Global Sustainable Development research at Warwick University has uncovered significant difficulties of health communication to fight the superbug crisis in developing countries. Health information events in Thai and Lao villages increased awareness of drug resistance, but the new knowledge tended to benefit more privileged groups and led villagers to start selling antibiotics while sparking rumours and misunderstanding about government antibiotic policies. The research has been published in special issues on antimicrobial resistance (AMR) in the journals Palgrave Communications and Antibiotics.

The research was part of a landmark study of health behaviours in low- and middle-income countries and involved more than 2,000 people in five villages in Thailand and Laos. On the face of it, the educational events appeared successful like many awareness-raising campaigns, increasing for instance the awareness of the words “drug resistance” from 56% to 86% (+30%) among all participants, compared to an improvement from 46% to 63% (+17%) in the villages more generally. However, most research does not consider other consequences of such activities, or how information flows. By analysing social networks and health behaviour more generally, and by interviewing villagers alongside their survey, the researchers were able to uncover and document often-neglected side-effects.

“We all have heard about being ‘lost in translation’,” reflects Ern Nutcha Charoenboon, Research officer and leader of the Thai research paper. “But it is something easily forgotten in educational programmes or awareness-raising campaigns. It turns out that we might have to redefine and approach public problems differently because mass education campaigns could create more harm than good.” Project leader Marco J Haenssgen concludes, “Global Sustainable Development research like this enables us to challenge established wisdom in health policy, understand social and contextual aspects of health behaviour, and to find innovative solutions for global challenges.”

The Antibiotics and Activity Spaces project is a study of antibiotic-related health behaviour in rural Thailand and Lao PDR, funded by the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with the Department of Health and Department for Environment Food & Rural Affairs (grant ref. ES/P00511X/1, administered by the UK Economic and Social Research Council).

Read more about this research:

• Today's article in The Conversation: https://theconversation.com/antibiotic-resistance-public-awareness-campaigns-might-not-work-111926
• Today's Warwick Press Release: https://warwick.ac.uk/newsandevents/pressreleases/awareness_campaigns_not
• Charoenboon, N, Haenssgen, MJ, Warapikuptanun, P, Xayavong, T & Khine Zaw, Y (2019). Translating AMR: A case study of context and consequences of antibiotic-related communication in three northern Thai villages. Palgrave Communications. doi: https://doi.org/10.1057/s41599-019-0226-9
• Haenssgen, M. J., Xayavong, T., Charoenboon, N., Warapikuptanun, P., & Khine Zaw, Y. (2018). The consequences of AMR education and awareness raising: outputs, outcomes, and behavioural impacts of an antibiotic-related educational activity in Lao PDR. Antibiotics, 7(4), 95. doi: https://doi.org/10.3390/antibiotics7040095

Remote research locations in northern Thailand.

Photo credits: Nutcha Charoenboon.