Motivating antibiotic stewardship in Bangladesh: Identifying audiences and target behaviours using the Behaviour Change Wheel

Abstract Background: South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals, a lack of compliance with policy among healthcare providers, high population density and high infectious disease burden. This paper describes development of social and behavioural change communication (SBCC) to increase appropriate use of antibiotics. Methods: We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) qualified physicians and 4) pharmaceutical companies/medical representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, to prioritize audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. Results: Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritized as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change; suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek qualified physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, several antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions; referring them to qualified physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. Conclusions: We prioritized drug shops for intervention delivery to drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and should address the impact on profit and livelihoods for drug shop staff for optimal compliance.

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Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel

BMC Public Health ◽

10.1186/s12889-021-10973-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leanne E. Unicomb ◽

Fosiul Alam Nizame ◽

Mohammad Rofi Uddin ◽

Papreen Nahar ◽

Patricia J. Lucas ◽

...

Keyword(s):

Behaviour Change ◽

Antibiotic Stewardship ◽

Behavioural Change ◽

Formative Research ◽

Drug Shop ◽

Health Seeking ◽

Behaviour Change Wheel ◽

Drug Shops ◽

Household Members ◽

The Impact

Abstract Background South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural change communication (SBCC) to increase the appropriate use of antibiotics. Methods We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) registered physicians and 4) pharmaceutical companies/medical sales representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, prioritise audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. Results Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritised as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change: suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek registered physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, important antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions, referring them to registered physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. Conclusions We prioritised drug shops for intervention delivery to all drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and address the impact on profit and livelihoods for drug shop staff for optimal compliance.

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Effective Knowledge Transfer and Behavioural Change in a Training Environment

Journal of Information & Knowledge Management ◽

10.1142/s0219649219500497 ◽

2019 ◽

Vol 18 (04) ◽

pp. 1950049

Author(s):

Amy Rosellini

Keyword(s):

Knowledge Transfer ◽

Behaviour Change ◽

Behavioural Change ◽

Measurement Model ◽

Model Complexity ◽

Training Environment ◽

Knowledge To Action ◽

Seci Model ◽

Transfer Measurement ◽

The Impact

Current models of knowledge transfer are insufficient in defining the factors that address the impact of knowledge transfer at different cycles of the process where a firm employs traditional training programs. The purpose of this study is to examine the models that identify relationships between effective knowledge transfer and behavioural change in the training environment. The study of these models is concerned with how training affects knowledge transfer, how knowledge transfer impacts behaviour change and how behaviour change affects overall job performance. This concept paper examines existing KM models such as SECI model, complexity theory, an entrepreneurship model and knowledge-to-action with the aim of developing an enhanced version of knowledge transfer measurement model (KTMM) that requires further testing.

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Breaking Free from Smoking: A Novel Digital Smoking Cessation Intervention for Offenders in UK Prisons

The Journal of Smoking Cessation ◽

10.1017/jsc.2018.3 ◽

2018 ◽

Vol 13 (4) ◽

pp. 189-200 ◽

Cited By ~ 2

Author(s):

Stephanie Dugdale ◽

Jonathan Ward ◽

Sarah Elison-Davies ◽

Glyn Davies ◽

Emma Brown

Keyword(s):

