“The Mould that Changed the World”: a quantitative and qualitative evaluation of knowledge and behavioural change in children in the UK following participation in a musical about antimicrobial resistance

Abstract

BackgroundA primary school musical—“The Mould that Changed the World”—was developed as a unique public engagement strategy to combat antimicrobial resistance (AMR) by engaging children in the story of the discovery of antibiotics, the risks of drug-resistant infections, and the importance of prudent antibiotic use. MethodsThe musical intervention was implemented in two UK primary schools. Parental consent was obtained for all participating children. All 182 participating children, aged 9–11 years, were given an online questionnaire in the classroom before rehearsals began and at 2 weeks after performance with a 6-month evaluation in one school. The effect of the musical was analysed using generalised linear models to control for confounding factors. For the qualitative evaluation, 15 participating children were selected randomly from each school to take part in semi-structured focus groups (n=5 per group) before rehearsals began and 2 weeks after performance. This study was approved by the University of Edinburgh research governance office as an evaluation of an intervention. FindingsConsistent with other intervention studies, knowledge gain was shown with children being more likely to answer questions on key messages of the musical correctly 2 weeks after performance (n=161) compared with the pre-rehearsal questionnaire (n=180; odds ratio 4·63 [95% CI 2·46–9·31], p<0·0001 for knowledge that bacteria can become resistant to antibiotics; 3·26 [1·75–6·32], p=0·00014 for knowledge that antibiotic resistant infections can be life threatening; 2·16 [1·39–3·38], p=0·00059 for knowledge that prudent use of antibiotics will halt rise of antibiotic resistant infections). Long-term knowledge gain was shown by a consistent level of correct answers on key messages between 2 weeks (response rate 95%, n=89) and 6 months after the musical (response rate 71%, n=67). Following the musical children participating in the focus groups (n=30) articulated a greater understanding of AMR and the risks of antibiotic overuse. They discussed intention to minimise personal antibiotic use and influence attitudes to antibiotics in their family and friends. InterpretationAlthough only evaluated in two schools, this study shows that initiatives such as musical theatre can improve both short-term and long-term knowledge in children. It shows a hitherto infrequently reported change in attitude and intention to behaviour change in children at an influential age for health beliefs. This unique public health tool has the potential for national roll-out in primary schools across the UK. FundingBritish Society of Antimicrobial Chemotherapy.