Empowering Communities, Advancing One Health: Nursing-Led Interventions Against Antimicrobial Resistance in Malaysia

By Dr. Muhammad Kamil Che Hasan and Team 

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager 

Antimicrobial resistance (AMR) stands as one of the most formidable global health threats of our time. Addressing it requires not only scientific innovation but also robust community engagement. Under the SEAOHUN One Health Research and Training (OHRT) Awards Program, our team at the Kulliyyah of Nursing, International Islamic University Malaysia, implemented the project “Community-Based Nursing Interventions for Antimicrobial Resistance through Public Empowerment”—a multifaceted initiative designed to tackle AMR through education, empowerment, and interdisciplinary collaboration.

With a grant of USD 10,000 and a project timeline from May to November 2024, we sought to reach underserved communities in Kuantan, Malaysia, equipping them with the knowledge and resources needed to make informed decisions about antimicrobial use. The experience was nothing short of transformative—not only for the community but for our team of educators, health professionals, and collaborators.

Implementation Experience: From Planning to Impact

Launching the project required rigorous groundwork, including ethical approvals, tool development, and stakeholder coordination. Our journey began with a community needs assessment involving 300 residents of Kuantan. Conducted in fresh markets and community hubs, this assessment uncovered widespread misconceptions about antibiotic use. For instance, many participants incorrectly believed antibiotics could treat viral infections like the flu, or were unsure about completing prescribed courses once symptoms subsided.

Armed with these insights, we developed the KAAP (Knowledge, Attitude, Awareness, and Practice) tool—later validated by experts and translated into Malay to ensure accessibility. Simultaneously, we designed a comprehensive training module titled “Combating Antimicrobial Resistance: Public Education and Action.” This module served as the backbone of our outreach efforts, guiding the development of seminars, brochures, flyers, and interactive sessions tailored for diverse learning styles.

Our activities spanned three main pillars: (1) capacity building for healthcare providers and public participants, (2) interactive workshops in schools and community centers, and (3) outreach programs reaching over 500 individuals, particularly underserved populations. These sessions emphasized antimicrobial stewardship, infection prevention, and responsible health behaviors—all underpinned by the One Health approach.

Enhancement of One Health Knowledge and Skills

The project greatly enhanced our team's competencies in both technical and interpersonal domains. On the hard skills side, we strengthened our abilities in community health assessment, data analysis, intervention design, and monitoring and evaluation. We conducted pre- and post-intervention assessments that revealed statistically significant improvements in awareness, knowledge, and practices.

On the soft skills front, the project deepened our capacity for community engagement, ethical sensitivity, cultural competence, and collaborative leadership. Working with local partners—from NGOs to senior citizen centers and schools—required building trust and tailoring our messages to resonate with diverse audiences. These experiences have enriched our professional development and expanded our capacity to deliver impactful, people-centered health initiatives.

Improving One Health Education and Practice

As faculty members in an OHUN member university, the project's influence on our teaching approach has been profound. By translating field experiences into case studies, simulation activities, and community-based learning modules, we can now offer students a more grounded and practical understanding of One Health principles. Our aim is to nurture a new generation of health professionals who are not only clinically competent but also community-conscious and systems-minded.

Moreover, the research and evidence generated from this initiative will feed directly into our academic outputs. We are in the process of preparing six manuscripts for publication and submitting twelve products—including questionnaires and educational tools—for copyright. These outputs will serve as teaching resources and reference materials for future One Health training in academic and policy settings.

Anticipated Impact on Target Groups

Looking ahead, we foresee a cascade of positive impacts. For the community, increased awareness and behavior change around antimicrobial use will likely reduce misuse and strengthen infection prevention. For healthcare providers, the skills gained from training sessions will enhance their ability to educate patients and advocate for rational antimicrobial use.

At an institutional level, the project strengthens the foundations for long-term integration of One Health concepts into national and regional health strategies. We are already working to formalize partnerships with local authorities to embed AMR education into ongoing health programs and explore digital learning platforms for broader dissemination.

