Living with microbial roommates: Health literacy capability in antimicrobial resistance education

Following the highlighting of antimicrobial resistance (AMR) as a sustainability challenge by UN and WHO, Zimbabwe established in 2016 a AMR national action plan (NAP) based on an One Health approach. The AMR NAP:

• identifies AMR as a challenge connecting human, animal and environmental health.
• emphasises learning and education among professionals, policy-makers and the public as foundational in relation to all other AMR efforts.

The situational analysis on AMR in Zimbabwe identified the educational and learning gap among health practitioners not in terms of a lack of knowledge but in the challenge of integrating AMR knowledge into health practices.

Analysis of the Global and Zimbabwean AMR policy highlights a pervasive 'black box' of AMR education, outlining inputs and expected outputs of education but seldom addressing the education and learning processes there between.

There are recurring assumptions regarding the links between, on the one hand, expressing awareness and knowledge about AMR, and on the other, developing certain attitudes to AMR as well as a propensity for certain actions (Ward, Kristiansen, & Sørensen, 2019; Veenker & Paans, 2016.) Furthermore, contradictions pervade within ‘rational’ behavioural change approaches between the holistic One Health problem articulations and the solution proposals that isolates individual action and practice from context and social and ecological (biosocial) environments.

As such, there is need for more substantial and research-based approaches to AMR education (Mölstad et al., 2017; Pavydė et al., 2015; Wernli et al., 2017). With the aim of populating the ‘black box’ of AMR education the project adapts a participatory research methodology operationalised in the Re-Solve AMR workshop series. Re-Solve was developed in collaboration with researchers in Southern Africa (ELRC, Rhodes University) and in Sweden (SWEDESD, Uppsala University).

The adapted tool, Re-Solve AMR, involves Zimbabwean health and educational practitioners working with antimicrobial resistance in participatory research process with the dual objectives of:

• engaging with, adapting and co-developing AMR educational purposes and methods in relation to contextual health practices.
• developing AMR education to support the development of capabilities for understanding, critically evaluating and conscious decision-making regarding AMR among especially community members and health sciences students.

Supporting these objectives, a digital tool focused on ongoing knowledge co-creation is developed.

As part of the workshop series, a holistic understanding of health (One Health/EcoHealth) is operationalised through a biosocial and infrastructural understanding of antimicrobials as interwoven with societies, encompassing human health, animal health and ecological health.

The projects attempts to move beyond an exclusive focus on irrational behaviours among health practitioners and members of the public and how to change these. As such, the value of exploring, together with health practitioners, situated rationalities (Chandler et al. 2018; Denyer-Willis & Chandler 2019; Dixon et al. 2021) of antimicrobial use is highlighted, i.e., becoming sensitive to the impact of situations of resource scarcity in health care, lacking infrastructures of water and sanitation on the how, when and where of antimicrobial use.

The impact of the participatory learning process operationalised in the workshops is expected to add value to AMR research, policy and practice in terms of a method for supporting the co-creation of situationally relevant knowledge, methods and practices, in collaboration with health practitioners.

By populating the ‘black box’ of AMR education in this way the project addresses three recurring challenges in AMR education,

1. to account for unexpected aspects of conducting AMR education and
2. to address the challenge of integrating AMR education in ongoing contextual health practices.
3. to alleviate the implementation gap between knowing and doing in AMR education

While many approaches to health education are either outcome-oriented or process-oriented, given the projects understanding of health as capability enables the integration of considerations for peoples health outcomes with the process of how these outcome are arrived at i.e. health literacy capabilities (Ruger 2010).

The expected results of the research project includes:

• Knowledge generation on how health practitioners, drawing on their professional experiences articulate the relationships between human, animal and ecological health in AMR education
• Theory development of AMR education in relation to holistic understandings of health, capabilities approach and transformative learning
• Method development of AMR educational approaches together with and health practitioners.