Table 3 Strengths and limitations of the project, and successes and limitations of the engagement process

Project strengths

Successes of the engagement approach

Using both in-person and online platforms

◦ The project engaged a large number of people from all walks of life from across Thailand

◦ The conversations raised many issues and suggestions on how to mitigate AMR

Conducting the regional conversations in four different regions of Thailand

◦ Useful to capture and compare different cultural and geographically specific solutions

◦ In some of the regional conversations, participants suggested low-hanging and locally actionable suggestions that they can initiate in their communities

Conversations events guided by Wellcome ‘s ‘Responsive Dialogues’ toolkit

◦ This engagement approach advocates for sustained multi-directional interactions among conversation participants, and could be considered one of the highest level on the ladder of citizen participation [53]

◦ Participants had the chance to discuss their ideas and be challenged by each other and reflect between sessions

◦ Direct interactions among policy makers, stakeholders and community members so they could hear first-hand issues raised by other parties

Project challenges

Limitations of the engagement approach

Regional differences in community structures and networks; varying availability of formal and informal stores selling antimicrobials and level of enforcement by authorities

◦ Solutions need to be context-specific, because each community or target group may speak different dialects and have a different level of understanding of health, healthcare and drugs

◦ Rather than ‘choosing promising/feasible solutions to take forward’ as suggested by the ‘Responsive Dialogues’ toolkit, we outlined the building blocks of solutions that can be adapted and developed according to context

Background of participants (primarily involved in the use of antimicrobials in human health, e.g. doctors, village health workers)

◦ Not many solutions related to the agriculture and environmental sectors. In Thailand, the use of antimicrobials in aquaculture, poultry, livestock and fruit farming is recognized [14, 47, 54]

Representation of groups and different perspectives

◦ Possible inadvertent exclusion of groups when inviting stakeholders and community participants, as we might not have been able to access all groups through our extended networks

◦ Difficult to achieve ‘true representation’ of all stakeholder groups in all meetings due to availability of participants, number limit to run productive workshops and group discussions, resources, etc

Project focused on engagement with adults (and not children), and on awareness and engagement around AMR, relating to strategy 5 of the NSP-AMR

◦ Excludes other factors known to affect antibiotic use in communities, which are unrelated to a lack of knowledge or awareness [49, 55]

◦ We did not specifically engage participants with the other five strategies of the NSP-AMR

Power dynamics in conversation events

◦ We may not have heard adequately from community members

◦ Although we had expert facilitators in our team, we could not completely eliminate power dynamics

COVID-19 public health restrictions (e.g. limit on participant numbers, social distancing)

◦ Did not manage to invite all the participants we intended to

◦ Venues were larger than that optimum for such intimate dialogues

Lack of follow-up with participants after conversation events

◦ Disseminated findings of the project after the events via a ‘LINE’ (instant messenger) group and the brochure, but did not have the resources to conduct follow-up discussions

External influences on the discussion through our project set-up

◦ Although participatory in nature, the ‘Responsive Dialogues’ framework still steers conversations in a certain way (e.g. through pre-selection of participants and discussion topics) instead of asking communities which issues matter most to them

◦ Facilitators and organisers were external and not part of the community, like for example in a recently described ‘Community Dialogue Approach’, where community volunteers were trained in facilitation techniques [56]