Community engagement strategies for antimicrobial resistance control and interventions

Antimicrobial resistance (AMR) is a major global health threat spanning biomedical, social and ethical domains. Conventional stewardship and regulatory strategies, often vertical and clinically oriented, frequently overlook community realities and the systemic drivers of antimicrobial use. Focusing on low- and middle-income countries (LMICs), this review blends insights from the literature and authors' experiential knowledge of working on AMR in LMICs and highlights community engagement as an essential yet underexplored component of AMR control. Community engagement encompasses complementary breadth-based approaches (e.g., awareness-raising activities and population-level communication) and depth-based approaches (e.g., community dialogue, coproduction, shared decision-making and accountability), together forming a 'diagonal approach' to developing locally relevant and sustainable AMR interventions. This approach integrates population-level communication with context-specific partnerships involving communities and other One Health stakeholders. Drawing on evidence from community engagement, ethics, health systems and One Health, we examine how integrated engagement approaches across various sectors can address the social and structural determinants of antimicrobial use while complementing stewardship efforts and health system strengthening. We argue that embedding meaningful community engagement within AMR policies and interventions can support equitable, context-sensitive and sustainable AMR governance and strengthen the long-term effectiveness of antimicrobial stewardship.