Development of a behaviour change intervention to improve antibiotic use among university students from low- and middle-income countries, a study using evidence- and person-based approaches

Problem

Antimicrobial resistance (AMR) is a health threat in low- and middle-income countries (LMICs). Antibiotic misuse in LMICs is a main contributing factor to AMR. Studies indicated that contextual factors, including social and cultural factors, could affect people's antibiotic use behaviours. University students in LMICs frequently self-medicate with antibiotics, often inappropriately, although they have relatively high educational level. Therefore, they should be a key population for reducing antibiotic misuse. However, there is no behaviour change intervention aiming to improving antibiotic stewardship for this population. This study aims to identify antibiotic misuse factors, and co-design an intervention with LMIC students to improve antibiotic stewardship.

Approach

First, we drew on a systematic review to understand factors for antibiotic misuse among the general public in LMICs. These were collated in an Intervention Planning Table to be used as the basis for co-designing the intervention. We are now using leaflets and snowballing methods to invite LMIC students to a PPI panel. They will be consulted through a workshop to discuss the synthesis results, and co-design target behaviours, beliefs and attitudes. Students, as part of the general public and antibiotic consumers, are able to express their views about these factors, being similar to the whole general public in some ways but also having different perspectives and experiences, to co-design an intervention that is more suitable for themselves. By working with PPI, we hope to be able to develop an intervention that is more feasible, acceptable and engaging.

Findings

Having a strong belief in the curative power of antibiotics, and successful experiences of antibiotic treatment are associated with inappropriate antibiotic use. Easy access to antibiotics and long waiting time and high cost of medical consulting also drive antibiotic use. The interplay of individual, social, cultural, and organisational factors affects people’s antibiotic use behaviour. The synthesis results will be tabulated and provided in the workshop to support co-designing the intervention with students. During the workshop, in-depth discussion will be conducted to define and prioritise target behaviours, beliefs and attitudes. Based on their individual experiences and cultural backgrounds, students will contribute to the intervention development by expressing their perspectives towards antibiotic misuse and relevant factors.

Consequences

The qualitative synthesis helps provide an explicit and detailed understanding of how and why the students in LMICs misuse antibiotics, based on which we will be able to develop a suitable intervention targeting these factors to improve their beliefs, attitudes, and practices. It is important that students are able to express their thoughts and co-design an intervention that suits themselves. The process of co-designing the intervention highlights PPI as an essential part of a research team in decision making, to ensure the acceptability and engagement of the intervention, as well as its future generalisability.