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Antimicrobial resistance challenging professional learning in three LMICs

Heli Kaatrakoski (Department of Social Studies, University of Stavanger, Stavanger, Norway)
Allison Littlejohn (UCL Knowledge Lab, University College London, London, UK)
Koula Charitonos (Institute of Educational Technology, The Open University, Milton Keynes, UK)

Journal of Workplace Learning

ISSN: 1366-5626

Article publication date: 8 March 2021

Issue publication date: 29 June 2021




Antimicrobial resistance (AMR) is a huge global challenge calling for changes in learning and working in health-care settings. The purpose of this study is to examine tensions expressed by professionals involved in AMR in three low- and middle-income countries (LMIC) in Asia and Africa.


The qualitative study was based on 60 face-to-face or online interviews in three LMICs. The interviews were analyzed by thematic analysis and analysis of elements of an activity system.


A number of tensions within activity systems were analyzed revealing key issues inhibiting reconceptualization of object of work and moving toward new activity. The study suggests four opposing forces: (1) cost efficiency and good public health objectives; (2) historically and culturally developed hierarchies and good public health objectives; (3) individual responsibility and institutional responsibility; and (4) fragmented set ups and holistic view of activity as critical when developing learning and work activities in analyzed settings.


This study expands the analysis of learning needs beyond individual skills and knowledge by taking a systemic approach using the cultural-historical activity theory framework. It shows that learning around AMR is needed at individual, organizational and national level.



This research was funded by the UK Government Department for Health and Social Care Fleming Fund. The authors thank the Fleming Fund and Mott MacDonald, the organisation that co-ordinated the work, for their support. Thanks to Mr Tim Seal, Senior Project Manager, for work on project management and data collection. Special thanks go to the participants of this study who contributed their insights.


Kaatrakoski, H., Littlejohn, A. and Charitonos, K. (2021), "Antimicrobial resistance challenging professional learning in three LMICs", Journal of Workplace Learning, Vol. 33 No. 6, pp. 446-459.



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