Table 2 The four co-created ‘building blocks’ of solutions to tackle AMR and detailed recommendations from the conversation events

Messages around AMR should be clear and tailored to the target audience

⇒ Tailor information materials according to target audience

⇒ Adapt messages according to context and use the local dialect, or illustrations suitable for the target group

⇒ Messaging should use channels preferred by the target group (e.g. with youth groups, social media platforms are most popular)

⇒ Materials should preferably be informed by communications and behaviour change research and tested with the target group before roll-out

⇒ Embed monitoring and evaluation in communication and engagement initiatives. In some communities, it may be useful to engage community influencers or leaders to pass on the knowledge

More initiatives to increase general health literacy

⇒ Instead of only focusing messaging on antimicrobials and AMR, there should be a move to increase holistic health literacy, which includes sanitation, nutrition and wellness

⇒ Incorporate AMR and health literacy in the school curriculum and informal learning centres for adults

Increased availability of AMR-related information at the local level

⇒ Participants at the local level, such as village health volunteers and healthcare staff at the primary care level, would like AMR-related information to be ‘returned to the community’. These include local data on usage of antimicrobials, deaths due to drug resistant infections and stories at local level. This way, they can make better informed decisions in relation to antimicrobial usage and provide information to their communities

Increased local ownership of AMR mitigation efforts

⇒ Support shared leadership and increased local leadership in mitigating the problem of AMR

⇒ Community leaders are best placed to create awareness and share knowledge on health and AMR because they know how to engage with their own community

⇒ Local level administration is more permanent than higher level administration and politicians, and there are shorter command chains to implement any activities or programmes

⇒ Local leaders can establish their own AMR task force and community surveillance on unauthorised sales of antimicrobials. This concept is called bo-worn in Thai, which means sublime, heavenly or great

⇒ Bo-worn consists of three parts, bo, wo and ro which is short for baan (house or for this context means community or group); wat (temple, mosque or church which are places of warship) and rong-rean (school and educational institutions). This concept has been used widely to promote and strengthen local networks to address local issues in a sustainable way [40, 41]

⇒ Participants said they themselves will find opportunities to raise awareness of AMR in the communities. These include local talks, information sessions and in-person, one-on-one "heart-to-heart’ conversations (จับเข่าคุย (jap khao kooi)”

⇒ Solutions should take into consideration the culture and preferences of engagement of each region:

◦ Northern region: folk story telling

◦ Northeastern region: fun and light-hearted activities

◦ Southern region: family or community-based activities

◦ Central region and other urban areas: social media