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Virhia J, Laurie E, Lembo T, Seni J, Pollack R, Davis A, Mapunjo S, Mshana SE, Mmbaga BT, Hilton S. Developing a logic model for communication-based interventions on antimicrobial resistance (AMR). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002965. [PMID: 38870108 PMCID: PMC11175528 DOI: 10.1371/journal.pgph.0002965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/08/2024] [Indexed: 06/15/2024]
Abstract
The importance of communication in enhancing people's awareness and understanding of antimicrobial resistance (AMR) is consistently recognised in global and national action plans (NAPs). Despite this, there have been relatively few national AMR communication campaigns which use a structured approach to take account of the local context, encompass co-design with the target audience and use a logic model to help inform its design, implementation and evaluation. Designing a logic model for communication-based interventions can help map out the planning, resources, messaging, assumptions and intended outcomes of the campaign to maximise its impact, ensure it is fit for context and minimise any unintended consequences on individuals and society. Building on an AMR research project in Tanzania, Supporting the National Action Plan for AMR (SNAP-AMR), we co-designed the SNAP-AMR Logic Model with key stakeholders to implement AMR communication campaigns and related legacy materials to be employed in support of the Tanzanian NAP, but with broader relevance to a range of contexts. In developing the SNAP-AMR Logic Model, we reviewed relevant communication theories to create and target messages, and we considered behavioural change theories. We defined all key elements of the SNAP-AMR Logic Model as follows: (1) resources (inputs) required to enable the design and implementation of campaigns, e.g. funding, expertise and facilities; (2) activities, e.g. co-design of workshops (to define audience, content, messages and means of delivery), developing and testing of materials and data collection for evaluation purposes; (3) immediate deliverables (outputs) such as the production of legacy materials and toolkits; and (4) changes (outcomes) the campaigns aim to deliver, e.g. in social cognition and behaviours. The SNAP-AMR Logic Model efficiently captures all the elements required to design, deliver and evaluate AMR communication-based interventions, hence providing government and advocacy stakeholders with a valuable tool to implement their own campaigns. The model has potential to be rolled out to other countries with similar AMR socio-cultural, epidemiological and economic contexts.
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Affiliation(s)
- Jennika Virhia
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Emma Laurie
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tiziana Lembo
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences, Bugando Medical Centre, Mwanza, Tanzania
| | - Roxana Pollack
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Alicia Davis
- School of Social and Political Sciences/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Siana Mapunjo
- National Institute for Medical Research and Ministry of Health, Dodoma, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill-Bugando School of Medicine, Catholic University of Health and Allied Sciences, Bugando Medical Centre, Mwanza, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shona Hilton
- MRC/CSO School of Social & Public Health Sciences Unit/School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Rickard H, Watkin S, Baldwin N, De Souza A, Ciric L, Cloutman-Green E. Antimicrobial resistance as a super wicked problem: how do we engage the public to be part of the solution. Infect Prev Pract 2023; 5:100314. [PMID: 38107239 PMCID: PMC10724478 DOI: 10.1016/j.infpip.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023] Open
Abstract
Antimicrobial resistance (AMR) is now regarded as one of the greatest global challenges of the 21st century. The complexity, urgent timeframe, and lack of clear solution to AMR have contributed to its classification as a 'super wicked problem'. Yet knowledge surveys of the general public have found that they still harbour numerous misconceptions linked to both the sources and impact of AMR. This confusion is compounded by AMR being a One Health issue, and therefore a factor in not just human health but in other industries, such as farming. This can further inhibit understanding and knowledge transfer around AMR for those without a prior knowledge base. In order to address the escalating risk that AMR presents, however, it is essential to address this knowledge gap and engage with the public to support wide scale changes in behaviour and consumer choice. The WHO now requires national action plans tackling AMR to include patient and public involvement/engagement (PPI/E) to support changing the trajectory of AMR. Despite this, little detail is available as part of strategic plans on how PPI/E should be undertaken in order to aid implementation. This paper discusses a number of approaches to support the design and delivery of PPI/E in relation to AMR, including the different social behaviour models underlying successful PPI/E strategies, and key considerations linked to specific activity types. The framework produced includes features for steps from initial planning and design through to evaluation. The aim is to help improve the ability of scientists and healthcare professionals to produce high quality AMR PPI/E.
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Affiliation(s)
- Helen Rickard
- Healthy Infrastructure Research Group, University College London, Department of Civil Environmental and Geomatic Engineering, Chadwick Building, London, UK
| | - Sam Watkin
- Healthy Infrastructure Research Group, University College London, Department of Civil Environmental and Geomatic Engineering, Chadwick Building, London, UK
- Nosocomial Project, London, UK
| | | | - Anthony De Souza
- Great Ormond Street Hospital NHS Foundation Trust, Camelia Botnar Laboratories, Department of Microbiology, London, UK
| | - Lena Ciric
- Healthy Infrastructure Research Group, University College London, Department of Civil Environmental and Geomatic Engineering, Chadwick Building, London, UK
| | - Elaine Cloutman-Green
- Healthy Infrastructure Research Group, University College London, Department of Civil Environmental and Geomatic Engineering, Chadwick Building, London, UK
- Nosocomial Project, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, Camelia Botnar Laboratories, Department of Microbiology, London, UK
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Chadborn T, Williams S, Jorgensen T, Price C, Buckel A, Altieri E. An approach for embedding behavioural science in antimicrobial resistance One Health research. J Infect Public Health 2023; 16 Suppl 1:134-140. [PMID: 37973498 DOI: 10.1016/j.jiph.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
Antimicrobial Resistance (AMR) is a global health emergency that threatens modern medicine and incurs great cost to human health. The World Health Organization as part of a quadripartite joint initiative with the Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, and United Nations Environment Programme, has recently published a One Health Priority Research Agenda for AMR. In this article we present a multidisciplinary approach, proposed by behavioural science experts, One Health experts and AMR experts to support the implementation of the Priority Research Agenda. We review, using specific examples of complex interventions designed to tackle AMR in which behavioural science has been embedded, five main steps: Define - what behaviours are a priority in each context; Diagnose - What are the barriers and enablers to the behaviours prioritised? Design - what interventions exist and what new or enhanced interventions could work to tackle the barriers identified? and, Implement and Evaluate the intervention(s). The approach presented will be useful for funders and researchers who wish to incorporate methods, frameworks and insights from the behavioural sciences into research plans, proposals and protocols in relation to a multisectoral One Health agenda and produce findings that are more relevant to policymakers.