Smoking Cessation ◽

Behaviour Change ◽

Behavioural Change ◽

Intervention Development ◽

Clinical Effectiveness ◽

Smoking Cessation Intervention ◽

Balance Model ◽

Smoking Ban ◽

Cessation Intervention ◽

Behaviour Change Wheel

Introduction: The level of smoking cessation support across UK prisons is variable, with most offering pharmacological support, such as nicotine replacement therapy. However, with a complete smoking ban in prisons in England now imminent, additional standardised behavioural support is necessary to help offenders go smoke-free.Aims: This study used the Behaviour Change Wheel to aim to develop the content of an online smoking cessation intervention for offenders, with consideration of their capability, motivation and opportunity for behaviour change.Methods: This was an intervention development study. The Behaviour Change Wheel was used to map cognitive, behavioural, physiological and social targets for the intervention, onto appropriate intervention techniques for inclusion in the smoking cessation programme for offenders.Results: Psychological capability, social opportunity and reflective and automatic motivation were identified through deductive thematic analysis as areas of change required to achieve smoking cessation. A total of 27 behavioural change techniques were chosen for this smoking cessation intervention and were mapped onto the Lifestyle Balance Model which provided the theoretical basis on which the components of the programme are conceptualised. This included strategies around increasing motivation to quit, anticipating smoking triggers, modifying smoking-related thoughts, regulating emotions, managing cravings, replacing smoking and rewarding nicotine abstinence and adopting a healthier lifestyle.Conclusions: Through the utilisation of the Behaviour Change Wheel, the development process of this digital smoking cessation intervention was achieved. Further research is planned to evaluate the clinical effectiveness of this intervention and to explore how the programme is implemented in practice within prison settings.

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Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

Harm Reduction Journal ◽

10.1186/s12954-021-00491-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Vasilis S. Vasiliou ◽

Samantha Dockray ◽

Samantha Dick ◽

Martin P. Davoren ◽

Ciara Heavin ◽

...

Keyword(s):

Higher Education ◽

Drug Use ◽

Harm Reduction ◽

Behaviour Change ◽

Drug Users ◽

Behavioural Change ◽

Intervention Development ◽

Education Students ◽

Behaviour Change Technique ◽

Behaviour Change Wheel

Abstract Background Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet these interventions have moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours and mapping the content of new interventions, may improve upon the effectiveness of interventions for lower-risk drug-users. To the best of our knowledge, this is the first study to systematically apply the Behaviour Change Wheel (BCW) approach to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviors. It is also the first study which identifies specific patterns of behaviours that are more responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF). Methods We employed an explanatory sequential mix-method design. We first conducted an on-line survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change their drug-use. Subsequently, we mapped all evidence onto the COM-B components and the TDF domains to identify clusters of behaviours to target for change, using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions—the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1). Results Twenty-nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision, and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours MyUSE intervention attempts to change. Conclusions The BCTs, identified, will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. We present examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF, along with suggestions of implementation practices for harm reduction at student population level.

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Reducing Drug-use Harms among Higher Education Students: X Contextual-Behaviour Change Digital Intervention Development Using the Behaviour Change Wheel

10.21203/rs.3.rs-86503/v1 ◽

2020 ◽

Author(s):

Vasilis S. Vasiliou ◽

Samantha Dockray ◽

Samantha Dick ◽

Martin P. Davoren ◽

Ciara Heavin ◽

...

Keyword(s):

Higher Education ◽

Drug Use ◽

Harm Reduction ◽

Behaviour Change ◽

Drug Users ◽

Online Survey ◽

Behavioural Change ◽

Education Students ◽

Behaviour Change Technique ◽

Behaviour Change Wheel

Abstract Background: Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet, these interventions have a moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours to map the content of new interventions can improve the effectiveness of interventions for lower-risk drug-users. This is the first study to systematically apply the Behaviour Change Wheel (BCW) to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviour. This is also the first study which identifies specific patterns of behaviours likely to be most responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF). Methods: We first conducted an online survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change drug-use. Subsequently, we mapped all evidence onto the COM-B and the TDF to identify clusters of behaviours to target for change using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions- the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1). Results: Twenty nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours this intervention attempts to change. Conclusions: The BCTs identified will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. Examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF are provided, along with suggestions of implementation practices for harm -reduction targeting students in higher education.

