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Arredondo-Rivera M, Barois Z, Monti GE, Steketee J, Daburon A. Bridging Food Systems and One Health: A key to preventing future pandemics? One Health 2024; 18:100727. [PMID: 38628630 PMCID: PMC11019457 DOI: 10.1016/j.onehlt.2024.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Food Systems and One Health are two approaches increasingly known for the holistic perspective they bring when addressing the issues that concern them: food and health. This systematic literature review aims to explore the evidence for using these approaches in a concerted manner to better manage zoonoses. By zoonoses management, we refer to improving the ability to address current zoonoses as well as preventing future ones. A total of 98 scientific articles were screened, of which 29 were considered eligible due to their focus on operationalizing each approach to help address zoonoses, as well as a combination of the two. Most articles implement One Health to prevent zoonoses by guiding stakeholders in concerted and participatory decision-making processes. However, the One Health approach can also be adopted via data modelling. Several articles refer to the monitoring and evaluation process of One Health initiatives to prevent zoonoses and discuss best practices to successfully implement the approach. Contrastingly, only three studies adopt a Food System approach to manage zoonoses, despite the profound connections existing between our food systems and the emergence of zoonotic risks. We conclude that there is a lack of integration between the One Health and Food System approaches to manage zoonoses. We also show that experts call for integration, so that not only human, animal, plant, and environmental health are considered, but also the socio-economic trade-offs when monitoring and developing strategies to manage zoonoses. This can be reversed, enabling zoonotic risks to be addressed when planning for our food systems of tomorrow.
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Affiliation(s)
- Marcia Arredondo-Rivera
- Wageningen Economic Research, Wageningen University & Research, Atlas (gebouw 104), Droevendaalsesteeg 4, 6708 PB Wageningen, the Netherlands
| | - Zoe Barois
- Wageningen Centre for Development Innovation, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB Wageningen, the Netherlands
| | - Gustavo Enrique Monti
- Quantitative Veterinary Epidemiology group, Wageningen University, Droevendaalsesteeg 1 (Campus) Building no. 107, 6702 PB Wageningen, the Netherlands
| | - Johanna Steketee
- Wageningen Centre for Development Innovation, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB Wageningen, the Netherlands
| | - Annabelle Daburon
- Wageningen Centre for Development Innovation, Wageningen University & Research, Droevendaalsesteeg 1, 6708 PB Wageningen, the Netherlands
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Nguyen-Thanh L, Wernli D, Målqvist M, Graells T, Jørgensen PS. Characterising proximal and distal drivers of antimicrobial resistance: An umbrella review. J Glob Antimicrob Resist 2024; 36:50-58. [PMID: 38128730 DOI: 10.1016/j.jgar.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a multifactorial challenge driven by a complex interplay of proximal drivers, such as the overuse and misuse of antimicrobials and the high burden of infectious diseases, and distal factors, encompassing broader societal conditions such as poverty, inadequate sanitation, and healthcare system deficiencies. However, distinguishing between proximal and distal drivers remains a conceptual challenge. OBJECTIVES We conducted an umbrella review, aiming to systematically map current evidence about proximal and distal drivers of AMR and to investigate their relationships. METHODS Forty-seven reviews were analysed, and unique causal links were retained to construct a causality network of AMR. To distinguish between proximal and distal drivers, we calculated a 'driver distalness index (Di)', defined as an average relative position of a driver in its causal pathways to AMR. RESULTS The primary emphasis of the literature remained on proximal drivers, with fragmented existing evidence about distal drivers. The network analysis showed that proximal drivers of AMR are associated with risks of resistance transmission (Di = 0.49, SD = 0.14) and antibiotic use (Di = 0.58, SD = 0.2), which are worsened by intermediate drivers linked with challenges of antibiotic discovery (Di = 0.62, SD = 0.07), infection prevention (Di = 0.67, SD = 0.14) and surveillance (Di = 0.69, SD = 0.16). Distal drivers, such as living conditions, access to sanitation infrastructure, population growth and urbanisation, and gaps in policy implementation were development and governance challenges, acting as deep leverage points in the system in addressing AMR. CONCLUSIONS Comprehensive AMR strategies aiming to address multiple chronic AMR challenges must take advantage of opportunities for upstream interventions that specifically address distal drivers.
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Affiliation(s)
- Luong Nguyen-Thanh
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Uppsala Antibiotic Centre (UAC), Uppsala University, Uppsala, Sweden; Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden.
| | - Didier Wernli
- Global Studies Institute and Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Mats Målqvist
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Peter Søgaard Jørgensen
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.
