Perspectives on antimicrobial resistance: establishing an interdisciplinary research approach

What and how can we learn from complex global problems for antimicrobial resistance policy? A comparative study combining historical and foresight approaches

OBJECTIVES

To (i) develop a methodology for using historical and comparative perspectives to inform policy and (ii) provide evidence for antimicrobial-resistance (AMR) policymaking by drawing on lessons from climate change and tobacco control.

METHODS

Using a qualitative design, we systematically examined two other complex, large-scale policy issues-climate change and tobacco control-to identify what relevance to AMR can be learned from how these issues have evolved over time. During 2018-2020, we employed a five-stage approach to conducting an exploratory study involving a review of secondary historical analysis, identification of drivers of change, prioritisation of the identified drivers, scenario generation and elicitation of possible policy responses. We sought to disrupt more 'traditional' policy and research spaces to create an alternative where, stimulated by historical analysis, academics (including historians) and policymakers could come together to challenge norms and practices and think creatively about AMR policy design.

RESULTS

An iterative process of analysis and engagement resulted in lessons for AMR policy concerning persistent evidence gaps and uncertainty, the need for cross-sector involvement and a collective effort through global governance, the demand for new interventions through more investment in research and innovation, and recognising the dynamic relationship between social change and policy to change people's attitudes and behaviours are crucial towards tackling AMR.

CONCLUSION

We draw on new methodological lessons around the pragmatism of future- and policy-oriented approaches incorporating robust historical and comparative analysis. The study demonstrates proof of concept and offers a reproducible method to advance further methodology, including transferrable policies that could tackle health problems, such as AMR.

A critical realist synthesis of cross-disciplinary health policy and systems research: defining characteristic features, developing an evaluation framework and identifying challenges

BACKGROUND

Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the characteristic features of context-mechanism-outcome (CMO) configurations in cross-disciplinary HPSR, (2) develop criteria for evaluating cross-disciplinarity and (3) synthesise emerging challenges of the approach.

METHOD

The paper is a critical realist synthesis conducted in three phases, as follows: (1) scoping the literature, (2) searching for and screening the evidence, and (3) extracting and synthesising the evidence. Five databases, namely the International Bibliography of the Social Sciences and Web of Science, PubMed central, Embase and CINHAL, and reference lists of studies that qualified for inclusion in the review were searched. The search covered peer-reviewed original research, reviews, commentary papers, and institutional or government reports published in English between January 1998 and January 2020.

RESULTS

A total of 7792 titles were identified in the online search and 137 publications, comprising pilot studies as well as anecdotal and empirical literature were selected for the final review. The review draws attention to the fact that cross-disciplinary HPSR is not defined by individual characteristics but by the combination of a particular type of research question and setting (context), a specific way of researchers working together (mechanism), and research output (outcome) that is superior to what could be achieved under a monodisciplinary approach. This CMO framework also informs the criteria for assessing whether a given HPSR is truly cross-disciplinary. The challenges of cross-disciplinary HPSR and their accompanying coping mechanisms were also found to be context driven, originating mainly from conceptual disagreements, institutional restrictions, communication and information management challenges, coordination problems, and resource limitations.

CONCLUSION

These findings have important implications. First, the CMO framework of cross-disciplinary HPSR can provide guidance for researchers engaging in new projects and for policy-makers using their findings. Second, the proposed criteria for evaluating theory and practice of cross-disciplinary HPSR may inform the systematic development of new research projects and the structured assessment of existing ones. Third, a better understanding of the challenges of cross-disciplinary HPSR and potential response mechanisms may help researchers to avoid these problems in the future.

Building bridges to operationalise one health - A Sino-Swedish collaboration to tackle antibiotic resistance

Antibiotic resistance is a complex global health challenge. The recent Global Action Plan on antimicrobial resistance highlights the importance of adopting One Health approaches that can cross traditional disciplinary boundaries. We report on the early experiences of a multisectoral Sino-Swedish research project that aims to address gaps in our current knowledge and seeks to improve the situation through system-wide interventions. Our research project is investigating antibiotic use and resistance in a rural area of China through a combination of epidemiological, health systems and laboratory investigations. We reflect here on the challenges inherent in conducting long distance cross-disciplinary collaborations, having now completed data and sample collection for a baseline situation analysis. In particular, we recognise the importance of investing in aspects such as effective communication, shared conceptual frameworks and leadership. We suggest that our experiences will be instructive to others planning to develop similar international One Health collaborations.

•

Antibiotic resistance is a complex global health challenge

•

One Health approaches are needed to facilitate understanding and action

•

China is one of the largest producers and consumers of antibiotics in the world

•

China is giving attention to antibiotic resistance at the highest political level

•

We report on the early stages of a Sino-Swedish One Health research programme

Doing Interdisciplinary Mixed Methods Health Care Research: Working the Boundaries, Tensions, and Synergistic Potential of Team-Based Research

Current trends in health care research point to a shift from disciplinary models to interdisciplinary team-based mixed methods inquiry designs. This keynote address discusses the problems and prospects of creating vibrant mixed methods health care interdisciplinary research teams that can harness their potential synergy that holds the promise of addressing complex health care issues. We examine the range of factors and issues these types of research teams need to consider to facilitate efficient interdisciplinary mixed methods team-based research. It is argued that concepts such as disciplinary comfort zones, a lack of attention to team dynamics, and low levels of reflexivity among interdisciplinary team members can inhibit the effectiveness of a research team. This keynote suggests a set of effective strategies to address the issues that emanate from the new field of research inquiry known as team science as well as lessons learned from tapping into research on organizational dynamics.