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Facilitators and barriers to fitness bootcamp participation using the Behaviour Change Wheel

Health Education Journal ◽

10.1177/00178969211044180 ◽

2021 ◽

pp. 001789692110441

Author(s):

Leo De Winter ◽

Leslie Morrison Gutman

Keyword(s):

Physical Activity ◽

Behaviour Change ◽

Intervention Development ◽

Behaviour Change Techniques ◽

Qualitative Research Design ◽

Behaviour Change Wheel ◽

The Social ◽

Facilitators And Barriers ◽

The Impact

Objective: Despite its importance for mental and physical health, many adults fail to meet current physical activity recommendations. Furthermore, most adults who begin a physical activity programme revert to being less active or even inactive within the first 6 months. Fitness bootcamps represent a potential intervention for improving physical activity in healthy adults. However, no study to date has examined the influences on long-term participation in fitness bootcamps, which is the first step to developing an effective intervention. Using the Behaviour Change Wheel (BCW) framework, this study identified the facilitators and barriers to long-term (1 year or more) fitness bootcamp participation, which were then linked to behaviour change techniques (BCTs) to facilitate intervention development. Design: Qualitative research design. Setting: Data collection occurred in England. Method: Interviews were conducted with 15 long-term fitness bootcamp participants. Results: Thematic analysis revealed 17 facilitators and 6 barriers to long-term fitness bootcamp participation. Participants highlighted the importance of facilitators such as convenience, being outdoors and enjoyment. The social environment, including having a positive instructor and supportive group members, was further noted as a key influence on participation. While long-term participants faced occasional barriers to their routine such as physical injury, bad weather and competing events, the impact of these could be minimised through appropriate BCTs such as ‘demonstration of the behaviour’ and ‘restructuring the social/physical environment’. Conclusion: Findings from this study highlight the importance of social and environmental factors to promoting long-term fitness bootcamp participation and the inclusion of social and physical environmental restructuring as key intervention components.

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What (if any) behaviour change techniques do government-led cybersecurity awareness campaigns use?

Journal of Cybersecurity ◽

10.1093/cybsec/tyaa019 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Tommy van Steen ◽

Emma Norris ◽

Kirsty Atha ◽

Adam Joinson

Keyword(s):

Behaviour Change ◽

Human Error ◽

Behavioural Change ◽

Behaviour Change Techniques ◽

Direct Effects ◽

Awareness Campaigns ◽

Change Technique ◽

Behaviour Change Wheel ◽

Effectiveness Studies

Abstract With the surge in cyber incidents in recent years, many linked to human error, governments are quite naturally developing security campaigns to improve citizens’ security behaviour. However, it remains not only unclear how successful these campaigns are in changing behaviour, but also what established behaviour change techniques—if any—they employ in order to achieve this goal. To investigate this, we analysed 17 government-sponsored cybersecurity campaign materials. We coded the materials for their intervention functions according to the Behaviour Change Wheel and their behaviour change techniques in accordance with the Behavioural Change Technique Taxonomy (version 1). Our findings show that security campaigns are often focused on education and increasing awareness, under the assumption that as long as citizens are aware of the risk, and are provided with information on how to improve their security behaviour, behaviour will change. Additionally, there is a lack of published effectiveness studies investigating the direct effects of a governmental cybersecurity campaign. Proposed improvements to security campaigns are discussed.

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Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study

BMC Health Services Research ◽

10.1186/s12913-019-4521-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Sarah Basharat ◽

Babar Tasneem Shaikh ◽

Haroon Ur Rashid ◽

Mamoon Rashid

Keyword(s):

Oral Cancer ◽

Financial Burden ◽

Behavioural Change ◽

Tertiary Care ◽

Care Facility ◽

Delayed Presentation ◽

Health Seeking Behaviour ◽

Health Seeking ◽

Tertiary Care Facility ◽

The Impact

Abstract Background Delayed diagnosis of Oral Cancer (OC) can mean a difference in quality and expectancy of life for the patient. This delay could be from the healthcare side, or more importantly from the patient’s side. Globally, there are studies enumerating the causes for delays from the patients’ side in seeking healthcare for Oral Cancer; however, no similar research is found in the context of Pakistan. This study endeavoured to understand the health seeking behaviour, reasons for delay in consultation and the impact on OC patients’ lives. Methods In-depth interviews were conducted with randomly selected OC patients at a private sector tertiary care facility in Islamabad (who met the inclusion criteria of having successfully been treated for Oral Cancer) which caters to the most diverse population for the treatment of Oral Cancer. Theoretical saturation was achieved at 14 interviews. All participants gave verbal consent for participation, which was recorded prior to the interviews. Results Patients (age range 43–68 years) had received the surgical treatment and radiation. The reported delay before seeking a proper medical advice ranged from 1 month to 2 years. Lack of awareness about OC risk factors, symptoms, and whom to approach for treatment were the main reasons. Most respondents relied on self-treatment considering the non-healing wound/ulcer to be a minor issue until they were advised a consultation with a specialist. Treatment started within 1–3 months after a confirmed diagnosis on biopsy. The reported average expenditure on treatment was US$5000-10,000, mostly covered through a private health insurance and others borrowed the money. Conclusion A socio-behavioural change campaign for the general population can result in earlier presentation of the OC, minimizing the financial burden on the patient as well as the health system, and improving the quality of life of the patients.

