engagement/data-sharing) complying with the data access policy. The researchers have to follow the unit data access policy (The policy documents are available on the above link). Queries and applications for data should be directed to Rita enjoyment among audience who were also willing to support future engagement activities and preferred forum theatre approach over formal health talks. Conclusions We conclude that forum theatre is an effective innovative approach to engage and disseminate knowledge on appropriate use of antibiotics with the community in a participatory way.

Background The Pint of Science festival is the biggest annual international science festival. In May 2017, we coordinated the first Pint of Science festival in Thailand and reported our initial reflections. Building on this work, we set out to evaluate more systematically events conducted in 2018. Methods In 2018, we conducted Pint of Science events at four different locations in Bangkok. Overall, there were 18 talks held over six event-days in 2018. We administered 180 self-reported questionnaires as well as conducted 11 semi-structured interviews and a focus group discussion with audience members and speakers. Results Of the 180 questionnaires handed out, 125 attendees completed the questionnaire. The majority of attendees came because they were interested in science (68.0%), to learn something new (46.4%) and to enjoy themselves (44.8%). Our qualitative results confirm the quantitative findings. In addition, speakers viewed that they benefited by improving their communication skills and having the opportunity to network with scientists and non-scientists. Speakers also mentioned that such events were a good means to engage with the public, can improve the visibility of their work and potentially attract more funding. To improve the Pint of Science activities, audience members suggested to include a more diverse range of topics, more collaborations with other local research institutions and to hold the event at larger venues. Conclusions We conclude that Pint of Science was well received in Bangkok with recommendations to improve minor issues related to practicalities and logistics.

Introduction: Physical therapists in Myanmar use a prescriptive model of Clinical Decision Making (CDM). Improving CDM effectiveness is one essential factor in professionalizing practice and enhancing patient outcomes. This study assesses the changes in CDM skills and behaviors using the PRECEDE-PROCEED planning Model (PPM). Methods: In the PRECEDE planning phases, we investigated the current clinical decision making knowledge, and process, clinical practice culture, and contributing factors of CDM among Myanmar physical therapists. A qualitative approach consisted of 18 in-depth interviews and one focus group discussion was used. In the PROCEED evaluation and implementation phases, we developed and presented the CDM educational book at CDM workshop, which was a 4-day intensive program in Yangon, Myanmar with 34 participants. The participant's CDM knowledge and processes were assessed before and after the educational program to explore the potential impact on implementing CDM which can ultimately improve patient care in the health settings of Myanmar. Results: In the PRECEDE phases, we explored the predisposing and reinforcing factors of Myanmar physical therapists' CDM. We found that CDM models and deliberative decision making process that is used internationally were not followed by Myanmar physical therapists who followed the physician's prescriptions. Teaching and learning emphasize a stimulus-response-repeat-outcome cycle without internal processing or application to clinical situations. Using the PROCEED model components, we developed a 14 chapters CDM workbook and a 4-day workshop as a behavioral change intervention. Participants' prior technical CDM behavior was transformed into professional CDM behavior that included an understanding of clinical practice models and improvement in the cognitive process of CDM processes. The workbook coupled with the intensive active-learning, hands-on workshop of examination and intervention procedures were effective in improving CDM. Discussion: The application of PPM provided a through understandings of current CDM process of Myanmar therapists and aided in the development of the tailored CDM educational program to improve participants' CDM. Using the PPM model for developing a set of Physical Therapy educational content and curriculum was new. The application of PPM was beneficial to use accepted clinical practice models, standardized tests and measures, set goals and clinical outcomes, reassessed to determine change and implement evidence-based practice.

