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

2020 ◽  
Author(s):  
Anna-Leena Lohiniva ◽  
Einas S. Elwali ◽  
Duha Abuobaida ◽  
Ashwag Abdulrahim ◽  
Paul Bukuluki ◽  
...  
Keyword(s):  
Behavior Change ◽  
Primary Healthcare ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Behavior Change Techniques ◽  
Change Strategy ◽  
Appropriate Behavior ◽  
Intention To Change

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.

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

2020 ◽  
Author(s):  
Anna-Leena Lohiniva ◽  
Einas S. Elwali ◽  
Duha Abuobaida ◽  
Ashwag Abdulrahim ◽  
Paul Bukuluki ◽  
...  
Keyword(s):  
Behavior Change ◽  
Primary Healthcare ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Behavior Change Techniques ◽  
Change Strategy ◽  
Appropriate Behavior ◽  
Intention To Change

Abstract Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse and overuse of antibiotics is common also in Sudan. Addressing antibiotic use is a key component of AMR response.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. The strategy is needed to enhance the prescribers’ appropriate prescription of antibiotics and to reduce the patient’s demand towards unnecessary antibiotics.Methods: The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques (BCTs). The process included two major elements (1) a formative qualitative research study using focus group discussions and in-depth interviews targeting prescribers and patients. (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 with prescribers 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, explored the fact that antibiotic prescribing is influenced by many 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.

scholarly journals A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Anna-Leena Lohiniva ◽  
Einas Elwali ◽  
Duha Abuobaida ◽  
Ashwag Abdulrahim ◽  
Paul Bukuluki ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Primary Healthcare ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Local Context ◽  
Change Strategy ◽  
Qualitative Research Study ◽  
Inappropriate Use ◽  
Healthcare Settings ◽  
Behaviour Change Wheel

Abstract Background Inappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan. Objectives The project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan. Methods The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy. Results The TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education. Conclusion Using the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.

scholarly journals Interventions for prudent antibiotic use in primary healthcare: an econometric analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Elina Lampi ◽  
Fredrik Carlsson ◽  
Pär-Daniel Sundvall ◽  
Marcela Jaime Torres ◽  
Peter Ulleryd ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Primary Healthcare ◽  
Optimal Strategies ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Dynamic Panel Data ◽  
Public Healthcare ◽  
Antibiotic Prescribing ◽  
Self Evaluation ◽  
Healthcare Data

Abstract Background Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare. Methods The study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions. Results The first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions. Conclusions Single educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.

scholarly journals Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

2021 ◽  
pp. 104973232199344
Author(s):  
Oladunni Oluwoye ◽  
Elizabeth Fraser
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Theoretical Domains Framework ◽  
First Episode Psychosis ◽  
Barriers And Facilitators ◽  
First Episode ◽  
Evidence Based ◽  
Behavior Change Techniques ◽  
Episode Psychosis ◽  
And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

scholarly journals Interventions for prudent antibiotic use in primary healthcare: An econometric analysis

2019 ◽  
Author(s):  
Fredrik Carlsson ◽  
Elina Lampi ◽  
Pär-Daniel Sundvall ◽  
Marcela Jaime Torres ◽  
Peter Ulleryd ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Primary Healthcare ◽  
Optimal Strategies ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Dynamic Panel Data ◽  
Public Healthcare ◽  
Antibiotic Prescribing ◽  
Self Evaluation ◽  
Healthcare Data

Abstract Background Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare.Methods The study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions.Results The first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions.Conclusions Single educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.

scholarly journals Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

2020 ◽  
Vol 75 (12) ◽  
pp. 3458-3470 ◽  
Author(s):  
Angel Chater ◽  
Hannah Family ◽  
Rosemary Lim ◽  
Molly Courtenay
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Social Influences ◽  
Public Awareness ◽  
Theoretical Domains Framework ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Prescribing Behaviour ◽  
Tract Infections

Abstract Background The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. Objectives To identify what evidence exists regarding the influences on NMPs’ antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). Methods The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. Results The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. Conclusions The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).

scholarly journals Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244432
Author(s):  
Laura Medina-Perucha ◽  
Ana García-Sangenís ◽  
Ana Moragas ◽  
Pablo Gálvez-Hernández ◽  
Josep María Cots ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Risk Perceptions ◽  
Antibiotic Use ◽  
Healthcare Services ◽  
Health Concern ◽  
Public Healthcare ◽  
Power Dynamics ◽  
Antibiotic Prescribing ◽  
Service Users ◽  
Tract Infections

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users’ experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users’ sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users’ autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577.

scholarly journals Interventions for prudent antibiotic use in primary healthcare: An econometric analysis

2020 ◽  
Author(s):  
Elina Lampi ◽  
Fredrik Carlsson ◽  
Pär-Daniel Sundvall ◽  
Marcela Jaime Torres ◽  
Peter Ulleryd ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Primary Healthcare ◽  
Optimal Strategies ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Dynamic Panel Data ◽  
Public Healthcare ◽  
Antibiotic Prescribing ◽  
Self Evaluation ◽  
Healthcare Data

Abstract Background Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare. Methods The study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions. Results The first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions. Conclusions Single educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.

scholarly journals Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers

2015 ◽  
Vol 58 (6) ◽  
Author(s):  
Laura M. Justice ◽  
Jessica R. Logan ◽  
Laura Damschroder
Keyword(s):  
Behavior Change ◽  
Language Impairment ◽  
Reading Interventions ◽  
Theoretical Domains Framework ◽  
Communication Disorders ◽  
Shared Reading ◽  
Implementation Barriers ◽  
Behavior Change Techniques ◽  
Integrative Framework ◽  
Barriers To Implementation

Purpose This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. Methods A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Results Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. Conclusions A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders.

scholarly journals The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature

2021 ◽  
Author(s):  
April Morrow ◽  
Priscilla Chan ◽  
Katherine M. Tucker ◽  
Natalie Taylor
Keyword(s):  
Systematic Review ◽  
Behavior Change ◽  
Theoretical Domains Framework ◽  
Behavior Change Techniques ◽  
Implementation Outcomes ◽  
Opportunities For Learning ◽  
Referral Practices ◽  
Genetics And Genomics ◽  
And Behavior ◽  
Behavior Change Theories

Abstract Purpose Despite rapid advancements in genetics and genomics, referral practices remain suboptimal. This systematic review assesses the extent to which approaches from implementation science have been applied to address suboptimal genetic referral practices. Methods A search of MEDLINE, EMBASE, and PsycINFO generated 7,794 articles, of which 28 were included. Lay barriers were mapped to the Theoretical Domains Framework (TDF) and interventions mapped to behavior change techniques. Use of implementation and behavior change frameworks was assessed, and the Theory and Techniques Tool used to determine theoretical alignment. Results Knowledge was the most frequent retrospectively TDF-coded barrier, followed by environmental context and resources, and skills. Significant referral improvements occurred in 56% of studies. Among these, the most frequent interventions were clinical data review systems, family history collection and referral tools, and embedding genetics staff into nongenetic specialties. Few studies used implementation frameworks or reported implementation outcomes, though some deployed intuitive strategies that aligned with theory. Conclusion Genetic referral interventions are rarely informed by implementation and/or behavior change theories, limiting opportunities for learning across contexts. Retrospective coding has provided a suite of theoretically linked strategies, which may be useful for informing future efforts. Incorporating these strategies into clinical guidelines may facilitate operationalization within the system.

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