Abstract
Addressing the growing threat of antimicrobial resistance is, in part, reliant on the complex challenge of changing human behaviour-in terms of reducing inappropriate antibiotic use and preventing infection. Whilst there is no 'one size fits all' recommended behavioural solution for improving antimicrobial stewardship, the behavioural and social sciences offer a range of theories, frameworks, methods and evidence-based principles that can help inform the design of behaviour change interventions that are context-specific and thus more likely to be effective. However, the state-of-the-art in antimicrobial stewardship research and practice suggests that behavioural and social influences are often not given due consideration in the design and evaluation of interventions to improve antimicrobial prescribing. In this paper, we discuss four potential areas where the behavioural and social sciences can help drive more effective and sustained behaviour change in antimicrobial stewardship: (i) defining the problem in behavioural terms and understanding current behaviour in context; (ii) adopting a theory-driven, systematic approach to intervention design; (iii) investigating implementation and sustainability of interventions in practice; and (iv) maximizing learning through evidence synthesis and detailed intervention reporting.
Highlights
In healthcare, gaps remain between clinical practice and recommendations based on evidence, policy, and guidelines.(1) Antimicrobial prescribing is no exception to this, with many studies documenting overuse and/or misuse of these vital agents in both secondary and primary care.promote prudent use of antimicrobials are collectively referred to as antimicrobial stewardship programmes (ASPs)
The design and implementation of ASPs may benefit from looking outside of the antimicrobial stewardship context to draw on the evidence, recommendations and lessons learnt from the broader behaviour change literature
Despite a multidisciplinary approach potentially requiring additional time and resource, it is critical to moving the field forward and addressing many of the limitations in intervention design, evaluation and reporting that are currently faced by antimicrobial stewardship research and practice
Summary
Gaps remain between clinical practice and recommendations based on evidence, policy, and guidelines.(1) Antimicrobial prescribing is no exception to this, with many studies documenting overuse and/or misuse of these vital agents in both secondary and primary care. These COM-B components can be which represent the range of potential factors [Figure 1 Here] Both COM-B and the TDF has been applied to conduct behavioural diagnoses of ‘what needs to change’ for numerous clinical behaviours.(32) In the context of antimicrobial stewardship, the TDF has been used to design surveys and semi-structured interview topic guides to explore the factors influencing antimicrobial prescribing across various healthcare settings, including hospitals, general dental practice and long-term cares facilities.(23, 33-35) Table 1 illustrates examples of barriers/enablers within each of 14 TDF domains using findings from these studies; representing the role that each domain plays in hindering and/or enabling changes to antimicrobial prescribing. One intervention based on Social Learning Theory aiming to increase primary care clinicians’ motivation and confidence to change their prescribing practice resulted in significant reductions in all cause antibiotic prescribing in over one year, with no accompanying significant changes to hospital admissions, repeat consultations or costs.(15, 50)
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