Community participation and governance pathways for antimicrobial resistance mitigation through urban wastewater surveillance and management policy

Antimicrobial resistance has emerged as a critical public health and environmental challenge, with urban wastewater systems increasingly recognized as strategic loci for surveillance and mitigation. This study investigates how community awareness, perceived environmental and health benefits, institutional trust, participatory planning, and equity considerations influence public willingness to participate in wastewater treatment plant effluent programs designed to mitigate antimicrobial resistance. Data, collected from residents within an urban river basin and analyzed using partial least squares structural equation modeling (PLS-SEM), reveal that community awareness of antibiotic resistance risks and perceived environmental and health benefits significantly enhance participatory planning. Participatory planning is identified as the most robust predictor of willingness to engage in antimicrobial resistance management initiatives associated with wastewater treatment. Institutional trust does not demonstrate a significant direct effect; however, perceived affordability and equity marginally influence participation through interaction effects. These findings suggest that effective wastewater-based antimicrobial resistance surveillance is optimally achieved when coupled with inclusive planning mechanisms and benefit-oriented public engagement, rather than relying solely on institutional authority or cost considerations. This study underscores the imperative of integrating social participation into wastewater surveillance frameworks to strengthen public health responses and foster sustainable antimicrobial resistance mitigation in urban environments.