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

Inappropriate antibiotics use due to low public knowledge and awareness contributes to the growing Antimicrobial Resistance (AMR) burden, especially in low- and middle-income countries (LMICs). The aim of Responsive Dialogues (RDs) 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 RDs with poultry farmers, government and private pharmacists or prescribers, and male caregivers in Malawi. Using 13 semi-structured interviews and three focus groups, 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 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 valuable participatory approach for co-creating contextually relevant AMR solutions in resource-limited settings. Sustained impact requires addressing structural barriers, establishing feedback mechanisms, and integrating RDs outputs within existing health system structures and national AMR action plans.