A regional One Health approach to mapping antimicrobial resistance interactions via systems thinking.

BACKGROUND: Antimicrobial resistance (AMR), as an original One Health problem, combines inextricable interactions between the human, animal and environmental dimensions. Addressing this challenge requires systemic thinking and coordinated networking between different levels of society and regional institutions. Knowledge of causal relationships, their mutual influence and the ability to assess the impact of possible interventions are prerequisites for coherent action to combat the further spread of antimicrobial resistance in a region. An integrated regional approach has not yet been addressed in One Health research on antimicrobial resistance. METHODS: This study is based on a systems thinking approach and uses a causal loop diagram to visualise the relationships between human, animal and ecological components in a circular AMR system map for a One Health model region. The participatory approach actively involved regional stakeholders in the data collection and modelling process through surveys, semi structured interviews and interactive workshops. Based on the developed causal loop diagram, leverage point analysis is applied to estimate which types of interventions would have the greatest ability to address antimicrobial resistance in the One Health region. RESULTS: Our results show that the system mapping tool is suitable for demonstrating the relationships regarding AMR in the One Health context for a defined region. It provides an opportunity to identify and visualise important risk factors that are direct or indirect drivers of AMR. Specifically, two amplifying and two balancing loops have been constructed in the model, covering antibiotic stewardship, public awareness, regional data management and environmental impact. Interdisciplinary and intersectoral collaboration, homogeneity of data and public awareness were identified as important leverage points. The graphical illustration of the causal loop diagram enables political and economic decision-makers to develop a deeper understanding of regional resistance patterns and the rational use of antibiotics from a One Health perspective. CONCLUSION: This study is one of the first applications of a participatory systems thinking approach to the topic of AMR in the context of a One Health region. TRAIL REGISTRATION: Not applicable.