Children against antibiotics misuse and antimicrobial resistance: assessing effectiveness of storytelling and picture drawing as public engagement approaches [version 2; peer review: 2 approved]

Background: Interventions delivered in schools have been found to be effective in improving knowledge of antibiotics and antimicrobial resistance (AMR) among school-aged children, particularly those in high-income countries, but the evidence is largely lacking in low- and middle-income countries. This study aimed to design, implement and assess storytelling in one school and picture drawing in another school as engagement approaches for improving knowledge, attitudes and beliefs about antibiotics and AMR among schoolchildren in Ghana. Methods: Two schools with a total population of 375 schoolchildren ages 11-15 years in Tema, a city in Ghana, participated in public engagement interventions involving storytelling in one school and picture drawing in another school. The interventions included eight weeks of engagement led by science teachers and a competition held in each school. For quantitative outcome-based evaluation, schoolchildren were randomly sampled in each school (31 in the storytelling school and 32 in the picture-drawing school). Purposive sampling was also used to select 20 schoolchildren in each school for qualitative outcome-based evaluation. Respondents completed identical knowledge, attitudes and beliefs questionnaires and were interviewed at two time points (before and at most a week) after key interventions to assess changes in antibiotics and AMR knowledge, attitudes and beliefs. McNemar test was conducted to assess statistical significance between baseline and endline scores. Framework analysis was used for analysing the qualitative data. Results: Picture drawing had more significant effects (both positive and negative) on schoolchildren’s AMR knowledge, attitudes and beliefs, whereas storytelling had a negative effect on children’s AMR knowledge and no significant impact on beliefs and attitudes. Conclusions: Our project’s findings suggest that public engagement interventions that use picture drawing and storytelling may influence the knowledge, attitudes and beliefs of schoolchildren regarding antibiotic misuse and AMR. However, modifications are required to make them much more effective