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Affiliation(s)
- Tim Chadborn
- Behavioural Insights Unit, World Health Organization (WHO), Switzerland.
| | - Simon Williams
- Behavioural Insights Unit, World Health Organization (WHO), Switzerland
| | - Tine Jorgensen
- AMR Unit, Communicable Diseases and Environment Division, World Health Organization (WHO EURO), Switzerland
| | - Cortney Price
- Office of Innovation (OIN), Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Anica Buckel
- Food and Agriculture Organization of the United Nations (FAO), Nairobi, Kenya
| | - Elena Altieri
- Behavioural Insights Unit, World Health Organization (WHO), Switzerland
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Alejandro AL, Leo WWC, Bruce M. Opportunities to Improve Awareness of Antimicrobial Resistance Through Social Marketing: A Systematic Review of Interventions Targeting Parents and Children. HEALTH COMMUNICATION 2023; 38:3376-3392. [PMID: 36437539 DOI: 10.1080/10410236.2022.2149132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Lack of knowledge from parents concerning the appropriate use of antimicrobials leads to poor treatment choices and mismanagement of antimicrobials for their children. Social marketing (SM) strategies have the potential to help parents access useful information on the appropriate use of antimicrobials. Still, its application in interventions targeting antimicrobial/antibiotic resistance awareness is minimal. This study explores the use of SM in antimicrobial/antibiotic awareness campaigns (AACs) to identify opportunities for SM approaches in developing future communication interventions targeting parents and children. We conduct a systematic review of interventions targeting parents and children between 2000 and 2022. Articles meeting the selection criteria were assessed against social marketing benchmark criteria (SMBC). We identified 6978 original records, 16 of which were included in the final review. None of the articles explicitly identified SM as part of their interventions. Twelve interventions (75%) included 1 to 4 (out of 8) benchmark criteria, while four (25%) had 5-8 benchmarks in their interventions. Of the interventions with less than four benchmark criteria, six studies (50%) reported a positive effect direction outcome, and six studies (50%) reported negative/no change direction on the outcome of interests. Meanwhile, all interventions with five or more SMBC resulted in a positive effect direction in their outcomes. In this review, the use of SM has shown promising results, indicating opportunities for future antimicrobial resistance (AMR) interventions that incorporate social marketing benchmark criteria to improve intervention outcomes.
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Affiliation(s)
- Aaron Lapuz Alejandro
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University
- Department of Nursing, Fiona Stanley Hospital
| | | | - Mieghan Bruce
- Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University
- School of Veterinary Medicine, Murdoch University
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5
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Hawkins R, Michael P, Byrne-Davis L, Bull E, Skone-James R, Hart J. The behaviours identified and the behaviour change techniques planned in health partnerships for antimicrobial stewardship. Appl Psychol Health Well Being 2023; 15:983-998. [PMID: 36433921 DOI: 10.1111/aphw.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Antimicrobial stewardship (AMS) interventions promote optimised use of antimicrobials by healthcare professionals. In 2019-2020, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) supported 12 global health partnerships in low- and middle-income countries to co-develop education and training interventions to improve AMS practices amongst hospital staff. This study aimed to describe six of the CwPAMS health partnerships' target behaviours and behaviour change techniques (BCTs) within their planned AMS interventions. Content analysis extracted behaviours and BCTs from partnership materials. Techniques used by partnerships with (n = 2) and without (n = 4) an embedded behavioural scientist were compared, to understand their added value. Nineteen AMS related behaviours for hospital staff were targeted; most commonly hand hygiene and antibiotic prescribing behaviours. Twenty-three BCTs were coded, with instructing participants on how to perform the behaviours the most prominent across all, including partnerships with a behavioural scientist. Intervention materials did not always report the context of the intervention being delivered, including who was delivering it and the target. Behaviours for change were also often not specified. Partnerships varied in reporting their content and specific behaviours, impacting replicability of their interventions, and limiting knowledge exchange. An AMS behaviour change intervention resource is recommended to support clear specification of prospective AMS interventions.
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Affiliation(s)
- Rachel Hawkins
- Faculty of Biology, Medicine and Health, Manchester, The University of Manchester, Manchester, UK
| | - Panayiotis Michael
- Faculty of Biology, Medicine and Health, Manchester, The University of Manchester, Manchester, UK
| | - Lucie Byrne-Davis
- Faculty of Biology, Medicine and Health, Manchester, The University of Manchester, Manchester, UK
| | - Eleanor Bull
- Faculty of Biology, Medicine and Health, Manchester, The University of Manchester, Manchester, UK
| | | | - Jo Hart
- Faculty of Biology, Medicine and Health, Manchester, The University of Manchester, Manchester, UK
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Mergelsberg ELP, de Ruijter D, Crone MR, Smit ES, Hoving C. Active Ingredients of Interventions Improving Smoking Cessation Support by Dutch Primary Care Providers: A Systematic Review. Eval Health Prof 2023; 46:3-22. [PMID: 35594377 DOI: 10.1177/01632787221099941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to assess active ingredients, change mechanisms, and fidelity in interventions aiming to increase the quality of smoking cessation care in the Dutch primary healthcare setting. We conducted a systematic review searching five scientific databases on August 2nd, 2019, updated on October 28th, 2021. We included effect data of behavioural interventions aiming at improving the provision of smoking cessation support by Dutch primary care providers to their patients. We excluded studies published before 2000 and those without a behavioural support intervention for primary care providers targeting smoking cessation in their patients. We found 1939 articles and included 15 distinct interventions in the review. We provided an overview of study characteristics, intervention effects, fidelity, active ingredients and change mechanisms using the Behaviour Change Techniques (BCT) Taxonomy and Mechanisms of Action (MoAs) protocols. Interventions seemed more effective when including a face-to-face component, using active learning strategies and providing a tool to help follow the guidelines in practice (e.g., physical cards with information). BCTs, MoAs, and fidelity were overall poorly reported on. To support the application of smoking cessation practices in Dutch primary care, we recommend implementation of face-to-face training programs incorporating active skill training elements combined with practical tools.
