Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

Abstract

Background: Overuse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities' antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes. Method: A systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as 'very promising' (all outcomes statistically significant), 'quite promising' (some outcomes statistically significant), or 'not promising' (no outcomes statistically significant). 'Promise ratios' (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2. Results: Twenty studies (of19 interventions) were included. Seven interventions (37%) were 'very promising', eight 'quite promising' (42%) and four 'not promising' (21%). Most promising intervention types were 'persuasion' (n = 12; promise ratio (PR) = 5.0), 'enablement' (n = 16; PR = 4.33) and 'education' (n = 19; PR = 3.75). Most promising behaviour change techniques were 'feedback on behaviour' (n = 9; PR = 8.0) and 'restructuring the social environment' (e.g. staff role changes; n = 8; PR = 7.0).

Motivating voluntary compliance to behavioural restrictions: Self-determination theory–based checklist of principles for COVID-19 and other emergency communications

“…The feedback should be clear and accurate but nonjudgemental. Providing feedback on performance or outcome of behaviour has been linked to larger effects in various interventions to change behaviour, for example, reductions in alcohol consumption (Black et al, 2016), overweight adolescents physical activity and healthy eating change (Samdal et al, 2017), and reducing inappropriate antibiotic prescribing (Crayton et al, 2020). Some research indicates that it is feeling good rather than bad about the progress that produces stronger motivation (J. P. Reynolds et al, 2018), thus supporting SDT's assumption of the importance for fostering the sense of competence, by providing encouraging feedback (i.e., celebrating even small successes, rather than scolding people for not progressing enough).…”

Prescription Analysis of Outpatients in a Tertiary Care Hospital in Khyber Pakhtunkhwa, Pakistan

“…This work is licensed under the Creative Commons Attribution 4.0 International License Bangladesh and Nigeria (3.16). 12 However, these results were less than the studies carried out in Ghana (4.8 ≃ 5), Nigeria (6.1) 13 and Nepal (9.8 ≃ 10). 14…”

Systematic review of factors promoting behaviour change toward antibiotic use in hospitals

“…Furthermore, detailing the context for interventions implementation helps to clarify how it affects interventions effectiveness. The "Action, actor, context, target, time (AACTT)" framework [17] proposes five domains to describe interventions [16,18].…”

“…For example, interventions to change healthcare professionals' behaviours can be characterized with nine functions from the "Behaviour Change Wheel" (BCW) [15]. This classification has already been used [7,16] to better describe AMS activities.…”