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Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

BMJ Open ◽

10.1136/bmjopen-2020-037761 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037761

Author(s):

Kendra N. Williams ◽

Lisa M. Thompson ◽

Zoe Sakas ◽

Mayari Hengstermann ◽

Ashlinn Quinn ◽

...

Keyword(s):

Air Pollution ◽

Behaviour Change ◽

Formative Research ◽

Household Air Pollution ◽

Solid Fuels ◽

Adult Women ◽

Liquefied Petroleum Gas ◽

Potential Health ◽

The Impact ◽

Behavioural Strategies

IntroductionIncreasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda.MethodsUsing the Capability, Opportunity, Motivation–Behaviour (COM–B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial.ResultsWe identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits.ConclusionOur formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.Trial registration numberNCT02944682, Pre-results.

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Selecting behaviour change techniques to reduce sedentary behaviour in people with stroke using the Behaviour Change Wheel

10.21203/rs.2.10822/v2 ◽

2020 ◽

Author(s):

Roderick Wondergem ◽

Wendy Hendrickx ◽

Eveline Wouters ◽

Rob de Bie ◽

Johanna Visser ◽

...

Keyword(s):

Social Support ◽

Sedentary Behaviour ◽

Goal Setting ◽

Behaviour Change ◽

Cognitive Impairments ◽

Behavioural Change ◽

Action Planning ◽

Community Dwelling ◽

Behaviour Change Wheel ◽

The Social

Abstract Background: Research has shown that sedentary behaviour increases the risk of stroke, cardiovascular disease and mortality. People with stroke are highly sedentary. Therefore, reducing sedentary behaviour might reduce the risk of secondary events and death. Personalized strategies using behavioural change techniques (BCTs) directed at reducing sedentary behaviour in people with stroke are currently lacking. Therefore, the aim of this study is to systematically determine the BCTs for a behavioural change intervention, directed at reducing sedentary behaviour in community-dwelling people with stroke,.Method: To complete the stages of the Behaviour Change Wheel , information on understanding the behaviour, identifying intervention functions, identifying BCTs and modes of delivery were needed. Per stage a literature search was conducted and nominal group technique (NGT) sessions were conducted to identify BCTs. The NGT sessions were conducted with professionals working with people with stroke and international researchers working in the stroke or sedentary behaviour field. Four different patients symptom profiles, as frequently seen in clinical practice, were used by participants during the NGT sessions: : 1. no physical or cognitive impairments; profile 2. mainly cognitive impairments; profile 3. mainly physical impairments; and profile 4. both physical and cognitive impairments. Per profile participants made their choice by rating the BCTs.Results: Five BCTs should always be included: ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’. For patients without cognitive impairments, ‘self-monitoring’, ‘feedback on behaviour’, ‘information about health consequences’ and ‘goal setting on outcome’ were advised to be included, while for patients with cognitive impairments, ‘prompts/cues’, ‘graded tasks’, ‘restructuring the physical environment’ and ‘social support practical’ should be considered. Conclusion: BCTs were identified for a behavioural change intervention aiming to reduce sedentary behaviour in community-dwelling people with first-ever stroke. BCTs recommendations depend on the presence of physical and cognitive impairments, although ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’ are recommended in all people with first-ever stroke. The identified BCTs serve as the basis for further development of a personalized blended care intervention to reduce sedentary behaviour in people with stroke.

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