Aisha Mukasheva

Background; Antimicrobial resistance (AMR) poses a critical environmental threat, yet institutional factors shaping frontline stewardship practices remain poorly understood. Nurses occupy a central role in pharmaceutical handling and waste disposal, but evidence on how healthcare systems enable or obstruct the translation of stewardship knowledge into compliant practice is sparse. We investigated whether environmental stewardship failures among frontline nurses in Kazakhstan primarily reflect knowledge deficits or institutional and professional barriers to behavioural translation.Methods: We conducted a parallel convergent mixed-methods study combining a cross-sectional survey of 25,609 nurses across all 20 administrative regions of Kazakhstan with 52 semi-structured interviews in sfindix tertiary hospitals. Multivariable logistic and linear regression models assessed associations between antibiotic disposal training, stewardship knowledge, professional responsibility perceptions, and disposal behaviours. Qualitative thematic analysis explored institutional mechanisms underlying quantitative patterns.Findings: Of 25,609 nurses, 61·9% reported receiving antibiotic disposal training. Awareness of recommended disposal methods (89·6%) and environmental disposal risks (87·6%) was high, yet substantial behavioural gaps persisted. Among nurses with correct disposal knowledge (n=21,064), trained nurses had lower odds of non-compliant behaviour (OR 0·511, 95% CI 0·466–0·560). Employer-integrated training showed the strongest association with compliance (OR 0·368, 95% CI 0·299–0·453), whereas government and NGO training were paradoxically associated with higher odds of non-compliance. Qualitative analysis identified a responsibility gap, professional role silos, fragmented disposal protocols, and reduced frontline visibility of pharmaceutical waste as key barriers.Interpretation: Environmental stewardship failures among nurses reflect institutional barriers to behavioural translation, not knowledge deficits alone. Stewardship responsibilities must be explicitly integrated into nursing roles, reinforced through workplace accountability mechanisms, and embedded within routine clinical workflows. Nurses represent a critical and underutilised resource within One Health AMR containment strategies.

This scoping review examines public health communication across nine Eastern European and Central Asian states—Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Turkmenistan, and Uzbekistan—highlighting how these systems have transitioned from Soviet-era legacies to contemporary practices. Eligibility criteria included the English- and Russian-language literature published from 1998 onwards, focusing on nine post-Soviet states. Sources of evidence comprised searches in Google Scholar, ScienceDirect, SSRN, Heliyon, MEDLINE/PubMed, and official government websites. Data were charted by three independent reviewers using a standardized form, with discrepancies resolved by senior reviewers. The review identifies persistent gaps in communication during health crises, with a particular focus on the COVID-19 pandemic, where centralized and hierarchical information flows often undermine transparency and responsiveness, as well as further increased health inequalities between rural and urban health outcomes. Despite ongoing reforms, the communication dimension of healthcare systems remains underdeveloped. Findings reveal that centralized and top-down communication remains a dominant feature across the region, hindering timely dissemination of information and limiting the capacity to counter misinformation, as both misinformation and disinformation sometimes emerge from the government. Ultimately, this review contributes a critical analysis of these systematic communication failures and underscores the need to strengthen public health communication and reduce health inequalities. To do it, governments must prioritize transparency, disclose decision-making processes, and rely on evidence-based messaging to build trust. Effective crisis response requires not only government leadership but also the active engagement of the medical and patient communities, supported by civil society and independent media. This review points out the need for more inclusive, transparent, and trust-oriented communication strategies to enhance public health preparedness and resilience in nine Eastern European and Central Asian contexts.

This scoping review examines public health communication across nine Eastern European and Central Asian states—Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Turkmenistan, and Uzbekistan—highlighting how these systems have transitioned from Soviet-era legacies to contemporary practices. Eligibility criteria included English and Russian language literature published from 1998 onwards, focusing on nine Post-Soviet states. Sources of evidence comprised searches in Google Scholar, ScienceDirect, SSRN, Heliyon, MEDLINE/PubMed, and official government websites. Data were charted by three independent reviewers using a standardized form, with discrepancies resolved by senior reviewers.The review identifies persistent gaps in communication during health crises, with a particular focus on the COVID-19 pandemic, where centralized and hierarchical information flows often undermine transparency and responsiveness, as well as further increased health inequalities between rural and urban health outcomes. Despite ongoing reforms, the communication dimension of healthcare systems remains underdeveloped. Findings reveal that despite ongoing reforms, centralized and top-down communication remains a dominant feature across the region, hindering timely dissemination of information and limiting the capacity to counter misinformation, as both misinformation and disinformation sometimes emerge from the government. Strengthening public health communication and reducing health inequalities, governments must prioritize transparency, disclose decision-making processes, and rely on evidence-based messaging to build trust. Effective crisis response requires not only government leadership but also the active engagement of the medical and patient communities, supported by civil society and independent media. This review points out the need for more inclusive, transparent, and trust-oriented communication strategies to enhance public health preparedness and resilience in nine Eastern European and Central Asian contexts.