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

Study Overview
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Brief Summary
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The investigators will conduct two rural surveys in Thailand and Lao PDR to improve the understanding of antibiotic-related health behaviour among the general population. One survey will capture a cross-section of health behaviours that is representative for the rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), the other survey will create a two round village-level panel data set to study the evolution of health behaviours in the context of public engagement activities. The investigators will also collect complementary data about village-level infrastructure through observational check-lists, and collect secondary data on patient load from primary care units catering to their survey villages. As part of the questionnaire testing process, the investigators will conduct (and collect as primary data) cognitive interviews to improve the survey tool, to interpret their data, and to justify their methodological choices.

Detailed Description
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The investigators will collect two data sets each in Lao PDR and Thailand: the first contains district-level representative health behaviour of approx. 2,400 adults across 30 rural communities per country (4,800 in total; representing rural populations of approx. 1-2 million adults); the second is a complete social network census of approx. 1600 adults each in three rural communities per country (approx. 4,800 in total). Within the sampled villages, the investigators will complete checklists about existing formal and informal healthcare facilities and gather patient load data from primary care units catering to the respective villages. As part of the questionnaire testing process, the investigators will conduct (and collect as primary data) cognitive interviews to improve the survey tool, to interpret our data, and to justify our methodological choices. The investigators will carry out the district-level village survey in one round, and the village-level social network censuses in two rounds. Between the two village social network censuses, the investigators will engage in public engagement activities in the selected villages (focused on antibiotic use) and re-survey all adults in the three villages per country two to three months later. Objectives: The primary objective is to improve the understanding of patients' antibiotic-related behaviour to support creative thinking about targeted and unconventional antimicrobial resistance (AMR) interventions in low- and middle-income countries (LMICs). The investigators strive to achieve this primary objective by informing three research questions in Chiang Rai (Thailand) and Salavan (Lao PDR): What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways? Will people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices? Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?

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

Conditions
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Antibiotic Use, Rural Healthcare-seeking Behaviour, Marginalisation (Economic, Social, Spatial)

Intervention / Treatment
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* Behavioral: Observational study of behaviour


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any villager in rural Chiang Rai (Thailand) or Salavan (Lao PDR) who had been sampled to participate in the survey Is willing and able to give informed consent for participation in the study Is aged 18 years and above Exclusion Criteria: Respondent is not available or able to participate in interview after two attempts to arrange for appointment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| district-level representative rural survey<br>Approximately 4,800 adults in 60 villages across Thailand and Lao PDR to study health and antimicrobial resistance (AMR)-related behaviour in breadth. | Behavioral: Observational study of behaviour<br>* As a general population survey, our study does not involve a control group. Please note that the investigators do not interview patients; we involve only healthy members of the general public who consider themselves fit to be interviewed.<br>|
| village-level social network census<br>Approximately 4,800 adults across 6 villages in rural Thailand and Lao PDR that are exposed to AMR awareness activities to study health behaviour within social networks. | Behavioral: Observational study of behaviour<br>* As a general population survey, our study does not involve a control group. Please note that the investigators do not interview patients; we involve only healthy members of the general public who consider themselves fit to be interviewed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| General population and villagelevel data on antibiotic access and use within individuals' healthcare-seeking pathways | To improve the understanding of patients' antibiotic-related behaviour to support creative thinking about targeted and unconventional antimicrobial resistance (AMR) interventions in low- and middle-income countries (LMICs). | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for November 2017 to April 2018 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Indicators of economic, social, and spatial marginalisation | To understand the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for November 2017 to April 2018 | 
| Access to formal and informal medical treatment | To understand the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Access to prescription and over-the-counter medicines including antibiotics | To understand the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Degree of technology use during the healthcare seeking process | To understand the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Awareness about rational antibiotic use | To understand the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Typologies of desirable and undesirable healthcare practices with respect to antibiotic use | To understand whether people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Social network structures in rural communities | To understand whether people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Demand fluctuations for healthcare services over time within rural communities | To understand whether people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices. | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 
| Proxy indicators that predict problematic antibiotic use in the general population | To identify less data-intensive indicators to detect problematic contexts of antibiotic use | The study is expected to take place from January 2017 to October 2018, with data collection scheduled for April 2018. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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qualitative and survey research