1.3 Supporting behaviour change
Public and provider awareness of what a post-antibiotic era would be like can motivate individual behaviour change, and both healthcare delivery and food production systems can provide opportunities for individual practitioners, health workers (animal and human health sectors), and farmers to change their behaviours to improve AMS (IACG, 2018).
Broadly two kinds of intervention have been found to improve prescribing of antibiotics (Davey et al., 2017):
- restrictive techniques – rules-based approaches to improve prescribing
- enablement techniques – advice and feedback approaches to support prescribing.
Activity 4: Interventions to improve antibiotic prescribing
Read paragraphs four to eight of the Discussion section in an article about improving antibiotic prescribing practices using a One Health approach in Australia [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (Zhuo et al., 2018). Complete the following sentences:
Normative guidelines help shape individual practice patterns of healthcare workers prescribing, dispensing and treating patients with antimicrobials and similarly of veterinarians treating diseased animals. This normative guidance comes from a variety of sources:
- expert guidelines from the WHO, the FAO, the OIE,
Codex Alimentarius and other intergovernmental agencies - professional societies at the global and national levels
- disease-specific program initiatives
- country-level initiatives.
One example of a country-level initiative is described in Case Study 3.
Case Study 3: Thailand’s Antibiotic Smart Use project (So and Woodhouse, 2014)
The provincial health office collected data on:
- antibiotic prescription rates
- provider attitudes of effectiveness and knowledge of antibiotics
- non-prescription rates in cases of non-bacterial infections
- patient health and satisfaction.
Antibiotics Smart Use built decentralised networks that engaged local partners to adapt normative guidelines in their own healthcare settings and communities. These local partners comprised of networks of multidisciplinary groups across the healthcare, government and academic sectors, which extended to 22 public hospital systems in 15 provinces.
The network harnesses and shares success stories from local partners within the provider, hospital and pharmacist networks. A sequence of meetings brought together local stakeholders to evaluate the effectiveness of their current approach and to strengthen cooperative efforts. Extending this outreach, seed monies supported data collection and monitoring by hospitals, and training on treatment guidelines increased physician confidence.
The Antibiotics Smart Use project in Thailand shows the interplay between providers and patients, national guidelines and locally inspired efforts to implement them, and incentive systems and culturally mediated interventions. The project reveals the importance of local stakeholder ownership as well as the challenges of sharing and scaling these practices and sustaining such efforts.
Systems-level approaches at the regional/national level require an approach that targets multiple areas. Keys to the success of such interventions are:
- setting incremental targets
- enhancing surveillance
- providing feedback to trigger behaviour change.
Another way to create an enabling environment for behaviour change is to make AMR a core component in the health and veterinary sectors and agricultural practice in:
- professional education
- training
- certification and credentialing
- continuing education.
The WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance aims to strengthen efforts at the country level by outlining basic AMR competencies to guide the education and training of health workers (WHO, 2018a). The framework is aimed at institutions involved in pre-service and in-service training and education, as well as accreditation and regulatory bodies and policy- and decision-making authorities.
Collecting AMR, AMC and AMU data, and using this to provide tailored feedback and education to key stakeholders, is fundamental in achieving behaviour change and reducing inappropriate prescribing of antimicrobials. The framework can be used to design audit and data collection to support these aims.
Activity 5: A collaborative project
1.2 Raising awareness of AMR
