Table 1 Community Dialogues Approach for addressing the drivers of antibiotic resistance in Bangladesh
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WHY The CDA was adapted from the Integrated Model of Communication for Social Change. The model assumes that a stimulus is required to trigger dialogue among community members about issues that are of concern for the community. Dialogue is understood as a dynamic, iterative process that results in collective decision making to resolve those issues. This process results in social change through increasing individual and collective self-efficacy, strengthening community ownership and shaping social norms. In the CDA, the stimulus is both external (provision of training and tools) and internal (selection of volunteers, volunteers mobilise participants to attend community dialogue sessions) to the community. While volunteers are given the flexibility to tailor each community dialogue session to the specific needs and requirements of the community, the sessions are designed to be highly participatory, giving all participants the opportunity to share experiences and voice concerns. Each Community Dialogue session concludes with participants committing to a course of action. Participants are also encouraged to spread information through word of mouth, set a positive example among family, friends and neighbours and to hold each other to account for applying decisions reached during Community Dialogue sessions. | |
WHAT Materials A range of non-visual tools to support sensitisation, training, community dialogue sessions, supervision, monitoring and evaluation were developed by the study team: | |
Intervention materials | Purpose |
Sensitisation | |
Sensitisation sheet (villages) | Introduces the study and outlines selection criteria and proposed selection process for the role of community dialogue facilitator |
Sensitisation sheet (supervisors) | Summarises the role of supervisors and expected commitment |
Candidate contact details recording form | Used to record contact details of candidates for the role of community dialogue facilitators |
Training | |
Training-of-trainers manual | Describes content and format of a three-day training of trainers |
Training manual | Describes content and format of a two-day training for all community dialogue facilitators and supervisors |
Community dialogues | |
Community dialogue flipchart | • Visually illustrates the intervention’s key messages, with messages printed on the back of each page • Intended to be used by community dialogue facilitators to stimulate discussion among the community |
Community dialogue discussion guide | Lists questions community dialogue facilitators could explore with communities during each of the phases of the community dialogues |
Antibiotic resistance leaflet | • Uses a selection of drawings and messages from the flipchart • Intended to be handed out to community dialogue participants to share with friends, neighbours and family |
Community dialogue facilitators’ guide | The guide summarises the format and purpose of community dialogue and explains community dialogue facilitators’ roles and responsibilities. |
Monitoring and evaluation | |
Community dialogue report template | • Captures basic information about each community dialogue conducted • To be completed by the community dialogue facilitator |
Decision log | Used by community dialogue facilitators to record any decisions made by the community during the community dialogues |
Supervision | |
Supervision checklist and report template | Takes supervisors through issues to be discussed with community dialogue facilitators during monthly supervision exchanges |
Monthly community dialogue plan template | Helps supervisors and community dialogue facilitators to plan community dialogues for the coming month |
Procedures A set of procedures around sensitisation, training, community dialogue sessions, supervision, monitoring and evaluation were implemented: | |
Procedures | Purpose |
Sensitisation | The research team invited key stakeholders (including, for example, CHCPs and Union Parishad Chairs) from each community to a sensitisation meeting. The study was introduced and they were requested to introduce the study within their communities and to facilitate the selection of community dialogue facilitators (based on criteria derived from the formative research) and supervisor from the CSGs and CGs. |
Training | Members of the research team delivered a three-day training of trainers session in Dhaka; after which the trainers delivered two-day trainings for the community dialogue facilitators and supervisors. |
Community dialogues | Community dialogue facilitators delivered community dialogues over a period of 6 months. Male facilitators delivered dialogues with male participants, and female facilitators with female participants. |
Monitoring and evaluation | Community dialogue facilitators completed a brief report after each community dialogue, and a decision log of any decisions taken by the community. |
Supervision | Supervisors held review meetings with community dialogues facilitators every month, using a check list and report template to guide the process. The supervision meetings also included planning for the next month’s activities. |
An implementation guide can be found here: | |
WHO PROVIDED Community dialogue facilitators were selected from within the community, using the following criteria (which were developed through the formative research): • Candidates should be adults • Candidates should be literate • Candidates should be passionate about improving health at village level • Candidates should be of good standing within their community • Candidates should be comfortable talking and leading discussions with community members Supervisors were selected from within the existing CSGs and CGs. | |
HOW Community dialogue facilitators delivered community dialogues to groups over a period of 6 months. Male facilitators delivered dialogues with male participants, and female facilitators with female participants. | |
WHERE Community dialogue facilitators were advised to identify an appropriate public space, such as a school building, in which to deliver the community dialogue. | |
WHEN AND HOW MUCH Community dialogue facilitators were advised to identify a time of day that was suitable for participants to deliver the dialogue. They were advised to ensure that each area within their community was reached at least once per month. | |