Background. The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods. We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion. This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Dated 20 December 2019

Background. The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods. We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion. This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Dated 20 December 2019

Background In healthcare practice, ethical challenges are inevitable and their optimal handling may potentialy improve patient care. Ethical development in medical education is critical for the transition from a medical and health sciences student to an ethical healthcare practitioner. Understanding the health professions students’ approaches towards practice-driven ethical dilemmas could harness i the effective ethical development in their medical education. This study attempts to identify the health professions students’ approaches towards practice-driven ethical dilemmas. Methods An inductive qualitative evaluation was conducted on six recorded videos of health professions students’ case-based online group discussions, followed by a one-hour online ethics workshop. The online ethics workshop was organized with students from the College of Medicine, College of Dental Medicine and College of Pharmacy at the University of Sharjah, and the College of Medicine at the United Arab Emirates University. . The recorded videos were transcribed verbatim and imported to the qualitative data analysis software of MAXQDA 2022. Data were analyzed applying four stages of review, reflect, reduce and retrieve and two different coders triangulated the findings. Results Six themes emerged from the qualitative analysis of the health professions students’ approaches to the practice-based ethical dilemmas; (1) emotions, (2) personal experiences, (3) law and legal system, (4) professional background, (5) knowledge of medical research and (6) inter-professional education. In addition, during the case-based group discussions in the ethics workshop, students efficiently applied the relevant ethical principles of autonomy, beneficence, non-maleficence and justice in their reasoning process to reach an ethical decision. Conclusion The findings of this study explained how health professions students resolve ethical dilemmas in their ethical reasoning process. This work sheds light on ethical development in medical education by gaining students’ perspectives in dealing with complex clinical scenarios. The findings from this qualitative evaluation will aid academic medical institutions in developing medical and research-based ethics curriculum to transform students to ethical leaders.

Background.The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)?Methods.We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion.DiscussionThis study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs.Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Date 20 December 2019

ObjectiveTo explore behavioural factors relating to prescription adherence and the communication of prescription adherence messages for patients with acute febrile illness, and to develop a Training & Communication (T&C) intervention to be delivered as part of a clinical trial. The clinical trial intervention package consists of improved diagnostic tools, clinical practices and the T&C package, for children, adolescents and adults presenting with fever symptoms at outpatient facilities in five LMICs.DesignContent analysis of primary, qualitative data collection, informed by the Capability, Opportunity, Motivation (COM-B) theory of behaviour, the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) approach.SettingHealth facilities and local communities in five LMICs in Africa and Asia.ParticipantsHealth facility prescribers and local community adults.InterventionFebrile illness is a common presentation among adults and children in primary care settings, but diagnosing the cause of fever is challenging, especially in low-resource settings. Prescribers’ and patients’ behaviours underpin treatment practices, and antibiotics are the customary fallback choice for lack of better alternatives. However, in most cases antibiotics would not be required, do not cure the ongoing infection, and may have short-term (toxicity, costs) and long-term (drug resistance) untoward effects.Trialling new approaches including point-of-care tests and diagnostic algorithms alone would provide limited information on real-life applicability if behaviours are not accounted for.Accordingly, we designed an innovative, multiphase, mixed methods study, combining qualitative and behaviour approaches, with a quantitative two-arm, clinic based, randomised controlled trial. Qualitative and behavioural methods are used to: support the development of the Training & Communication component of the clinical trial, collect patient information on adherence, and support recommendations for future behaviour change interventions.This paper describes the qualitative research methods used to generate the clinical trial training and communication interventions, in support of adherence to prescriptions.Article SummaryStrengths and limitations of this studyThis is the first study we know of to explore the behavioural factors affecting prescription adherence and the communication of adherence messages in the LMIC study locations.The use of behavioural frameworks to shape the design of data gathering topic guides has the potential to illuminate the drivers for antibiotic prescription adherence, and generate the knowledge needed to support the design of effective communication interventions.The local nature of behavioural drivers means it is unlikely that the research findings will be generalisable and directly usable in other locations, however the process by which behavioural drivers are identified, and the process to convert to a training and communication package intervention, are applicable beyond the study sites.The scope of the clinical trial intervention, of which the T&C package is one component, precludes a wider behaviour change intervention which may be beneficial to improving adherence. This will be explored in a set of intervention recommendations.Because the T&C intervention is one component of the package of interventions for the clinical trial, we cannot rule out the influence of other intervention components (for example the use of an increased number of diagnostic tests) on prescription adherence. Similarly, due to the intervention ‘package’ approach, we cannot conclude how much the T&C package contributed to patient recovery at Day7, the primary outcome.