Behaviour change and antibiotic prescribing in healthcare settings

The Annual Report of the Chief Medical Officer published in March 2013 highlighted the threat posed by antibiotic resistance to the UK. This report is part of the response to that call to action. It proposes new and enhanced interventions that have the potential to reduce the risk of antibiotic resistance. These interventions are grounded in behavioural science, underpinned by a thorough review of the evidence, and have robust theoretical foundations for their mechanism of action. We undertook a literature search to identify more than 150 scientific articles to review. Few of them took a behavioural science approach. From these we assessed the available evidence about key behaviours that support antibiotic stewardship across three important constituencies: the public and patients; primary care; and secondary care. We subsequently carried out a ‘behavioural analysis’ using the theoretical domains framework17 and COM-B18 model. The theoretical domains framework distils a range of behaviour change theories into domains explaining common influences on behaviour. COM-B is an associated model of behaviour. These analyses identified the key behaviours and, importantly, drivers for those behaviours that may be amenable to change. From this we were able to identify a series of potential new or enhanced interventions that may mitigate antibiotic resistance. We are sharing this behavioural analysis for two reasons. First, so it can be used by any interested parties working to develop policies, strategies, interventions or campaigns to reduce antibiotic resistance. It is already informing actions in Public Health England (PHE) and the Department of Health (DH). Second, as an example for behavioural or implementation scientists who are interested in the application of a theoretical behavioural framework to address the factors relevant to a pressing policy challenge. This report is not a statement of government policy, nor does it commit DH or PHE to a particular course of action. Rather, the behavioural insights teams in DH and PHEwill continue to work alongside our colleagues and other experts to consider whether, and how, the proposed interventions could be tested and implemented. Others are also encouraged to use these strategically-identified opportunities to contribute to the fight against antimicrobial resistance.