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Affiliation(s)
- Enrique L P Mergelsberg
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands.,EnBerg Analytics, Perth, WA, Australia
| | - Dennis de Ruijter
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands
| | - Mathilde R Crone
- Public Health and Primary Care, 4501Leiden University Medical Center, RC Leiden, Zuid-Holland, The Netherlands
| | - Eline S Smit
- Department of Communication Science, 1234University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands
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Jorgoni L, Carmado E, Jeffs L, Nakamachi Y, Somanader D, Bell CM, Morris AM. Knowledge, perspectives and health outcome expectations of antibiotic therapy in hospitalized patients. Infect Prev Pract 2022; 4:100245. [PMID: 36177091 PMCID: PMC9513770 DOI: 10.1016/j.infpip.2022.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background The World Health Organization (WHO) has recognized antimicrobial resistance (AMR) as a top threat to global health. However, the public has an incomplete understanding of AMR and its consequences. Aim The aim of this study was to explore patients’ understanding, perspective and health outcome expectations for antibiotic therapy within an inpatient internal medicine population. Methods A mixed methods study, combining a cross-sectional survey with qualitative methods. Fourteen questions (10 paper survey and four open ended interview questions) were used, and were completed by the participant in one sitting. Participants were recruited from General Internal Medicine units at two academic hospitals in Canada (convenience sample). Findings Thirty participants were included. Out of a scale of 1–100%, participants indicated moderate concern (mean of 40%) about getting an infection that could not be cured by antibiotics. The majority agreed that they trusted their healthcare team to decide on appropriate antibiotic therapy (mean of 81%). The participants strongly agreed (mean of 90%) that it was important to understand the rationale for their antibiotic therapy. Three themes emerged from the qualitative analysis: 1) varying levels of knowledge; 2) viewing antibiotics as beneficial while emphasizing effectiveness; and 3) trusting the healthcare team with expectations for inclusion in decision making. Conclusion The study results showed varying levels of patients’ antibiotic knowledge and large gaps in awareness related to AMR. Exploring the role and workflow of interdisciplinary healthcare professionals may be a potential strategy to minimize patients’ knowledge gap related to antimicrobial therapy and AMR.
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Visschers VHM, Feck V, Herrmann A. Knowledge, Social Influences, Perceived Risks and Benefits, and Cultural Values Explain the Public's Decisions Related to Prudent Antibiotic Use. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:1488-1503. [PMID: 34784422 PMCID: PMC9544676 DOI: 10.1111/risa.13851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
People should use antibiotics (AB) prudently to mitigate antibiotic resistance (ABR). Previous studies-and, subsequently, interventions-on ABR have focused mainly on improving public awareness and knowledge. We investigated a comprehensive theory-based explanatory model to understand the public's decision making regarding prudent AB use, based on, among others, the theory of planned behavior. In a cross-sectional online survey, the psychological determinants of people's decisions about prudent AB use were examined in a sample of 1,228 Swiss adults. The questionnaire assessed respondents' demand for AB, willingness to adopt measures that prevent the need for AB, perceived risks of ABR, perceived benefits of AB, attitudes and social influences regarding AB, knowledge of AB and ABR, and cultural values. Mokken scale analysis revealed three types of knowledge: knowledge of the functioning of AB, of ABR, and of preventive measures. Structural equation modeling indicated that respondents' demand for AB was mostly predicted by social influences, perceived benefits of AB, and knowledge of AB functioning. Willingness to prevent AB use was mainly related to conservative values, perceived risks of ABR, negative attitudes toward AB, and knowledge of preventive measures. Our study suggests that the provision of information about AB and preventive measures is a first step toward changing people's decisions related to prudent AB use. Future interventions that additionally utilize cultural values to convey important messages and target additional factors, such as social influences, the risks of ABR, and the benefits of cautious AB use, can be more successful in promoting prudent AB use.
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Affiliation(s)
- Vivianne H. M. Visschers
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Vanessa Feck
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Anne Herrmann
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
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Warran K, Burton A, Fancourt D. What are the active ingredients of 'arts in health' activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. Wellcome Open Res 2022; 7:10. [PMID: 35600003 PMCID: PMC9106992 DOI: 10.12688/wellcomeopenres.17414.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/03/2023] Open
Abstract
Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of project, people, and contexts. Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation. Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails.
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Affiliation(s)
- Katey Warran
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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10
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Warran K, Burton A, Fancourt D. What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. Wellcome Open Res 2022; 7:10. [PMID: 35600003 PMCID: PMC9106992 DOI: 10.12688/wellcomeopenres.17414.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/02/2023] Open
Abstract
Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of
project, people, and
contexts.
Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The
people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation.
Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails.
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Affiliation(s)
- Katey Warran
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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11
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Hawkins O, Scott AM, Montgomery A, Nicholas B, Mullan J, van Oijen A, Degeling C. Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis. PLoS One 2022; 17:e0261917. [PMID: 35030191 PMCID: PMC8759643 DOI: 10.1371/journal.pone.0261917] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use. METHODS National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public's KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model. RESULTS Policies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden. CONCLUSIONS Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.
