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Currently submitted to: JMIR Research Protocols

Date Submitted: Sep 16, 2020
Open Peer Review Period: Sep 16, 2020 - Nov 11, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

A protocol for an integrated mixed-method approach to determining how to mitigate antimicrobial resistance across the One Health spectrum

  • Irene Anna Lambraki; 
  • Shannon Majowicz; 
  • Elizabeth Jane Parmley; 
  • Didier Wernli; 
  • Anaïs Léger; 
  • Tiscar Graells; 
  • Melanie Cousins; 
  • Stephan Harbarth; 
  • Carolee Carson; 
  • Patrik Henriksson; 
  • Max Troell; 
  • Peter Søgaard Jørgensen



Antimicrobial resistance (AMR) is an existing and looming global challenge with serious health, social and economic consequences. Building social and ecological resilience to reduce AMR and mitigate its impact is critical.


This paper describes a study protocol designed to compare and assess interventions that address AMR in humans, animals and/or the environment and engage diverse perspectives to determine what actions will help to build social and ecological capacity and readiness to tackle AMR now and in the future.


We will apply social-ecological system resilience theory to AMR, for the first time, in an explicit One Health context using mixed-methods. We will identify interventions that address AMR and its key pressure antimicrobial use in the scientific literature and through an online survey. Intervention impacts and the factors that challenge or contribute to the success of interventions will be determined, triangulated against expert opinion in participatory workshops, and complemented using quantitative time-series analyses. We will then identify indicators, using regression modelling, which can predict national AMU or AMR dynamics across animal and human health. Together, these analyses will help to quantify causal loop diagrams of AMR in the Europe and Southeast Asian food system context that are developed by diverse stakeholders in participatory workshops. Then, using these CLDs, the long-term impacts of selected interventions on AMR will be explored under alternate future scenarios via simulation modelling and participatory workshops. A publicly available and evolving learning platform housing information about interventions on AMR from a One Health perspective in a fully accessible online database will be developed, to help decision-makers to identify and adapt promising interventions for application in their jurisdictions. Discussion: This protocol provides an example of how to study complex problems like AMR, which require the integration of knowledge across sectors and disciplines, to develop and implement sustainable solutions. We anticipate our study will contribute to understanding about what actions to take and in what contexts to ensure long-term success in mitigating AMR and its impact, and provide useful tools (e.g., causal loop diagrams, simulation models, public database of compiled interventions) to guide management and policy decisions.


Please cite as:

Lambraki IA, Majowicz S, Parmley EJ, Wernli D, Léger A, Graells T, Cousins M, Harbarth S, Carson C, Henriksson P, Troell M, Jørgensen PS

A protocol for an integrated mixed-method approach to determining how to mitigate antimicrobial resistance across the One Health spectrum

JMIR Preprints. 16/09/2020:24378

DOI: 10.2196/preprints.24378


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