Introduction: The antimicrobial resistance of infectious pathogens is an original One Health problem. Mastering this complex and highly dynamic issue can no longer be solved by simple, locally applicable measures, but requires systems thinking and coordinated cooperation between the various levels of society and regional entities. However, an integrated regional approach has hardly been addressed in One Health research of antibiotic resistance so far. Methods: The aim of this study was to analyse and visualize the cause-effect relationships of antibiotic resistance from the perspective of the One Health region of Western Pomerania in northeastern Germany. The participatory approach actively involves regional stakeholders in the data collection and modeling process through surveys, semi-structured interviews and an interactive workshop. Results: As a result, a conceptual causal diagram for the rational use of antibiotics was developed as an example for the One Health region of Western Pomerania. In the modeling, two reinforcing loops and three balancing loops were constructed, which cover the areas of antibiotic management, public awareness, regional data management, meat consumption and environmental impact. In addition, there are cross-links between raising awareness, collaboration and antibiotic prescribing behavior. Conclusion: The final causal loop diagram enables decision-makers to develop a deeper understanding of regional antibiotic and resistance management from a One Health perspective and subsequently identify appropriate leverage points for rational use of antibiotics. Key Messages • The spread of antibiotic resistance is considered a One Health problem that needs to be addressed with systems thinking due to its dynamic nature and complexity. • The causal loop diagram underlines the regional approach that involves all regional stakeholders in the modelling and evaluation process. • The study is proof that community involvement in research helps raise public awareness and break down barriers between scientists, the public and politicians. The modelling enables decision makers to develop a deeper understanding of regional antibiotic management from a One Health perspective.