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Affiliation(s)
- Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Bevan Nicholas
- Illawarra-Shoalhaven Local Health District, NSW Health, Wollongong, NSW, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Antoine van Oijen
- Molecular Horizons, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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12
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Degeling C, Brookes V, Hill T, Hall J, Rowles A, Tull C, Mullan J, Byrne M, Reynolds N, Hawkins O. Changes in the Framing of Antimicrobial Resistance in Print Media in Australia and the United Kingdom (2011-2020): A Comparative Qualitative Content and Trends Analysis. Antibiotics (Basel) 2021; 10:1432. [PMID: 34943644 PMCID: PMC8698020 DOI: 10.3390/antibiotics10121432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/21/2023] Open
Abstract
Educating the public about antimicrobial resistance (AMR) is considered a key part of an optimal public health response. In both media depictions and policy discourses around health risks, how a problem is framed underpins public awareness and understanding, while also guiding opinions on what actions can and should be taken. Using a mixed methods approach we analyse newspaper content in Australia and the United Kingdom (UK) from 2011 to 2020 to track how causes, consequences and solutions to AMR are represented in countries with different policy approaches. Analyses demonstrate greater variability in the frames used in UK newspapers reflecting large hospital and community outbreaks and a sustained period of policy reform mid-decade. Newspapers in Australia focus more on AMR causes and consequences, highlighting the importance of scientific discovery, whereas UK coverage has greater discussion of the social and economic drivers of AMR and their associated solutions. Variations in the trends of different frames around AMR in UK newspapers indicate greater levels of public deliberation and debate around immediate and actionable solutions; whereas AMR has not had the same health and political impacts in Australia resulting in a media framing that potentially encourages greater public complacency about the issue.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Victoria Brookes
- Sydney School of Veterinary Science Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Tarant Hill
- Illawarra-Shoalhaven Local Health District, NSW Health, Warrawong, NSW 2502, Australia;
| | - Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Anastacia Rowles
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Cassandra Tull
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Mitchell Byrne
- College of Human and Health Sciences, Charles Darwin University, Darwin, NT 0909, Australia;
| | - Nina Reynolds
- School of Business, Faculty of Business and Law, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
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13
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Davis MD, Lohm D, Flowers P, Whittaker A. The immune self, hygiene and performative virtue in general public narratives on antibiotics and antimicrobial resistance. Health (London) 2021; 27:491-507. [PMID: 34541910 DOI: 10.1177/13634593211046832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper employs an assemblage lens to generate analyses of general public narratives on antimicrobial resistance (AMR). Global efforts to reduce AMR include communications aiming to promote general public awareness, provide knowledge, encourage careful antibiotics use, and discourage demands for them. These efforts are somewhat compromised by the assumptions they make of individual lack of knowledge and motivation and the manner in which the AMR problem is framed in isolation from the biological, social and economic structures that produce it. Conceptualising AMR as an effect of antimicrobial assemblages of which publics are but one part, we analysed interviews with the general public on the lived experience of infections, antibiotic treatments and AMR. Far from science and policy discourse on AMR, these narratives showed antibiotics to be partly solutions to the social and biomedical challenges of infection, framed by self-defensive immunity and hygiene, the affective benefits of 'immune boosting', and the imperative to sustain the moral standing of the healthy citizen. Failing public awareness and action on AMR can be attributed to public health messages that overlook the social, affective and moral dimensions of infection care and separate AMR from its socio-economic drivers.
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14
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Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson CA, Majowicz SE, Troell M, Parmley EJ, Jørgensen PS, Wernli D. Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: analysis of 42 interventions targeting E. coli. BMC Infect Dis 2021; 21:873. [PMID: 34445962 PMCID: PMC8390193 DOI: 10.1186/s12879-021-06483-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is among the most pressing One Health issues. While interventions and policies with various targets and goals have been implemented, evidence about factors underpinning success and failure of interventions in different sectors is lacking. The objective of this study is to identify characteristics of AMR interventions that increase their capacity to impact AMR. This study focuses on AMR interventions targeting E. coli. Methods We used the AMR-Intervene framework to extract descriptions of the social and ecological systems of interventions to determine factors contributing to their success. Results We identified 52 scientific publications referring to 42 unique E. coli AMR interventions. We mainly identified interventions implemented in high-income countries (36/42), at the national level (16/42), targeting primarily one sector of society (37/42) that was mainly the human sector (25/42). Interventions were primarily funded by governments (38/42). Most intervention targeted a low leverage point in the AMR system, (36/42), and aimed to change the epidemiology of AMR (14/42). Among all included publications, 55% (29/52) described at least one success factor or obstacle (29/52) and 19% (10/52) identified at least one success factor and one obstacle. Most reported success factors related to communication between the actors and stakeholders and the role of media, and stressed the importance of collaboration between disciplines and external partners. Described obstacles covered data quality, access to data and statistical analyses, and the validity of the results. Conclusions Overall, we identified a lack of diversity regarding interventions. In addition, most published E. coli interventions were poorly described with limited evidence of the factors that contributed to the intervention success or failure. Design and reporting guidelines would help to improve reporting quality and provide a valuable tool for improving the science of AMR interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06483-z.
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Affiliation(s)
- Anaïs Léger
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, Case postale, 1211, Geneva, Switzerland.
| | - Irene Lambraki
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05, Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691, Stockholm, Sweden
| | - Melanie Cousins
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Patrik J G Henriksson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691, Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, P.O. Box 50005, 104 05, Stockholm, Sweden.,WorldFish, Jalan Batu Maung, 11960, Bayan Lepas, Penang, Malaysia
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carolee A Carson
- Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Canada
| | - Shannon E Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691, Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, P.O. Box 50005, 104 05, Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Peter S Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05, Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691, Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, Case postale, 1211, Geneva, Switzerland
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15
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Anderson A. Analysing incompliant attitudes towards antibiotic prescription completion in the UK. J Antimicrob Chemother 2021; 75:756-763. [PMID: 31800084 PMCID: PMC7021095 DOI: 10.1093/jac/dkz492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/14/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives To analyse demographic, social and geographic predictors of incompliant attitudes towards prescription completion in the UK. Methods Two waves of the Eurobarometer survey (85.1 and 90.1) were analysed, with a final sample size of 2016. Using logistic regression, the best-fitting combination of a set of identified variables was specified. The regression output and the model-averaged importance of each variable were analysed. Results Compared with a median prevalence region, respondents in the Nomenclature of Territorial Units for Statistics (NUTS) 1 London (OR = 2.358, 95% CI = 1.100–5.398) and Scotland (OR = 2.418, 95% CI = 1.083–5.693) regions were most likely to report an incompliant attitude. Respondents who correctly answered questions about whether unnecessary use of antibiotics could make them ineffective in future (OR = 0.353, 95% CI = 0.230–0.544), whether antibiotics kill viruses (OR = 0.644, 95% CI = 0.450–0.919) and whether antibiotics treat colds (OR = 0.412, 95% CI = 0.287–0.591) were less likely to report incompliant attitudes. Conversely, respondents who correctly responded that antibiotics can cause side effects (OR = 1.419, 95% CI = 1.014–1.999) were more likely to report incompliant attitudes. There was some evidence of associations between political orientation and level of compliance. Uncooperative survey respondents (OR = 2.001, 95% CI = 1.108–3.526) were more likely to report incompliant attitudes. Conclusions Incompliant attitudes towards antibiotic prescription compliance in the UK are associated with a variety of factors, including regional geographic variation in attitudes. Knowledge about antibiotics can relate to good stewardship attitudes, but concerns over side effects are associated with poor attitudes. Further research should examine the underlying attitudes and beliefs that political orientation may be a marker for in the context of antibiotic stewardship. Survey samples reliant on self-selection are likely to be biased towards good stewardship.
