Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study

Abstract

Background Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174.

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

“…The hesitation of healthcare professionals towards tablet devices as one source of patient information has been reported in a recent study in Germany where general practitioners and MAs were found to be reluctant to provide tablet devices in the primary care setting [ 36 ]. Fear of theft, hygiene issues and being contradictory to physician’s personal values were identified as main challenges.…”

eHealthResp, a Digital Intervention to Improve Antibiotic Prescribing in Respiratory Infections: A Pilot Study

“…Digital health tools have been widely used by health professionals in medical practice over the last years, as they have the potential to significantly improve the efficiency, accessibility, and quality of care in health systems [ 26 , 27 , 28 , 29 ], including antibiotic prescription among healthcare practitioners in primary care [ 29 , 30 ]. Our pilot study has also shown that all physicians unanimously agreed that the tools here presented, namely the online course and mobile application, which constitute a major part of the educational intervention, may also be very efficient in improving the quality of antibiotic prescription and avoiding the uncertainty of a clinical diagnosis, as long as all stakeholders involved are aware of their capabilities and limitations.…”

Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention

“…The educational website for the regional campaign was considered to be visually appealing by participants, yet it lacked in awareness and targeted dissemination strategies. Detailed results regarding the application of digital information delivery in the CHANGE-3 study have been reported [ 28 ]. Findings might be very specific for the current older generation of GPs and patients in Germany, or even with regards to gender, particularly as they partially confirm results of prior research in German primary care: A randomized controlled trial concluded that such findings needed to be replicated and that - although information technology can support effective interventions - disadvantages such as technical requirements of the users and devices should also be considered when integrating digital solutions into wider care-related situations and populations [ 29 ].…”