A Scoping Review of the Use of Social and Behavioral Change in Acute Care Antimicrobial Stewardship Initiatives

Abstract

Purpose: Antimicrobial stewardship (AS) initiatives are implemented with a goal of reducing antimicrobial resistance. It is unknown exactly how many acute care AS initiatives have since been based on social and behavioral theory. The purpose of this scoping review is to provide an updated review of theory-informed acute care AS initiatives in the published literature, including how social and behavioral theories have been used in the described interventions. Methods: PubMed, EMBASE, CINAHL, PsycINFO, and ProQuest Dissertations were searched using a combination of AS, acute care, and social and behavioral theory search terms from April 2011 to November 2019. Using both an initial review of titles and abstracts and a second review of full text, a total of 4 articles were identified after a review of 2014 records. Each article was coded using a guide that abstracted details of study methods, the AS intervention, and use of theory based on a validated theory coding scheme. Results: The interventions included combinations of decision-making tools, provider education, and prospective audit and feedback. Two studies included an evaluation of the described initiative, with findings indicating improvement in antimicrobial use. All interventions utilized theory in developing AS interventions. However, gaps were evident in the use of theory in the evaluations, including inconsistent measurement of theory constructs and lack of testing of the theory. Conclusion: AS interventions are frequently published; however, theory-based acute care AS interventions are not commonly described. More consistent and comprehensive utilization of social and behavioral theories may enhance effectiveness of AS programs.

Utilizing social and behavioral change methods in clinical pharmacy initiatives

“…One way to assess the depth of social and behavioral theory is by a coding scheme 44 . This coding scheme has been used to assess the depth of theory use in medication use initiatives 8‐10 . Although developed as a way to assess the depth of theory utilization, this coding scheme can also be helpful when planning theory‐based initiatives to proactively determine if the theory is utilized as thoroughly as possible within an initiative.…”

“…Unfortunately, social and behavioral theories are underutilized in planning pharmacy initiatives. [8][9][10][11] This is likely due to a confluence of reasons: lack of incorporation of social scientists into medical interdisciplinary teams, formal training in program planning, and knowledge of these resources. In addition, the terminology in social and behavioral theories can cause a distancing for those who would otherwise be interested in using the concepts within.…”

“…Systematic reviews of social and behavioral use in pharmacy initiatives indicate the use of a wide variety of theories, with no single, predominant theory utilized. [8][9][10] Based on this information, the theories included in this article were chosen based on the strength of data supporting each theory within public health and pharmacy initiatives, ease of use, and their applicability to the scenarios. Each theory will be discussed, data supporting their use in pharmacy or public health initiatives will be reviewed, and finally, an example initiative will have the change technique applied.…”

“…Given the overlap between the goals and characteristics of public health and pharmacy initiatives, there is an opportunity to advance pharmacy initiatives by incorporating social and behavioral change theories into existing pharmacy planning techniques. Unfortunately, social and behavioral theories are underutilized in planning pharmacy initiatives 8‐11 . This is likely due to a confluence of reasons: lack of incorporation of social scientists into medical interdisciplinary teams, formal training in program planning, and knowledge of these resources.…”

“…These include two social and behavioral theories focused on individual behavior change, and one ecological model. Systematic reviews of social and behavioral use in pharmacy initiatives indicate the use of a wide variety of theories, with no single, predominant theory utilized 8‐10 . Based on this information, the theories included in this article were chosen based on the strength of data supporting each theory within public health and pharmacy initiatives, ease of use, and their applicability to the scenarios.…”