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Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion
  1. Marco J Haenssgen1,2,3,4,
  2. Nutcha Charoenboon4,
  3. Giacomo Zanello5,
  4. Mayfong Mayxay6,7,
  5. Felix Reed-Tsochas2,8,9,
  6. Caroline O H Jones1,10,
  7. Romyen Kosaikanont11,
  8. Pollavat Praphattong12,
  9. Pathompong Manohan11,
  10. Yoel Lubell1,4,
  11. Paul N Newton1,6,
  12. Sommay Keomany13,
  13. Heiman F L Wertheim14,15,
  14. Jeffrey Lienert2,16,
  15. Thipphaphone Xayavong4,
  16. Penporn Warapikuptanun4,
  17. Yuzana Khine Zaw4,17,
  18. Patchapoom U-Thong4,
  19. Patipat Benjaroon4,
  20. Narinnira Sangkham4,
  21. Kanokporn Wibunjak4,
  22. Poowadon Chai-In4,
  23. Sirirat Chailert4,
  24. Patthanan Thavethanutthanawin4,
  25. Krittanon Promsutt4,
  26. Amphayvone Thepkhamkong4,
  27. Nicksan Sithongdeng4,
  28. Maipheth Keovilayvanh4,
  29. Nid Khamsoukthavong4,
  30. Phaengnitta Phanthasomchit4,
  31. Chanthasone Phanthavong4,
  32. Somsanith Boualaiseng4,
  33. Souksakhone Vongsavang4,
  34. Rachel C Greer1,4,
  35. Thomas Althaus1,4,
  36. Supalert Nedsuwan18,
  37. Daranee Intralawan18,
  38. Tri Wangrangsimakul1,4,
  39. Direk Limmathurotsakul4,
  40. Proochista Ariana1
  1. 1Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  2. 2CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
  3. 3Green Templeton College, University of Oxford, Oxford, UK
  4. 4Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  5. 5School of Agriculture, Policy and Development, University of Reading, Reading, UK
  6. 6Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  7. 7Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
  8. 8Institute for New Economic Thinking, Oxford Martin School, University of Oxford, Oxford, UK
  9. 9Department of Sociology, University of Oxford, Oxford, UK
  10. 10Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
  11. 11School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand
  12. 12School of Liberal Arts, Mae Fah Luang University, Chiang Rai, Thailand
  13. 13Salavan Provincial Hospital, Salavan, Laos
  14. 14Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
  15. 15Medical Microbiology Department, Radboudumc, Nijmegen, The Netherlands
  16. 16National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
  17. 17Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
  18. 18Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  1. Correspondence to Dr Marco J Haenssgen; marco.haenssgen{at}


Background Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people’s antibiotic-related health behaviour through three research questions.

RQ1: What are the manifestations and determinants of problematic antibiotic use in patients’ healthcare-seeking pathways?

RQ2: Will people’s exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices?

RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?

Methods We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1–3), social network analysis (RQ2) and latent class analysis (RQ3).

Discussion Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour.

Trial registration number NCT03241316; Pre-results.

  • antimicrobial resistance
  • treatment-seeking behaviour
  • marginalisation
  • activity space
  • social research
  • survey
  • qualitative research
  • Thailand
  • Lao PDR

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Alberto L Garcia-Basteiro

  • Twitter Follow Marco J Haenssgen

  • Funding This project is 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 and Rural Affairs (grant ref. ES/P00511X/1, administered by the UK Economic and Social Research Council).

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