Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan

Abstract

Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse of antibiotics is common also in Sudan. Objectives: The project aimed to develop a theory driven behavior change strategy based on local understanding of drivers of antibiotic use at primary healthcare settings in Gezira State in Sudan. Methods: The strategy was designed based on the Theoretical Domains Framework to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques The process included (1) a formative qualitative research study (2) a knowledge co-production workshop that utilized the results of the qualitative study and aimed to design a salient, legitimate and credible behavior change strategy identifying relevant behavior change techniques (BCTs) to overcome key barriers. Results: The main TDF domains that emerged from the discussions were knowledge of antibiotics and AMR, skills to answer patient demand on antibiotics, prescription habits and work exhaustion, social influences, intention to change prescription practices and environmental factors. The main TDF domains that emerged through discussions with patients were antibiotic use habits, social influences, professional role belief in capabilities and intention to change. The workshop discussions resulted in the selection of five BTCs that included education, training, modeling, enablement and persuasion. Conclusion: This study, using the TDF and BCW taxonomy, identified that antibiotic prescribing is influenced by social and contextual factors. Knowledge co- production offered real benefits in addressing these complexities to come up with a set of context appropriate behavior change interventions.