Co-creating community driven solutions and policy asks to address antimicrobial resistance through Responsive Dialogues: A qualitative evaluation from Malawi

Low public awareness and inappropriate antibiotic use contribute to the growing Antimicrobial Resistance (AMR) burden, especially in low- and middle-income countries (LMICs). The aim of Responsive Dialogues is to engage communities and key stakeholders to share information, galvanize action and create local solutions to reduce the burden of AMR. RDs promote collaborative problem-solving and have been identified as a potential tool for engaging diverse stakeholders in addressing AMR. However, RDs were only recently developed, and empirical evidence about their utility and feasibility in LMICs is currently limited. We piloted Responsive Dialogues (RDs) with poultry farmers, government and private pharmacists or prescribers, and male caregivers in Malawi. Using 13 semi-structured interviews and three focus groups analyzed thematically, we assessed feasibility of this participatory approach to influence inclusive local AMR policies and solutions. The participatory nature of RDs promoted inclusive decision-making and facilitated participants capacity to co-create locally relevant AMR solutions. Information shared during RDs improved AMR awareness, prompting participants to recognize and reconsider antibiotic practices and co-create solutions including community education on responsible use, local stewardship committees, and integrating AMR education into existing health programs. Implementation barriers varied: farmers and private prescribers expressed concerns about economic losses from reduced antibiotic use, while male caregivers reported difficulties educating others without tangible materials or resources. Considerations for AMR-RDs scale-up include resource allocation, integration with existing health systems, and further research on long-term impact across different low resource settings. Despite these challenges, this pilot demonstrates that RDs offer a feasible participatory approach for co-creating contextually relevant AMR solutions in resource-limited settings, showing promise for engaging diverse stakeholders though sustained impact requires addressing identified barriers and health system integration.