ObjectivesThe aim of this paper is to explore the culture of antibiotic prescribing and consumption in the community for urinary tract infections (UTI) from the perspective of the general practitioners (GPs) and community member.DesignIndepth interviews were conducted with GPs, and focus groups were held with community members.SettingGeneral practice and community setting.Participants15 GPs practising in rural and urban locations in Ireland participated in the indepth interviews. 6 focus groups (n=42) with participants who had direct or indirect experiences with UTI were also undertaken.ResultsThe decision to prescribe or consume an antibiotic for a UTI is a set of complex processes including need recognition, information search and evaluation processes governed by the relationship and interactions between the GP and the patient. Different GP and patient decision-making profiles emerged emphasising the diversity and variety of general practice in real-life settings. The GP findings showed a requirement for more microbiological information on antibiotic resistance patterns to inform prescribing decisions. Focus group participants wanted a conversation with the GP about their illness and the treatment options available.ConclusionsCollectively, this research identified the consultation as a priority intervention environment for stimulating change in relation to antibiotics. This paper demonstrates how qualitative research can identify the interacting processes which are instrumental to the decision to prescribe or consume an antibiotic for a suspected UTI. Qualitative research empowers researchers to investigate the what, how and why of interventions in real-life setting. Qualitative research can play a critical and instrumental role in designing behavioural change strategies with high impact on practice. The results of this research were used to design a complex intervention informed by social marketing.Trial registration numberNCT01913860; Pre-results.
A marketing systems approach to stakeholders has never been more important in an increasingly interconnected world. Recognising the inherent limitations of a firm-centric stakeholder stance, this paper proposes a dynamic stakeholders framework to examine the interacting nature of interrelated and interdependent stakeholder effects from a societal perspective. It presents a systemic stakeholders framework that incorporates several defining features and core propositions based on Layton’s MAS mechanisms and Coleman’s Boat. The contribution of a dynamic stakeholders’ marketing system framework is not so much in identifying or defining the appropriate marketing mechanisms at work but in understanding the continuous feedback nature of the macro-micro-macro everyday dynamics which stakeholders listen to, learn about and leverage to act, react and interact.
Interpretation: A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. Trial registration: ClinicalTrials.gov, no. NCT01913860 AbstractSee also page 94 and www.cmaj.ca/lookup
Background: The adoption of systems thinking within social marketing is illustrated by the emerging literature relating to systems social marketing and macro-social marketing. Systems social marketing and macro-social marketing signal a shift from singular level behavior change toward a more holistic, multilevel change mode of operandi for complex and wicked problems. In recognition of this broadening perspective, Truong et al. took the first steps to describe the relationship between systems thinking and social marketing through a critical appraisal. However, their analysis stopped short of defining systems social marketing and macro-social marketing, examining how the concepts have been applied, and the impact this has on our change methodologies. Focus: This article is related to research and evaluation of the social marketing field. Research Question: This study aims to (a) examine the causality looseness surrounding the descriptions of systems social marketing and macro-social marketing, (b) conceptualize systems social marketing and macro-social marketing, and (c) develop a taxonomy for classifying and interpreting the systems-based social marketing–related literature. Methods: Following best practice protocols, a systematic review was conducted to identify systems social marketing and macro-social marketing literature and interventions published prior to March 2020. Five databases were searched using a combination of relevant search terms. Results: Sixteen thousand and forty-seven title and abstracts were screened, resulting in 45 articles being reviewed, 8 of which were interventions. Analysis of the findings indicated both systems social marketing and macro-social marketing use nonlinear causality and seeks to understand the structural and behavioral dynamics in a system to leverage change. Moreover, the findings suggest that systems social marketing focuses on evolutionary dynamics and a “whole system in the room” approach, pursuing top-down, bottom-up iterative processes with macro-social marketing pursuing institutional dynamics and “inside the system” top-down processes. Importance to Social Marketing Field: This article is one of the first efforts to examine the inner anatomy of systems social marketing and macro-social marketing for causality and definitional clarity. In drawing a distinction between the two orientations, social marketers can begin to understand in what contexts and settings these perspectives are most applicable. Recommendations: The taxonomy and search strategy can be adopted in other reviews as they offer a rich and diverse basis for further conceptual analysis of systems-based social marketing–related literature. Limitation: Community-based prevention marketing, community-based social marketing, and community-led assets-based social marketing articles were excluded from this review. Hence, further research could include these approaches and uncover their features, analogies, and differences versus systems social marketing and macro-social marketing.
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