Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis

Abstract

Antimicrobial resistance (AMR) is increasingly pervasive due to multiple, complex prescribing and consuming behaviours. Accordingly, behaviour change is an important component of response to AMR. Little is known about the best approaches to change antibiotic use practices and behaviours. This project aims to develop a context-specific behaviour change strategy focusing on promoting appropriate prescription practices following the World Health Organization recommendations for surgical prophylaxis. In an orthopaedic surgery unit in Egypt. The project included a formative qualitative research study with 31 in-depth interviews with orthopaedic surgeons that was based on the Theoretical Domains Framework (TDF) and an intervention that was developed to following the Behaviour Change Wheel (BCW) in a knowledge co-production workshop with ten public health experts that ensured that the theory based intervention was a culturally acceptable, practical and implementable intervention. The prescription of surgical prophylaxis was influenced by eight TDF domains from which workshop participants selected five to be included in the behaviour change intervention including, knowledge, belief in consequences (mistrust towards infection prevention and control measures), environmental factors (lack of prescription guidelines), professional role and reinforcement (a lack of appropriate follow up actions influenced prescription of surgical prophylaxis). The appropriate set of behaviour change functions of BCW and related activities to improve the current practices included education, enablement, persuasion, environmental restructuring and restriction. The study showed that a theory based, and context specific intervention can be created by using the TDF and BCW together with knowledge-co creation to improve the prescription of surgical prophylaxis in and Egyptian orthopaedic unit. The intervention needs to piloted and scaled up.

Barriers and enablers to blood culture sampling in Indonesia, Thailand and Viet Nam: a Theoretical Domains Framework-based survey

“…[16][17][18] The TDF has been widely used to explore barriers and enablers to healthcare professional behaviours, including diagnostic testing, antimicrobial stewardship and infection prevention control. [19][20][21][22] Here, we aimed to identify barriers and enablers to BC sampling in three middle-income countries in Southeast Asia (SEA) using a theory-based approach informed by the TDF.…”

“…The Theoretical Domains Framework (TDF) has been developed by synthesising a wide range of theories and enables researchers to investigate a broader range of individual, sociocultural and environmental behavioural influences than they would with a single theory alone 16–18. The TDF has been widely used to explore barriers and enablers to healthcare professional behaviours, including diagnostic testing, antimicrobial stewardship and infection prevention control 19–22…”

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators

“…Motivation includes all cognitive processes that energise and direct the behaviour, which can be automatic (emotion) or reflective (beliefs, intentions) (12). Various primary studies have used the BCW and COM-B model to develop interventions and to understand factors influencing behaviour relating to AMR and infection control (13)(14)(15)(16)). This includes, for example, development of antibiotic review toolkit (13), understanding how antimicrobial stewardship education and training are implemented (15), understanding hand hygiene (16) among others.…”

Effectiveness of an educational intervention in promoting antibiotic awareness among 8th to 10th grade students in Kerala, India

“…This can be attributed to the complexity of factors causing AMR's unavoidable consequences, like compromising our ability to treat common infections, resulting in disease prolongation, disability, and death. 2,11 Extension of this health problem beyond the confines of the hospital can be attributed to a lack of strict legislation, incorrect use of antibiotics, inappropriate knowledge of health professionals and beliefs, behaviors, and ignorance of patients. 2,6,11,12 Moreover, patients' misconception of antibiotics as 'harmless panacea' to infections often influences treatment decisions related to antibiotics prescription and consequent indiscriminate drug use.…”

“…2,11 Extension of this health problem beyond the confines of the hospital can be attributed to a lack of strict legislation, incorrect use of antibiotics, inappropriate knowledge of health professionals and beliefs, behaviors, and ignorance of patients. 2,6,11,12 Moreover, patients' misconception of antibiotics as 'harmless panacea' to infections often influences treatment decisions related to antibiotics prescription and consequent indiscriminate drug use. 13,14 Being the most widely used medicine worldwide, both for prophylactic and therapeutic purposes, the rate of antibiotic use among children is exceptionally high.…”