Investigating the intersectionality of power dynamics, hierarchies, and health-seeking and health-providing behaviours in hospital settings across different cultural boundaries

The social drivers of antimicrobial resistance (AMR) remain understudied.(1) The burden of AMR is greatest where resources are least available.

Across structures within society, including healthcare, power manifests itself according to gender, socioeconomic status, race, ethnicity, and class influencing infection-related health-seeking and health-providing behaviours.(2) I will investigate how and why social determinants influence how people seek, experience, and provide healthcare for (bacterial) infection prevention and control (IPC) and antibiotic use in South Africa and India.

Applying an innovative lens and mixed methods of: - ethnographic research, sociograms, and semi-structured interviews with healthcare providers, patients, and carers; - quantitative analysis of clinical practice in hospitals measuring the various predictors of AMR using bi-variable and multivariable regression analyses this research will provide empirical, high- quality evidence on how social determinants intersect with health, social well-being, and vulnerability in IPC practices and antibiotic use.

Using this knowledge I will: 1) design, implement, and measure effects of interventions accounting for these factors; 2) provide a toolkit for advocacy for actors in AMR and health to assist them to promote dialogue and policy on this issue.

This work directly benefits communities most affected by AMR, reframing healthcare structures and practices in participating sites with potential for wider translation.