‘If you want to go far, go together’—community-based behaviour change interventions to improve antibiotic use: a systematic review of quantitative and qualitative evidence

Abstract

Introduction A large proportion of the burden of infections with antibiotic-resistant bacteria is linked to community-associated infections. This suggests that interventions set in community settings are needed. Currently there is a gap in understanding the potential of such interventions across all geographies. This systematic review aimed to synthesize the evidence on the value of community-based behaviour change interventions to improve antibiotic use. These are any interventions or innovations to services intended to stimulate behaviour changes among the public towards correct antibiotic use, delivered in a community setting and online. Methods Systematic searches of studies published after 2001 were performed in several databases. Of 14 319 articles identified, 73 articles comprising quantitative, qualitative and mixed-methods studies met the inclusion criteria. Results Findings showed positive emerging evidence of the benefits of community-based behaviour change interventions to improve antibiotic use, with multifaceted interventions offering the highest benefit. Interventions that combine educational aspects with persuasion may be more effective than solely educational interventions. The review uncovered difficulties in assessing this type of research and highlights the need for standardized approaches in study design and outcomes measurements. There is emerging, but limited, indication on these interventions’ cost-effectiveness. Conclusions Policy makers should consider the potential of community-based behaviour change interventions to tackle antimicrobial resistance (AMR), complementing the clinical-based approaches. In addition to the direct AMR benefits, these could serve also as a means of (re)building trust, due to their inclusive participation leading to greater public ownership and use of community channels.

Azithromycin Prescriptions in Children From 2016-2018: Room for Improvement

“…Recent systematic review of stewardship interventions aimed at reducing antibiotic prescribing the community showed that a multifaceted approach showed improvement in prescribing practices. 24 The study highlighted the benefit of combining educational approach with communication interventions in the community and clinicians focusing on eliciting feeling to enable action. However, more research is needed to understand behavioral interventions to improve antibiotic use in the outpatient setting.…”

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“…45,46 As the Bangladeshi study demonstrates, attending to policy and sociobehavioral dynamics of antibiotic resistance also redirects attention to the evidence base for stewarding antibiotics, including both facilitators and barriers. 47,48,49 Collaborative effort could leverage multidisciplinary insights, with cultural analysis 50 and ethical analysis helping to identify values reflected in policy alternatives, values-based attitudes of stakeholders, and justificatory grounds of policy change. The resources listed in the Table focus specifically on policies that can improve antibiotic supply and distribution.…”

Innovative Phospholipid Carriers: A Viable Strategy to Counteract Antimicrobial Resistance

“…Last but not least, awareness campaigns [70,71], surveys [72], and technological integration in work [73,74] and learning [75,76] environments are crucial to stop an otherwise announced disastrous, unstoppable plague: communication is the key to unified, efficacious actions, especially when the enemy to defeat is so protean, diffused, and challenging.…”