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Affiliation(s)
- Alistair Anderson
- School of Geographical Sciences, University of Bristol, University Road, Bristol BS8 1SS, UK
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16
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Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson C, Majowicz S, Troell M, Parmley EJ, Jørgensen PS, Wernli D. AMR-Intervene: a social-ecological framework to capture the diversity of actions to tackle antimicrobial resistance from a One Health perspective. J Antimicrob Chemother 2021; 76:1-21. [PMID: 33057678 DOI: 10.1093/jac/dkaa394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The global threat of antimicrobial resistance (AMR) requires coordinated actions by and across different sectors. Increasing attention at the global and national levels has led to different strategies to tackle the challenge. The diversity of possible actions to address AMR is currently not well understood from a One Health perspective. AMR-Intervene, an interdisciplinary social-ecological framework, describes interventions to tackle AMR in terms of six components: (i) core information about the publication; (ii) social system; (iii) bio-ecological system; (iv) triggers and goals; (v) implementation and governance; and (vi) assessment. AMR-Intervene provides a broadly applicable framework, which can inform the design, implementation, assessment and reporting of interventions to tackle AMR and, in turn, enable faster uptake of successful interventions to build societal resilience to AMR.
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Affiliation(s)
- Anaïs Léger
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
| | - Irene Lambraki
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Melanie Cousins
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Patrik J G Henriksson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden.,WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carolee Carson
- Canadian Integrated Program for Antimicrobial Resistance Surveillance; Public Health Agency of Canada, Guelph, Canada
| | - Shannon Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Peter S Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
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17
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Shebehe J, Ottertun E, Carlén K, Gustafson D. Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland. BMC Public Health 2021; 21:1041. [PMID: 34078338 PMCID: PMC8170648 DOI: 10.1186/s12889-021-11018-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample. METHODS The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0-6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI). RESULTS Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences. CONCLUSION Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.
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Affiliation(s)
- J Shebehe
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - E Ottertun
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - K Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - D Gustafson
- School of Health Sciences, University of Skövde, Skövde, Sweden
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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18
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Zhang A, Hobman EV, De Barro P, Young A, Carter DJ, Byrne M. Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics. Antibiotics (Basel) 2021; 10:antibiotics10030232. [PMID: 33668953 PMCID: PMC7996601 DOI: 10.3390/antibiotics10030232] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Self-medication with antibiotics is a major contributing factor to antimicrobial resistance. Prior research examining factors associated with antibiotic self-medication has focused on an individual’s knowledge about antibiotics, antibiotic usage practices, accessibility to antibiotic medication, and demographic characteristics. The role of psychological distress associated with perceived health risks in explaining antibiotic self-medication is less understood. This study was designed to address this knowledge gap in the context of the COVID-19 pandemic in Australia. An online survey of 2217 participants was conducted at the height of the initial outbreak and revealed that 19.5% of participants took antibiotics to protect themselves from COVID-19. Multivariate logistic analysis examined the predictors of taking antibiotics for protection against COVID-19. An integrative framework developed from the results illustrates potential pathways and facilitating factors that may contribute to prophylactic self-medication with antibiotics. Specifically, COVID-19 pandemic-induced psychological distress was significantly positively related to self-medication. Preventive use of antibiotics was also facilitated by a lack of understanding about antibiotics, inappropriate antibiotics usage practices, the nature of the patient-doctor relationship, and demographic characteristics. The findings highlight that to combat antimicrobial resistance due to self-medication, interventions need to focus on interrupting entrenched behavioural responses and addressing emotional responses to perceived health risks.
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Affiliation(s)
- Airong Zhang
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
- Correspondence:
| | - Elizabeth V. Hobman
- Land & Water, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia;
| | - Paul De Barro
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
| | - Asaesja Young
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD 4102, Australia; (P.D.B.); (A.Y.)
| | - David J. Carter
- Faculty of Law, University of Technology Sydney, Sydney, NSW 2007, Australia;
| | - Mitchell Byrne
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT 0815, Australia;
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19
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Borek AJ, Wanat M, Atkins L, Sallis A, Ashiru-Oredope D, Beech E, Butler CC, Chadborn T, Hopkins S, Jones L, McNulty CAM, Roberts N, Shaw K, Taborn E, Tonkin-Crine S. Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies. BMJ Open 2020; 10:e039284. [PMID: 33334829 PMCID: PMC7747536 DOI: 10.1136/bmjopen-2020-039284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While various interventions have helped reduce antibiotic prescribing, further gains can be made. This study aimed to identify ways to optimise antimicrobial stewardship (AMS) interventions by assessing the extent to which important influences on antibiotic prescribing are addressed (or not) by behavioural content of AMS interventions. SETTINGS English primary care. INTERVENTIONS AMS interventions targeting healthcare professionals' antibiotic prescribing for respiratory tract infections. METHODS We conducted two rapid reviews. The first included qualitative studies with healthcare professionals on self-reported influences on antibiotic prescribing. The influences were inductively coded and categorised using the Theoretical Domains Framework (TDF). Prespecified criteria were used to identify key TDF domains. The second review included studies of AMS interventions. Data on effectiveness were extracted. Components of effective interventions were extracted and coded using the TDF, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) taxonomy. Using prespecified matrices, we assessed the extent to which BCTs and intervention functions addressed the key TDF domains of influences on prescribing. RESULTS We identified 13 qualitative studies, 41 types of influences on antibiotic prescribing and 6 key TDF domains of influences: 'beliefs about consequences', 'social influences', 'skills', 'environmental context and resources', 'intentions' and 'emotions'. We identified 17 research-tested AMS interventions; nine of them effective and four nationally implemented. Interventions addressed all six key TDF domains of influences. Four of these six key TDF domains were addressed by 50%-67% BCTs that were theoretically congruent with these domains, whereas TDF domain 'skills' was addressed by 24% of congruent BCTs and 'emotions' by none. CONCLUSIONS Further improvement of antibiotic prescribing could be facilitated by: (1) national implementation of effective research-tested AMS interventions (eg, electronic decision support tools, training in interactive use of leaflets, point-of-care testing); (2) targeting important, less-addressed TDF domains (eg, 'skills', 'emotions'); (3) using relevant, under-used BCTs to target key TDF domains (eg, 'forming/reversing habits', 'reducing negative emotions', 'social support'). These could be incorporated into existing, or developed as new, AMS interventions.