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Graells T, Lambraki IA, Cousins M, Léger A, Henriksson PJG, Troell M, Carson CA, Parmley EJ, Majowicz SE, Wernli D, Jørgensen PS. Exploring the factors that contribute to the successful implementation of antimicrobial resistance interventions: a comparison of high-income and low-middle-income countries. Front Public Health 2023; 11:1230848. [PMID: 37900049 PMCID: PMC10612146 DOI: 10.3389/fpubh.2023.1230848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a challenge to modern medicine. Interventions have been applied worldwide to tackle AMR, but these actions are often not reported to peers or published, leading to important knowledge gaps about what actions are being taken. Understanding factors that influence the implementation of AMR interventions and what factors are relevant in low-middle-income countries (LMICs) and high-income countries (HICs) were the key objectives of this exploratory study, with the aim to identifying which priorities these contexts need. Methods A questionnaire was used to explore context, characteristics, and success factors or obstacles to intervention success based on participant input. The context was analyzed using the AMR-Intervene framework, and success factors and obstacles to intervention success were identified using thematic analysis. Results Of the 77 interventions, 57 were implemented in HICs and 17 in LMICs. Interventions took place in the animal sector, followed by the human sector. Public organizations were mainly responsible for implementation and funding. Nine themes and 32 sub-themes emerged as important for intervention success. The themes most frequently reported were 'behavior', 'capacity and resources', 'planning', and 'information'. Five sub-themes were key in all contexts ('collaboration and coordination', 'implementation', 'assessment', 'governance', and 'awareness'), two were key in LMICs ('funding and finances' and 'surveillance, antimicrobial susceptibility testing and preventive screening'), and five were key in HICs ('mandatory', 'multiple profiles', 'personnel', 'management', and 'design'). Conclusion LMIC sub-themes showed that funding and surveillance were still key issues for interventions, while important HIC sub-themes were more specific and detailed, including mandatory enforcement, multiple profiles, and personnel needed for good management and good design. While behavior is often underrated when implementing AMR interventions, capacity and resources are usually considered, and LMICs can benefit from sub-themes captured in HICs if tailored to their contexts. The factors identified can improve the design, planning, implementation, and evaluation of interventions.
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Affiliation(s)
- Tiscar Graells
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Irene A. Lambraki
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Melanie Cousins
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Anaïs Léger
- Global Studies Institute, University of Geneva, Genève, Switzerland
| | - Patrik J. G. Henriksson
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
- WorldFish, Penang, Malaysia
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases; Public Health Agency of Canada, Guelph, ON, Canada
| | - Elizabeth Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Shannon E. Majowicz
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Genève, Switzerland
| | - Peter Søgaard Jørgensen
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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Agostini L, Onofrio R, Piccolo C, Stefanini A. A management perspective on resilience in healthcare: a framework and avenues for future research. BMC Health Serv Res 2023; 23:774. [PMID: 37468875 DOI: 10.1186/s12913-023-09701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/14/2023] [Indexed: 07/21/2023] Open
Abstract
Recent major health shocks, such as the 2014-16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.To fill this gap, this systematic literature review aims to provide a clear state of the art of the literature dealing with resilience in healthcare. Specifically, from the analysis of the theoretical articles and reviews, the key dimensions of resilience are identified, and a novel classification framework is proposed. The classification framework is then used to systematize extant empirical contributions. Two main dimensions of resilience are identified: the approach to resilience (reactive vs. proactive) and the type of crisis to deal with (acute shocks vs. chronic stressors). Four main streams of research are thus identified: (i) proactive approaches to acute shocks; (ii) proactive approaches to chronic stressors; (iii) reactive approaches to acute shocks; and (iv) reactive approaches to chronic stressors. These are scrutinised considering three additional dimensions: the level of analysis, the resources to nurture resilience, and the country context. The classification framework and the associated mapping contribute to systematising the fragmented literature on resilience in healthcare, providing a clear picture of the state of the art in this field and drawing a research agenda that opens interesting paths for future research.
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Affiliation(s)
- L Agostini
- Department of Management and Engineering, University of Padova, Stradella San Nicola 3, Padua, Italy.
| | - R Onofrio
- Department of Management, Economics and Industrial Engineering, Politecnico Di Milano, Piazza Leonardo da Vinci, 32, Milano, Italy
| | - C Piccolo
- Department of Industrial Engineering, University of Naples Federico II, C.So Umberto I, 40, Naples, Italy
| | - A Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Lungarno Antonio Pacinotti, 43, Pisa, Italy
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Wernli D, Søgaard Jørgensen P, Parmley EJ, Majowicz SE, Lambraki I, Carson CA, Cousins M, Graells T, Henriksson PJG, Léger A, Harbarth S, Troell M. Scope and applicability of social-ecological resilience to antimicrobial resistance. Lancet Planet Health 2023; 7:e630-e637. [PMID: 37438004 DOI: 10.1016/s2542-5196(23)00128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/15/2022] [Accepted: 05/31/2023] [Indexed: 07/14/2023]
Abstract
Social-ecological systems conceptualise how social human systems and ecological natural systems are intertwined. In this Personal View, we define the scope and applicability of social-ecological resilience to antimicrobial resistance. Resilience to antimicrobial resistance corresponds to the capacity to maintain the societal benefits of antimicrobial use and One Health systems' performance in the face of the evolutionary behaviour of microorganisms in response to antimicrobial use. Social-ecological resilience provides an appropriate framework to make sense of the disruptive impacts resulting from the emergence and spread of antimicrobial resistance; capture the diversity of strategies needed to tackle antimicrobial resistance and to live with it; understand the conditions that underpin the success or failure of interventions; and appreciate the need for adaptive and coevolutionary governance. Overall, resilience thinking is essential to improve understanding of how human societies dynamically can cope with, adapt, and transform to the growing global challenge of antimicrobial resistance.