Contributing to the Advancement of One Health in Malaysia

This initiative advances the One Health agenda by demonstrating how nursing-led, community-focused interventions can effectively address complex public health challenges. We bridged gaps between the human health sector, academia, and community organizations to deliver a cohesive, localized response to AMR.

By situating community empowerment at the heart of our approach, we helped translate the One Health vision into actionable strategies that are both replicable and scalable. The collaboration between academic institutions, health professionals, local NGOs, and community leaders stands as a model for future interdisciplinary projects in Malaysia and beyond.

Insights and Lessons Learned

Throughout the implementation of our One Health project, a number of critical insights emerged that shaped both our strategy and the depth of our impact. One of the most important lessons was the role of community trust as a foundation for success. Establishing meaningful relationships with local leaders and tailoring our content to fit cultural and linguistic contexts proved vital in fostering participation and ensuring that messages were both understood and embraced. This trust not only encouraged active engagement during the sessions but also strengthened the likelihood of long-term behavior change within the community.

Flexibility and adaptability were equally essential. As the project unfolded, we encountered diverse groups with varying needs—from senior citizens requiring adjusted schedules and delivery styles, to public audiences unfamiliar with medical terminology. By actively responding to feedback and being willing to revise our methods mid-course, we were able to create a more inclusive and effective learning environment. These adjustments, though sometimes minor, significantly enhanced the overall receptiveness and comprehension of our key messages about antimicrobial resistance (AMR).

Another valuable insight was the power of local ambassadors in amplifying our impact. By training community champions, we not only extended our reach beyond the immediate project timeline, but also empowered individuals to continue educating others long after our sessions ended. These ambassadors became trusted sources of information and played a pivotal role in sustaining the momentum of AMR awareness in their respective communities.

Our emphasis on continuous monitoring and evaluation also proved instrumental. Through pre- and post-intervention assessments, we were able to track measurable changes in community knowledge, attitudes, and practices. Notably, we observed a 35% increase in AMR awareness among participants, alongside a significant reduction in risky behaviors such as self-medication with antibiotics. These findings validated our approach and offered concrete evidence of the program’s effectiveness.

Finally, the experience underscored the importance of multi-sector collaboration. Bringing together healthcare professionals, academic institutions, local NGOs, and community organizations created a holistic platform for action. This integration of One Health concepts into our educational strategies demonstrated how complex issues like AMR can be addressed more effectively when approached from multiple angles. It reaffirmed that tackling AMR is not solely a medical challenge, but a shared responsibility that requires the collective efforts of human, animal, and environmental health sectors working in synergy.

In sum, these insights will not only inform the refinement of our future interventions but also serve as guiding principles for others undertaking similar initiatives within the One Health framework

Conclusion

The SEAOHUN OHRT Awards Program empowered us to bring science into the hands of the people—to turn concern about antimicrobial resistance into concrete, community-driven solutions. Through nursing-led education, evidence-based tools, and interdisciplinary collaboration, our project has contributed meaningfully to the advancement of One Health in Malaysia.

We are committed to continuing this work by expanding outreach, enhancing digital access, and advocating for stronger AMR policies. As our findings transition into peer-reviewed publications and educational platforms, we hope they will inspire similar initiatives across Southeast Asia and beyond.

Our journey proves that with the right support, even modest funding can yield meaningful impact when combined with community wisdom, professional expertise, and a shared commitment to health equity.

Team Leader: Dr. Muhammad Kamil Che Hasan – Dean / Associate Professor, Kulliyyah of Nursing, International Islamic University Malaysia

Team Members:

• Dr. Mohd Khairul Zul Hasymi Firdaus – IIUM

• Dr. Thandar Soe Sumaiyah Jamaludin – IIUM

• Dr. Zulkhairul Naim Sidek Ahmad – Universiti Malaysia Sabah

• Dr. Efta Triatuti – Universitas Brawijaya

• Kow Fang Fang – Hospital Tengku Ampuan Afzan

• Dr. Nik Noor Kaussar Nik Mohd Hatta – IIUM

• Dr. Shidqiyyah Abd Hamid – IIUM

• Dr. Nur Ain Mahat – IIUM