Antimicrobial stewardship in dentistry: an arts-based approach to intervention development

Abstract

BackgroundExcessive antibiotic prescribing is a global public health and patient safety problem. Around 10% of all antibiotic prescriptions worldwide are from primary dental care, with 80% estimated to be unnecessary. Earlier research identified 34 factors associated with dentists’ decisions on whether to prescribe antibiotics for adults with acute dental problems. We aimed to develop an evidence-based, theory-informed, story-based intervention to reduce antibiotic prescribing for adults during urgent dental appointments. MethodsCoproduction stakeholders included four people with lived experience of acute dental problems, four dentists, three dental nurses, three health-care researchers, two service managers, and two national policy makers. Two workshops were held: prioritising which of the 34 factors to target through the intervention; and developing narratives for the story-based intervention. A live scribe produced a graphic record of small-group discussions during the first meeting, which was followed by a full-group prioritisation exercise using nominal group technique. A theatre-company led the second workshop in which stakeholders assisted in developing the narratives through a values-based exercise and role play. A script was then commissioned. FindingsComplex relations between the factors influencing prescribing were captured by the graphic record which stimulated additional insight from group discussion. Stakeholders prioritised 11 factors for the intervention and advised that engaging the target audience about the risks of antibiotics (rather than just broadcasting messages to them) was particularly important. By exploiting the so-called stickiness of stories for sharing information, role play provided a rich source of narratives from which the professional script writer developed a series of nested video monologues called Quick Fix Frank. InterpretationAs well as focusing complex intervention development on issues important to end users, coproduction provided additional insight about antibiotic prescribing behaviours within the dynamic system of urgent dental appointments beyond that achieved from a previous systematic review and ethnographic study. The video monologues produced are part of a complex intervention (currently in development) for inclusion in the national dental antimicrobial stewardship toolkit. Testing and evaluation of the complex interventions will build on the experience of a similar online resource from primary medical care (Treating Antibiotics Responsibly: Guidance, Education & Tools). Its design makes it appropriate for engaging the wider population, including health-care professionals, in the messages that: antibiotics have risks as well as benefits, and antibiotics do not cure toothache. FundingWT was funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF-2016-09-148). This manuscript presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Services, the NIHR, or the Department of Health and Social Care.