⁶ National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
¹⁷ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
¹⁸ Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.

Abstract

Background: Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people's antibiotic-related health behaviour through 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 antibiotic awareness activities entail changed behaviours that 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?

Methods: We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1-3), social network analysis (RQ2) and latent class analysis (RQ3).

Discussion: Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour.

Trial registration number: NCT03241316; Pre-results.

Keywords: Lao PDR; Thailand; activity space; antimicrobial resistance; marginalisation; qualitative research; social research; survey; treatment-seeking behaviour.

Associated data

ClinicalTrials.gov/NCT03241316