Articulating citizen participation in national antimicrobial resistance policies: how does the UK compare to other European countries?

Abstract

Introduction National policies articulate the vision, objectives and resources required to deal with antimicrobial resistance (AMR). Participation of citizens in AMR activities is deemed essential, but may reflect and be limited to the roles allocated to them by national policies. We investigated and compared the language used and role given to citizens by different European AMR policies. Methods We downloaded national policies from the European Centre for Disease Prevention and Control website (March 2016) and purposively selected a sample of policies available in English from the UK, Spain, Norway, Germany and the Netherlands. We conducted a documentary analysis of policies to assess citizen participation using well established frameworks by Charles & DeMaio (1993) and Carman et al (2013). Results For language, across the five countries, policies refer to ‘the public’ or ‘patients’ but not ‘citizens’. The Norwegian policy used clear, commanding and committed language (‘must’, ‘will’) intended to facilitate citizen engagement in optimal antimicrobial activities and behaviours The Spanish policy adopted a ‘rational’ and didactic attitude towards antibiotic use by citizens, whilst Norway presented a progressive approach, ‘assuring’, ‘encouraging’ and ‘supporting’ citizen participation. For roles, The Netherlands and Spain emphasised ‘awareness’, UK centred on ‘education’ and Germany ‘training’. UK was the only country explicitly incorporating behavioural elements. Conclusions Better performing countries in terms of antimicrobial usage offer broader and comprehensive approaches towards the integration of citizens in AMR activities. A ‘rights’ perspective is missing from the area, and in general citizen advocacy is yet to be developed in AMR policies.