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Affiliation(s)
- Aleksandra J Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise Atkins
- Centre for Behaviour Change, University College London, London, UK
| | - Anna Sallis
- Behavioural Insights, Public Health England, London, UK
| | - Diane Ashiru-Oredope
- Antimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK
| | | | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Tim Chadborn
- Behavioural Insights, Public Health England, London, UK
| | - Susan Hopkins
- Antimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK
| | - Leah Jones
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Karen Shaw
- Antimicrobial Resistance and Stewardship and Healthcare Associated Infections (HCAI), Public Health England, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Esther Taborn
- NHS England and NHS Improvement, London, UK
- NHS East Kent Clinical Commissioning Groups, Canterbury, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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20
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Hanbury A, Sallis A, Chadborn T, Arber M, Sanderson A, Durlik C, Wood H. Retrospective coding of health care professional cancer screening behaviours and of real-world interventions designed to support them: Identifying recommendations to optimize intervention design. Br J Health Psychol 2020; 26:419-443. [PMID: 33236514 DOI: 10.1111/bjhp.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Screening can detect cancer earlier. Uptake of breast, cervical, and bowel cancer screening in England is below 75%. This study identifies the barriers and facilitators underpinning HCP screening behaviours which can support screening uptake, and reviews the design of real-world interventions targeting these, assessing for congruence between the two. The aim was to provide recommendations to improve the design of interventions. DESIGN AND METHODS Barriers/facilitators were identified by a literature review and qualitatively coded using the theoretical domains framework (TDF). Interventions were identified by stakeholders and coded using the behaviour change wheel and the taxonomy of behaviour change techniques. Congruence was assessed through comparing the intervention designs with behavioural science experts' recommendations which link the TDF domains to intervention design. Recommendations targeted missed opportunities. RESULTS Barriers/facilitators were extracted from 60 papers and most frequently coded to the TDF domains: environmental context and resources, knowledge and beliefs about consequences. Thirty-one interventions were identified, most frequently education, training or enablement functions, delivered via communication/marketing or service provision, and using BCTs designed to shape knowledge or highlight the consequences of or antecedents to screening. Intervention design was largely congruent with recommendations. However, there was less use of persuasion and modelling intervention functions and a reliance on BCTs such as providing instruction when other BCTs could be considered. CONCLUSIONS Recommendations include to consider a broader range of intervention functions and BCTs, particularly for training interventions which should make use of recommended BCTs such as 'graded tasks'.
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Affiliation(s)
- Andria Hanbury
- York Health Economics Consortium (YHEC), University of York, UK
| | - Anna Sallis
- Behavioural Insights, Public Health England, London, UK
| | - Tim Chadborn
- Behavioural Insights, Public Health England, London, UK
| | - Mick Arber
- York Health Economics Consortium (YHEC), University of York, UK
| | - Alice Sanderson
- York Health Economics Consortium (YHEC), University of York, UK
| | | | - Hannah Wood
- York Health Economics Consortium (YHEC), University of York, UK
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21
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Lin L, Alam P, Fearon E, Hargreaves JR. Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review. Implement Sci 2020; 15:90. [PMID: 33081791 PMCID: PMC7574316 DOI: 10.1186/s13012-020-01018-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background An epidemic of health disorders can be triggered by a collective manifestation of inappropriate behaviors, usually systematically fueled by non-medical factors at the individual and/or societal levels. This study aimed to (1) landscape and assess the evidence on interventions that reduce inappropriate demand of medical resources (medicines or procedures) by triggering behavioral change among healthcare consumers, (2) map out intervention components that have been tried and tested, and (3) identify the “active ingredients” of behavior change interventions that were proven to be effective in containing epidemics of inappropriate use of medical resources. Methods For this systematic review, we searched MEDLINE, EMBASE, the Cochrane Library, and PsychINFO from the databases’ inceptions to May 2019, without language restrictions, for behavioral intervention studies. Interventions had to be empirically evaluated with a control group that demonstrated whether the effects of the campaign extended beyond trends occurring in the absence of the intervention. Outcomes of interest were reductions in inappropriate or non-essential use of medicines and/or medical procedures for clinical conditions that do not require them. Two reviewers independently screened titles, abstracts, and full text for inclusion and extracted data on study characteristics (e.g., study design), intervention development, implementation strategies, and effect size. Data extraction sheets were based on the checklist from the Cochrane Handbook for Systematic Reviews. Results Forty-three studies were included. The behavior change technique taxonomy v1 (BCTTv1), which contains 93 behavioral change techniques (BCTs), was used to characterize components of the interventions reported in the included studies. Of the 93 BCTs, 15 (16%) were identified within the descriptions of the selected studies targeting healthcare consumers. Interventions consisting of education messages, recommended behavior alternatives, and a supporting environment that incentivizes or encourages the adoption of a new behavior were more likely to be successful. Conclusions There is a continued tendency in research reporting that mainly stresses the effectiveness of interventions rather than the process of identifying and developing key components and the parameters within which they operate. Reporting “negative results” is likely as critical as reporting “active ingredients” and positive findings for implementation science. This review calls for a standardized approach to report intervention studies. Trial registration PROSPERO registration number CRD42019139537
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Affiliation(s)
- Leesa Lin
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Prima Alam
- London School of Hygiene & Tropical Medicine, London, UK
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Atkins L, Chadborn T, Bondaronek P, Ashiru-Oredope D, Beech E, Herd N, de La Morinière V, González-Iraizoz M, Hopkins S, McNulty C, Sallis A. Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care. Antibiotics (Basel) 2020; 9:E512. [PMID: 32823693 PMCID: PMC7460499 DOI: 10.3390/antibiotics9080512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1-27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1-14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions.
