Grassroot interventions and communication for antimicrobial resistance and antibiotic stewardship in Nigeria

Antimicrobial resistance (AMR) is one of the most pressing global public health threats, driven in part by the misuse of antibiotics. Behaviours such as self-medication, accessing antibiotics without prescription, incomplete treatment adherence, and skipping doses contribute to the emergence and spread of AMR. While global strategies often prioritize behaviour change interventions, there remains limited understanding of how communities engage with public health information on AMR and antibiotic stewardship, particularly in Sub-Saharan Africa where the burden of AMR is high. This thesis by portfolio examines how communities understand, access, and respond to public health information on AMR and antibiotic stewardship. It assesses the extent to which existing AMR-related public health messaging reaches community audiences and motivates appropriate antibiotic-use behaviours. It further explores the role of participatory, grassroots approaches in shaping public health communication on AMR by working collaboratively with community members to co-produce culturally relevant public health communication materials. Using a mixed methods design, comprising of four components: (1) a scoping review; (2) a baseline community survey, focus group discussions and interviews; (3) a participatory review of existing public health messaging on AMR and antibiotic use; and (4) arts-based participatory co-production, the thesis examines how communities understand, access and respond to public health information on AMR. The findings show that many health messages on AMR use generic language and do not directly reflect the people’s experiences. In contrast, study participants' co-produced messages were well-received, with many highlighting that it would motivate them to behave differently. The thesis argues that effective responses to AMR require inclusive, community-informed approaches to designing public health information that is clear, contextually acceptable, and capable of motivating optimal antibiotic use.