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Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan
Anna-Leena Lohiniva
Eastern Mediterranean Regional Office: World Health Organisation Regional Office for the Eastern Mediterranean
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse of antibiotics is common also in Sudan.
Objectives: The project aimed to develop a theory driven behavior change strategy based on local understanding of drivers of antibiotic use at primary healthcare settings in Gezira State in Sudan.
Methods: The strategy was designed based on the Theoretical Domains Framework to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques The process included (1) a formative qualitative research study (2) a knowledge co-production workshop that utilized the results of the qualitative study and aimed to design a salient, legitimate and credible behavior change strategy identifying relevant behavior change techniques (BCTs) to overcome key barriers.
Results: The main TDF domains that emerged from the discussions were knowledge of antibiotics and AMR, skills to answer patient demand on antibiotics, prescription habits and work exhaustion, social influences, intention to change prescription practices and environmental factors. The main TDF domains that emerged through discussions with patients were antibiotic use habits, social influences, professional role belief in capabilities and intention to change. The workshop discussions resulted in the selection of five BTCs that included education, training, modeling, enablement and persuasion.
Conclusion: This study, using the TDF and BCW taxonomy, identified that antibiotic prescribing is influenced by social and contextual factors. Knowledge co- production offered real benefits in addressing these complexities to come up with a set of context appropriate behavior change interventions.
Keywords
behavior change, behavior change wheel, theory based intervention, antibiotic use, primary healthcare
| Domain | Definition for TAP |
|---|---|
| Knowledge | Knowledge of antibiotics and antimicrobial resistance |
| Skills | Communication and negotiation skills to answer patient demands |
| Memory, attention and decision process | Prescription habits and psychological reactions such as exhaustion Antibiotic use habits |
| Behavior regulation | Having made plans to change behavior |
| Social influence | Social networks, social norms |
| Environmental factors | External factors |
| Professional role | Reputation, professional relations, respect towards prescribers |
| Intentions, goals, positivism | Intentions, goals to change, believing that the change is something positive |
| Beliefs in capabilities | Doctors: Belief that one can stop the prescription of unnecessary antibiotics Patients: Belief that one can stop requesting antibiotics from doctors |
| Belief in consequences | Belief on outcomes if prescribers do not reduce prescription of broad-spectrum antibiotics / if patients do not stop demanding antibiotics |
| Reinforcement | Positive or negative feedback, follow up for prescription of consumption of antibiotics |
| Emotions | Feelings that impact change positively or negatively |
Due to technical limitations, table 2 is only available as a download in the Supplemental Files section.
| TDF domain | COMB | Barrier | Objective | Intervention function |
|---|---|---|---|---|
| Knowledge | Capability | Lack of knowledge of antibiotics and AMR | Improve knowledge about the principles of antibiotic therapy, the epidemiology of AMR | Education |
| Skills | Capability | Lack of communication skills | Improve negotiation sills to answer patient demand | Training |
| Intention to change prescription practices | Motivation | No intention to change behavior | Motivate change by promoting ethical principles and by giving examples of change | Enablement Modeling |
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On 26 Oct, 2020
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On 26 Oct, 2020
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This preprint is under consideration at Implementation Science Communications. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan
Anna-Leena Lohiniva
Eastern Mediterranean Regional Office: World Health Organisation Regional Office for the Eastern Mediterranean
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 28 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 11 Jan, 2021
Review #2 received
Received 16 Nov, 2020
Review #1 received
Received 16 Nov, 2020
Reviewer #1 agreed
On 26 Oct, 2020
Reviewer #2 agreed
On 26 Oct, 2020
Reviewers invited
Invitations sent on 25 Oct, 2020
Editor assigned
On 22 Sep, 2020
First submitted
On 21 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Scientific Communication
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse of antibiotics is common also in Sudan.
Objectives: The project aimed to develop a theory driven behavior change strategy based on local understanding of drivers of antibiotic use at primary healthcare settings in Gezira State in Sudan.
Methods: The strategy was designed based on the Theoretical Domains Framework to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques The process included (1) a formative qualitative research study (2) a knowledge co-production workshop that utilized the results of the qualitative study and aimed to design a salient, legitimate and credible behavior change strategy identifying relevant behavior change techniques (BCTs) to overcome key barriers.
Results: The main TDF domains that emerged from the discussions were knowledge of antibiotics and AMR, skills to answer patient demand on antibiotics, prescription habits and work exhaustion, social influences, intention to change prescription practices and environmental factors. The main TDF domains that emerged through discussions with patients were antibiotic use habits, social influences, professional role belief in capabilities and intention to change. The workshop discussions resulted in the selection of five BTCs that included education, training, modeling, enablement and persuasion.
Conclusion: This study, using the TDF and BCW taxonomy, identified that antibiotic prescribing is influenced by social and contextual factors. Knowledge co- production offered real benefits in addressing these complexities to come up with a set of context appropriate behavior change interventions.
| Domain | Definition for TAP |
|---|---|
| Knowledge | Knowledge of antibiotics and antimicrobial resistance |
| Skills | Communication and negotiation skills to answer patient demands |
| Memory, attention and decision process | Prescription habits and psychological reactions such as exhaustion Antibiotic use habits |
| Behavior regulation | Having made plans to change behavior |
| Social influence | Social networks, social norms |
| Environmental factors | External factors |
| Professional role | Reputation, professional relations, respect towards prescribers |
| Intentions, goals, positivism | Intentions, goals to change, believing that the change is something positive |
| Beliefs in capabilities | Doctors: Belief that one can stop the prescription of unnecessary antibiotics Patients: Belief that one can stop requesting antibiotics from doctors |
| Belief in consequences | Belief on outcomes if prescribers do not reduce prescription of broad-spectrum antibiotics / if patients do not stop demanding antibiotics |
| Reinforcement | Positive or negative feedback, follow up for prescription of consumption of antibiotics |
| Emotions | Feelings that impact change positively or negatively |
Due to technical limitations, table 2 is only available as a download in the Supplemental Files section.
| TDF domain | COMB | Barrier | Objective | Intervention function |
|---|---|---|---|---|
| Knowledge | Capability | Lack of knowledge of antibiotics and AMR | Improve knowledge about the principles of antibiotic therapy, the epidemiology of AMR | Education |
| Skills | Capability | Lack of communication skills | Improve negotiation sills to answer patient demand | Training |
| Intention to change prescription practices | Motivation | No intention to change behavior | Motivate change by promoting ethical principles and by giving examples of change | Enablement Modeling |