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Affiliation(s)
- Lou Atkins
- Center for Behavior Change, University College London, Alexandra House, 7–19 Queens Square, London WC1N 3AZ, UK;
| | - Tim Chadborn
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
| | - Paulina Bondaronek
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
| | - Diane Ashiru-Oredope
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
| | - Elizabeth Beech
- NHS England and NHS Improvement, Wellington House, 1st Floor, 133-155 Waterloo Road, London SE1 8UG, UK;
| | - Natalie Herd
- Center for Behavior Change, University College London, Alexandra House, 7–19 Queens Square, London WC1N 3AZ, UK;
| | | | - Marta González-Iraizoz
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
| | - Susan Hopkins
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
| | - Cliodna McNulty
- Public Health England, Primary Care Unit, Twyver House, Bruton Way, Gloucester GL1 1DQ, UK;
| | - Anna Sallis
- Public Health England Behavioral Insights (PHEBI), Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK; (T.C.); (P.B.); (D.A.-O.); (M.G.-I.); (S.H.); (A.S.)
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23
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Sallis A, Bondaronek P, Sanders JG, Yu LM, Harris V, Vlaev I, Sanders M, Tonkin-Crine S, Chadborn T. Prescriber Commitment Posters to Increase Prudent Antibiotic Prescribing in English General Practice: A Cluster Randomized Controlled Trial. Antibiotics (Basel) 2020; 9:E490. [PMID: 32784625 PMCID: PMC7569839 DOI: 10.3390/antibiotics9080490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 01/21/2023] Open
Abstract
Unnecessary antibiotic prescribing contributes to Antimicrobial Resistance posing a major public health risk. Estimates suggest as many as half of antibiotics prescribed for respiratory infections may be unnecessary. We conducted a three-armed unblinded cluster randomized controlled trial (ISRCTN trial registry 83322985). Interventions were a commitment poster (CP) advocating safe antibiotic prescribing or a CP plus an antimicrobial stewardship message (AM) on telephone appointment booking lines, tested against a usual care control group. The primary outcome measure was antibiotic item dispensing rates per 1000 population adjusted for practice demographics. The outcome measures for post-hoc analysis were dispensing rates of antibiotics usually prescribed for upper respiratory tract infections and broad spectrum antibiotics. In total, 196 practice units were randomized to usual care (n = 60), CP (n = 66), and CP&AM (n = 70). There was no effect on the overall dispensing rates for either interventions compared to usual care (CP 5.673, 95%CI -9.768 to 21.113, p = 0.458; CP&AM, -12.575, 95%CI -30.726 to 5.576, p = 0.167). Secondary analysis, which included pooling the data into one model, showed a significant effect of the AM (-18.444, 95%CI -32.596 to -4.292, p = 0.012). Fewer penicillins and macrolides were prescribed in the CP&AM intervention compared to usual care (-12.996, 95% CI -34.585 to -4.913, p = 0.018). Commitment posters did not reduce antibiotic prescribing. An automated patient antimicrobial stewardship message showed effects and requires further testing.
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Affiliation(s)
- Anna Sallis
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
| | - Paulina Bondaronek
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London SE1 8UG, UK
| | - Jet G. Sanders
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
- Department of Psychological and Behavioural Science, London School of Economics and Political Sciences, London SE1 8UG, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
| | - Victoria Harris
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry CV4 7AL, UK;
| | - Michael Sanders
- The Behavioural Insights Team. 4 Matthew Parker St, Westminster, London SW1H 9NP, UK;
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (L.-M.Y.); (V.H.); (S.T.-C.)
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX2 6GG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights (PHEBI), Research, Translation & Innovation, Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK; (P.B.); (J.G.S.); (T.C.)
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24
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Chambers JA, Crumlish M, Comerford DA, O’Carroll RE. Antimicrobial Resistance in Humans and Animals: Rapid Review of Psychological and Behavioral Determinants. Antibiotics (Basel) 2020; 9:antibiotics9060285. [PMID: 32471045 PMCID: PMC7345344 DOI: 10.3390/antibiotics9060285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 05/24/2020] [Indexed: 12/02/2022] Open
Abstract
A rapid review of current evidence examining psychological issues regarding the use of antibiotics and antimicrobials and resistance to these in both human and animal populations was conducted. Specific areas of interest were studies examining psychological determinants of AMR and interventions which attempt to change behavior with regard to AMR in the general population; animals; and fish, in particular. Although there is some evidence of the effectiveness of behavior change in general human populations, there is limited evidence in farmed animals, with a particular dearth in fish farming. We conclude there is an urgent need for more psychological research to identify major barriers and facilitators to change and evaluate the effectiveness of theory-based interventions aimed at reducing AM use in food production animals, including the promotion of alternatives to AMs, such as vaccination.
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Affiliation(s)
- Julie A. Chambers
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK;
| | - Margaret Crumlish
- Institute of Aquaculture, University of Stirling, Stirling FK9 4LA, UK;
| | | | - Ronan E. O’Carroll
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK;
- Correspondence:
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25
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Ahmed R, Bashir A, Brown JEP, Cox JAG, Hilton AC, Jordan SL, Theodosiou E, Worthington T. Aston University's Antimicrobial Resistance (AMR) Roadshow: raising awareness and embedding knowledge of AMR in key stage 4 learners. Infect Prev Pract 2020; 2:100060. [PMID: 34368704 PMCID: PMC8336141 DOI: 10.1016/j.infpip.2020.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global healthcare problem and therefore raising awareness within young learners is imperative. An AMR roadshow was designed to take key stage 4 students' learning ‘out of the classroom’, assess pre-existing knowledge of AMR and determine the impact of the roadshow on knowledge retention. Knowledge and subsequent retention were measured pre- and post-event through a standardised questionnaire. The roadshow significantly improved knowledge and understanding of AMR, which was retained for a minimum of twelve weeks. Engaging and interactive strategies addressing key health issues provide a positive learning experience which contributes to retained knowledge in young learners.