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Affiliation(s)
- Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland.
| | - Peter Søgaard Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Stockholm, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Shannon E Majowicz
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Irene Lambraki
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Carolee A Carson
- Centre for Food-borne, Environmental Zoonotic and Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - Melanie Cousins
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Stockholm, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Patrik J G Henriksson
- Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, Stockholm, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden; WorldFish, Jalan Batu Maung, Penang, Malaysia
| | - Anaïs Léger
- Federal Food Safety and Veterinary Office, Bern, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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Jato-Espino D, Mayor-Vitoria F, Moscardó V, Capra-Ribeiro F, Bartolomé del Pino LE. Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases. Front Public Health 2023; 11:1215574. [PMID: 37457260 PMCID: PMC10340543 DOI: 10.3389/fpubh.2023.1215574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.
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Affiliation(s)
- Daniel Jato-Espino
- GREENIUS Research Group, Universidad Internacional de Valencia—VIU, Calle Pintor Sorolla, Valencia, Spain
| | - Fernando Mayor-Vitoria
- GREENIUS Research Group, Universidad Internacional de Valencia—VIU, Calle Pintor Sorolla, Valencia, Spain
| | - Vanessa Moscardó
- GREENIUS Research Group, Universidad Internacional de Valencia—VIU, Calle Pintor Sorolla, Valencia, Spain
| | - Fabio Capra-Ribeiro
- GREENIUS Research Group, Universidad Internacional de Valencia—VIU, Calle Pintor Sorolla, Valencia, Spain
- School of Architecture, College of Art and Design, Louisiana State University, Baton Rouge, LA, United States
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Lambraki IA, Cousins M, Graells T, Léger A, Abdelrahman S, Desbois AP, Gallagher R, Staaf Larsson B, Mattson B, Henriksson P, Troell M, Søgaard Jørgensen P, Wernli D, Carson CA, Parmley EJ, Majowicz SE. Governing Antimicrobial Resistance (AMR) in a Changing Climate: A Participatory Scenario Planning Approach Applied to Sweden in 2050. Front Public Health 2022; 10:831097. [PMID: 35874997 PMCID: PMC9298947 DOI: 10.3389/fpubh.2022.831097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case. Methods We conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions (taxation of antimicrobials at point of sale, and infection prevention measures) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures. Results Recognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) "Tax Burn Out" revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) "Addressing the Basics" identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) "Siloed Nations" described a movement toward nationalism and protectionism that would derail the "Addressing the Basics" scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues. Conclusion Our participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate.
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Affiliation(s)
- Irene Anna Lambraki
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Melanie Cousins
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Anaïs Léger
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Sara Abdelrahman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Andrew P Desbois
- Faculty of Natural Sciences, Institute of Aquaculture, University of Stirling, Stirling, United Kingdom
| | | | - Birgitta Staaf Larsson
- Swedish Centre for Animal Welfare, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Bengt Mattson
- LIF, The Swedish Pharmaceutical Industry Association, Stockholm, Sweden
| | - Patrik Henriksson
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.,Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden.,WorldFish, Penang, Malaysia
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.,Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Peter Søgaard Jørgensen
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Carolee Anne Carson
- Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - Elizabeth Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Studying Factors Affecting Success of Antimicrobial Resistance Interventions through the Lens of Experience: A Thematic Analysis. Antibiotics (Basel) 2022; 11:antibiotics11050639. [PMID: 35625282 PMCID: PMC9137464 DOI: 10.3390/antibiotics11050639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Antimicrobial resistance (AMR) affects the environment, and animal and human health. Institutions worldwide have applied various measures, some of which have reduced antimicrobial use and AMR. However, little is known about factors influencing the success of AMR interventions. To address this gap, we engaged health professionals, designers, and implementers of AMR interventions in an exploratory study to learn about their experience and factors that challenged or facilitated interventions and the context in which interventions were implemented. Based on participant input, our thematic analysis identified behaviour; institutional governance and management; and sharing and enhancing information as key factors influencing success. Important sub-themes included: correct behaviour reinforcement, financial resources, training, assessment, and awareness of AMR. Overall, interventions were located in high-income countries, the human sector, and were publicly funded and implemented. In these contexts, behaviour patterns strongly influenced success, yet are often underrated or overlooked when designing AMR interventions. Improving our understanding of what contributes to successful interventions would allow for better designs of policies that are tailored to specific contexts. Exploratory approaches can provide encouraging results in complex challenges, as made evident in our study. Remaining challenges include more engagement in this type of study by professionals and characterisation of themes that influence intervention outcomes by context.
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