Intensive care unit professionals' knowledge and behavior related to the adoption of contact precautions

This study aimed to assess the knowledge and behavior of professionals working in Intensive Care Units (ICU) related to the adoption of contact precautions for the control of hospital infections (HI). This cross-sectional study used a semi-structured questionnaire to collect data. Descriptive and multivariate analyses were carried out, including logistic regression and decision tree using CHAID algorithm. A total of 102 professionals participated in the study, of whom 36.3% presented appropriate knowledge and 51% appropriate behavior in relation to HI control measures. Nursing professionals had almost four times more chance (OR = 3.58, CI 1.48-8.68) of presenting appropriate behavior than the remaining professionals. The multivariate analysis did not reveal variables associated with knowledge. No statistically significant association was found between knowledge and behavior (p = 0.196). These results suggest the need to implement educational activities so as to permit a balance between theory and professionals' practice concerning HI preventive measures, aiming to improve knowledge and behavior.

Creating cross-disciplinary research alliances to advance nursing science

PURPOSE

To demonstrate the utility of a developmental approach to building and sustaining cross-disciplinary research alliances.

ORGANIZING CONSTRUCT

Cross-disciplinary collaborations offer great promise for advancing an evolving program of research. Funding agencies' commitment to interdisciplinary work further heightens these collaborations. Nurse researchers, however, are not necessarily equipped with the knowledge and skills needed to strategically and successfully build and maintain cross-disciplinary collaborations.

METHODS

Successful strategies for forging, extending, and sustaining alliances are organized using a developmental approach and illustrated by exemplars.

FINDINGS

The initial phase of forging alliances is focused on creating a limited network to support relatively clear-cut research goals. The cohesive cross-disciplinary team is subsequently extended beyond the initial team to strategically address broader research goals. As the team matures, emphasis shifts toward sustaining the team through shared leadership that more actively focuses on the development of the field than the development of individual programs of research.

CONCLUSIONS

The advancement of nursing science requires nurse researchers to rethink the developmental phases of building appropriate research teams. Strategic approaches for forging, extending, and sustaining cross-disciplinary alliances position nurse researchers as leaders in innovative cross-disciplinary research. The development of cross-disciplinary teams supports translational research and, by extension, the science that undergirds practice.

CLINICAL RELEVANCE

Research that reflects cross-disciplinary perspectives is particularly well suited to addressing the complex health issues encountered by patients, families, and communities.

It's all about relationships: a qualitative study of health researchers' perspectives of conducting interdisciplinary health research

Background

Interdisciplinary research has been promoted as an optimal research paradigm in the health sciences, yet little is known about how researchers experience interdisciplinarity in practice. This study sought to determine how interdisciplinary research was conceptualized and operationalized from the researcher's perspective and to better understand how best to facilitate interdisciplinary research success.

Methods

Key informant interviews were conducted with health researchers with expertise or experience in conducting interdisciplinary research. Interviews were completed either in person or over the telephone using a semi-structured interview guide. Data collection occurred simultaneously with data analysis so that emerging themes could be explored in subsequent interviews. A content analysis approach was used.

Results

Nineteen researchers took part in this study. Interdisciplinary research was conceptualized disparately between participants, and there was modest attention towards operationalization of interdisciplinary research. There was one overriding theme, "It's all about relationships", that emerged from the data. Within this theme, there were four related subthemes: 1) Involvement in interdisciplinary research; 2) Why do I do interdisciplinary research?; 3) Managing and fostering interdisciplinary relationships; and 4) The prickly side to interdisciplinary research. Together, these themes suggest that the choice to conduct interdisciplinary research, though often driven by the research question, is highly influenced by interpersonal and relationship-related factors. In addition, researchers preferred to engage in interdisciplinary research with those that they had already established relationships and where their role in the research process was clearly articulated. A focus on relationship building was seen as a strong facilitator of interdisciplinary success.

Conclusion

Many health researchers experienced mixed reactions towards their involvement in interdisciplinary research. A well thought-out rationale for interdisciplinary research, and strategies to utilize the contribution of each researcher involved were seen as facilitators towards maximizing the benefits that could be derived from interdisciplinary research.

Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature

BACKGROUND

Despite the priority placed on preventing transmission of multidrug-resistant organisms (MDROs) in health care facilities, there is a lack of consensus among recommended infection control guidelines. We focused on control measures that have a great potential to affect patient care, patient services, and hospital cost/resources: barrier precautions/patient isolation and surveillance cultures.

METHODS

We conducted a systematic review of the literature and published English-language guidelines pertaining to the use of barrier precautions/patient isolation and surveillance cultures to prevent the transmission of MDROs. The recommendations made by the published guidelines were summarized and compared. The primary research studies identified through our literature search were evaluated for study quality. We then summarized the outcomes of the studies with the highest quality scores and made recommendations for future work.

RESULTS

A total of 29 studies were included in our assessment of study quality; of those, 7 studies were of high quality.

CONCLUSION

This systematic review identified key gaps in the literature including a need for greater monitoring of implementation of the interventions, more cost analyses of interventions, determining the independent contribution of specific interventions, and identifying the minimum interventions needed to reduce transmission.