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Affiliation(s)
- Rabia Ahmed
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Amreen Bashir
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - James E P Brown
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Jonathan A G Cox
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Anthony C Hilton
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Samantha L Jordan
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Eirini Theodosiou
- School of Engineering and Applied Science, Aston University, Birmingham B4 7ET, UK
| | - Tony Worthington
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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26
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Redfern J, Bowater L, Coulthwaite L, Verran J. Raising awareness of antimicrobial resistance among the general public in the UK: the role of public engagement activities. JAC Antimicrob Resist 2020; 2:dlaa012. [PMID: 34222970 PMCID: PMC8210175 DOI: 10.1093/jacamr/dlaa012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In response to the accepted risk of emerging antimicrobial resistance, many organizations and institutions have developed and delivered events and activities designed to raise awareness of the issue and to change the behaviour of the intended audience. However, few of these events for a general public audience are documented or able to be sourced by those who might wish to repeat, adapt or modify, particularly those events that are successful. 'Insider knowledge' appears to be the best search tool. Moreover, evaluation of the success or impact of the event is rarely published. It would be useful if there were a 'hub' where descriptions of such activities could be deposited, enabling the building of a significant resource with real academic value.
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Affiliation(s)
- James Redfern
- Department of Natural Sciences, Manchester Metropolitan University, Manchester, UK
| | - Laura Bowater
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa Coulthwaite
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Joanna Verran
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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27
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van der Zande MM, Dembinsky M, Aresi G, van Staa TP. General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices. BMC FAMILY PRACTICE 2019; 20:172. [PMID: 31823739 PMCID: PMC6905031 DOI: 10.1186/s12875-019-1065-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 12/01/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is high on the UK public health policy agenda, and poses challenges to patient safety and the provision of health services. Widespread prescribing of antibiotics is thought to increase AMR, and mostly takes place in primary medical care. However, prescribing rates vary substantially between general practices. The aim of this study was to understand contextual factors related to general practitioners' (GPs) antibiotic prescribing behaviour in low, high, and around the mean (medium) prescribing primary care practices. METHODS Qualitative semi-structured interviews were conducted with 41 GPs working in North-West England. Participants were purposively sampled from practices with low, medium, and high antibiotic prescribing rates adjusted for the number and characteristics of patients registered in a practice. The interviews were analysed thematically. RESULTS This study found that optimizing antibiotic prescribing creates tensions for GPs, particularly in doctor-patient communication during a consultation. GPs balanced patient expectations and their own decision-making in their communication. When not prescribing antibiotics, GPs reported the need for supportive mechanisms, such as regular practice meetings, within the practice, and in the wider healthcare system (e.g. longer consultation times). In low prescribing practices, GPs reported that increasing dialogue with colleagues, having consistent patterns of prescribing within the practice, supportive practice policies, and enough resources such as consultation time were important supports when not prescribing antibiotics. CONCLUSIONS Insight into GPs' negotiations with patient and public health demands, and consistent and supportive practice-level policies can help support prudent antibiotic prescribing among primary care practices.
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Affiliation(s)
- Marieke M van der Zande
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Vaughan House, Portsmouth Road, Manchester, M13 9PL, UK.
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
| | - Melanie Dembinsky
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Vaughan House, Portsmouth Road, Manchester, M13 9PL, UK
- Health Sciences & Sport, University of Stirling, Stirling, UK
| | - Giovanni Aresi
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Vaughan House, Portsmouth Road, Manchester, M13 9PL, UK
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Tjeerd P van Staa
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Vaughan House, Portsmouth Road, Manchester, M13 9PL, UK
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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The drugs don't work: evaluation of educational theatre to gauge and influence public opinion on antimicrobial resistance. J Hosp Infect 2019; 104:193-197. [PMID: 31628957 DOI: 10.1016/j.jhin.2019.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
Abstract
Increased public awareness of antimicrobial resistance (AMR) is a key component of effective antimicrobial stewardship strategies. Educational theatre combined with an expert panel was used to engage the public about AMR through delivery of a play entitled 'The drugs don't work'. Audience knowledge and understanding of AMR were measured by pre- and post-play questionnaires. Performance of the play and discussion with the expert panel significantly improved audience knowledge and understanding of AMR, including antibiotic misuse and prescribing. Educational theatre provides a positive learning experience and is an innovative method of public engagement to disseminate important public health messages.
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Courtenay M, Rowbotham S, Lim R, Peters S, Yates K, Chater A. Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B. BMJ Open 2019; 9:e029177. [PMID: 31221892 PMCID: PMC6588983 DOI: 10.1136/bmjopen-2019-029177] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Respiratory tract infections are frequently managed by nurse and pharmacist prescribers, and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing among these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to: (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections and (2) identify the behaviour change techniques (BCTs) that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour. DESIGN Qualitative design comprising semistructured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour. SETTING Primary care. PARTICIPANTS Twenty one prescribers (4 pharmacists and 17 nurses). RESULTS A range of factors across 12 domains of the TDF were found to influence prescriber behaviour, and 40 BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting and information about health consequences) were identified as supporting prescribers in managing these expectations. CONCLUSION With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups.
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Affiliation(s)
| | - Samantha Rowbotham
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Lim
- School of Pharmacy, Reading University, Reading, UK
| | - Sarah Peters
- Health Sciences, University of Manchester, Manchester, UK
| | - Kathryn Yates
- Londonwide LMC, Londonwode LMCs and Londonwide Enterprise Ltd, London, UK, UK
| | - Angel Chater
- Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
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Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, Smith F, MacDonald J, Price L, Flowers P. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol 2018; 24:66-87. [PMID: 30221433 PMCID: PMC6585774 DOI: 10.1111/bjhp.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Indexed: 11/26/2022]
Abstract
Objectives In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). Methods A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. Conclusions The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the ‘post‐antibiotic’ era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health‐related behavioural change.
What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an ‘affective’ analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Affiliation(s)
- Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Milton Keynes, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lesley Price
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Paul Flowers
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
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