Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors?

Abstract

There is increasing evidence that psycho-social factors can influence antimicrobial prescribing practice in hospitals and the community, and represent potential barriers to antimicrobial stewardship interventions. Clinicians are conditioned both by emotional and cognitive factors based on fear, uncertainty, a set of beliefs, risk perception and cognitive bias, and by interpersonal factors established through social norms and peer and doctor–patient communication. However, a gap is emerging between research and practice, and no stewardship recommendation addresses the most appropriate human resource allocation or modalities to account for psycho-social determinants of prescribing. There is a need for translation of the evidence available from human behaviour studies to the design and implementation of stewardship interventions and policies at hospital and community levels. The integration of behaviour experts into multidisciplinary stewardship teams seems essential to positively impact on prescribers’ communication and decision-making competencies, and reduce inappropriate antibiotic prescribing.

Antibiotic resistance: Tools for effective translational research

“…In human, a recent review on the impact of antibiotic stewardship programmes in community and hospital settings thus showed the existence of numerous methodological biases in most published studies [5]: no randomisation, mainly single centre studies , retrospective with few evaluations of the clinical, or medico-economic impact. Moreover, very little attention has been given to the contribution of behavioural change strategies [6,7] and of the role of artificial intelligence in this domain to date. The use of artificial intelligence tools would enable the development of therapeutic decision support algorithms or, in animals, the supervision of livestock to provide prompt detection of infections and thus reduce the number of animals requiring treatment.…”

Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program

“…This includes analysis of components of behaviour psychology, health-care structure and cultural context, and an addressing of those that lead to irrational use. 70…”

“…99,112,113 It is thus not clear to what extent such techniques are generalisable to the context of antimicrobial use. Recent reviews suggest using, and studies have used, proper behavioural science techniques, 70,114,115 including intervention mapping and the behavioural change wheel in antimicrobial stewardship interventions, and the results are encouraging. However, since the issue of non-rational antimicrobial use is affected by a plethora of factors working on different levels and not only on individual behavioural psychology, 116 more studies are needed to identify how to properly apply such techniques to the stewardship context.…”

A decade of antimicrobial resistance research in social science fields: a scientometric review

“…However, within the social science field, academic literature on AMR has historically been lacking [15]. It is only in recent years that the values of social sciences are increasingly recognised in AMR research [16][17][18].…”