An innovative public health project has used poetry, peer education and film to creatively raise awareness of antibiotic use among refugee and asylum seeker communities in Liverpool.
Stay Healthy Liverpool is a research project working with local communities and professionals to embed storytelling and creativity into efforts to tackle health inequities.
The project, funded by UK Research and Innovation (UKRI) and delivered by the Infection Innovation Consortium: iiCON, is part of ReCITE, a programme led by Liverpool School of Tropical Medicine.
Together with community partners, researchers at LSTM co-developed research tools and methods to gather insights on antibiotic knowledge and use among asylum seeker communities in Liverpool.
108 asylum seekers were surveyed by Primary Care 24 clinic staff, NHS Community Inclusion Team and community champions recruited from initial accommodation sites. Community insights found that many asylum seekers experienced multiple barriers accessing healthcare, including long wait times, language barriers and lack of systems knowledge, potentially resulting in the underuse of necessary antibiotics. They also found prevalent misconceptions around antibiotic use and reported misuse of antibiotics. Group discussions with asylum seekers showed that these misconceptions were often shaped by experiences of antibiotics being used as a “quick fix” within fragmented and under-resourced health systems.
Utilising this data, the CIT co-produced a powerful film with scriptwriters and actors from refugee and asylum seeker communities, and produced a leaflet and illustrated map showing how and where to access local health services. A group of nine multilingual community champions were then trained to disseminate these resources in local communities, hosting a series of education sessions.
Raya Qaid, a senior Community Inclusion Worker in the Community Inclusion Team, leading some parts of champions training and data collection, said: “We are committed to empowering people and communities and improving the population's health and wellbeing. Educating individuals, listening to their stories and experiences helped us to build a strong communication bridge between them and the health care service. Also, it helped us to shape a better service to accommodate their needs by encouraging professionals to actively listen to their worries and their understanding of using antibiotics.”
Tagwa Ibrahim, a pharmacist and community champion, said: “I am truly delighted and proud to be an antimicrobial resistance champion. Raising awareness about responsible antibiotics use and combating antimicrobial resistance was incredibly rewarding. It allowed me to blend my passion for pharmacy with my desire to help others.”
Stay Healthy Liverpool was delivered by a Community Innovation Team comprised of LSTM researchers, social enterprise provider Primary Care 24 and the NHS Community Inclusion Team The peer education sessions were supported by multiple partners: Merseyside Refugee Support Network, Refugee Women Connect, Care of Calis, British Red Cross, and Brownlow Health.
The Community Innovation Team are now evaluating knowledge and behaviour change towards antibiotic use following dissemination of the resources.
As part of the UKRI Tackling Infections project delivered by iiCON for UKRI, companies and research groups with novel solutions to tackle infection transmission were offered the opportunity to bid for funding to progress projects and networks to shape the direction of the UK’s infection response. Following the process,11 successful projects, including Stay Healthy Liverpool, were awarded a share of £1.5 million funding.
Nour Essale, Community Mobiliser on the ReCITE project, said: “This is exactly why I am so proud of the ReCITE team and the community innovation model we’re implementing.
“Our community champions hold incredible experience, insight, and knowledge. They are the real experts in their communities.”
Reda Madroumi, Community Mobiliser on the AMR CIT project, said: “Working as both an academic and a community mobiliser on the AMR CIT project showed me that real change happens when communities take ownership. Seeing our champions grow and lead peer-to-peer sessions that shift knowledge and behaviours has been truly inspiring.”
Professor Janet Hemingway, iiCON Director, said: “We’re pleased to be supporting this innovative, creative engagement project. Stay Healthy Liverpool is playing an important role in raising awareness of antibiotic use in refugee and asylum seeker communities in Liverpool – helping to stop transmission and empower and inform key communities in our region.”
Stay Healthy Liverpool is one of many ReCITE CIT projects across Liverpool, tackling issues such as low rates of cancer screening and immunisation, dementia, mental health and social wellbeing.
ReCITE builds on LSTM’s previous work leveraging learnings from Kenya to establish Community Innovation Teams in Liverpool, able to use local data to identify problems and develop local solutions to issues such as low vaccine uptake in under-served communities in Liverpool during the COVID-19 pandemic.