What are the ‘active ingredients’ of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

McParland, Joanna L.; Williams, Lynn; Gozdzielewska, Lucyna; Young, Mairi; Smith, Fraser; MacDonald, Jennifer; Langdridge, Darren; Davis, Mark David McGregor; Price, Lesley; Flowers, Paul

doi:10.1111/bjhp.12317

Cited by 38 publications

(35 citation statements)

References 51 publications

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“…The Theoretical Domains Framework (TDF) can be considered an elaboration of COM-B (see Table S1). McParland [21] used the TDF and the Behavior Change Technique (BCT) Taxonomy version 1 (BCTTv1) [22], a classification of "active ingredients" that are used to change behavior, to describe public awareness AMR interventions. The authors concluded that there is a clear potential for improvement of interventions.…”

Section: Introductionmentioning

confidence: 99%

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

et al. 2020

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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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Section: Introductionmentioning

confidence: 99%

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

et al. 2020

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“…Again long-term outcomes were not examined. Although only four of the studies reported any explicit theoretical basis (two social marketing theory; two 'precede-proceed' model), intervention descriptions revealed that all included at least one behavioral change technique [19]. The most common of these focused on educating participants about the consequences of behavior and using a trusted source of information to instruct participants on how to perform AMR-related behaviors.…”

Section: Interventionsmentioning

confidence: 99%

Antimicrobial Resistance in Humans and Animals: Rapid Review of Psychological and Behavioral Determinants

et al. 2020

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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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“…Not until recent years did researchers systematically report efforts in the identification of the root causes of operational barriers and facilitators in designing, implementing, and evaluating interventions. For instance, in 2018 and 2019, Langdridge et al have attempted to decipher the intervention elements and visual imagery used in public antimicrobial stewardship [23,103].…”

Section: Relation To Other Studiesmentioning

confidence: 99%

Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

et al. 2020

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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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What are the ‘active ingredients’ of interventions targeting the public's engagement with antimicrobial resistance and how might they work?

Cited by 38 publications

References 51 publications

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

Antimicrobial Resistance in Humans and Animals: Rapid Review of Psychological and Behavioral Determinants

Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

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