A behavioural approach to slowing antimicrobial resistance

The World Health Organisation has declared antimicrobial resistance to be a serious and growing threat in healthcare settings worldwide, leading to loss of life, longer hospital stays, difficulty in treating new resistant bugs and higher healthcare costs. This project sets out to identify which behaviours could help slow the rate of antimicrobial resistance.

This project aimed to identify behaviours that offer suitable targets for intervention, based on their potential impact on slowing antimicrobial resistance, current adoption rates, and likelihood of future behaviour adoption.

The following research questions were examined:

  1. What audience / actor is best to target for behaviour change interventions, based on the potential of their behaviour to impact antimicrobial resistance?
  2. Focusing on this audience / actor, which of their behaviours are likely to have the greatest impact on slowing antimicrobial resistance?
  3. What are the current adoption rates for each of their behaviours (and therefore which behaviours offer the greatest opportunity for changing behaviour)?
  4. Which of their behaviours are they most likely to engage in moving forward?
  5. Where do their behaviours sit within the Impact-Likelihood Matrix, a behavioural selection tool that assesses impact, likelihood and current participation rates?

The challenge:
Identifying and prioritising behaviours to slow antimicrobial (‘superbug’) resistance
Centre to Impact AMR (CIAMR), Monash University

What did we do?

To identify a suitable target actor and their behaviours, a 4-hour online behaviour identification workshop was conducted with 12 antimicrobial resistance experts across Australia and New Zealand, in April 2022.

The scope of the workshop was focused on consumers (e.g., the general public) rather than providers (e.g., doctors) while recognising that some groups may play both roles (e.g., farmers). The experts participated in a system mapping and prioritisation exercise and landed on the “general community” as being the most suitable target group, along with 12 community behaviours centering around;

●     antibiotics use,

●     lobbying for change,

●     antimicrobial marketing, and

●     regular hand washing.

Using these 12 behaviours we then surveyed a larger group of 21 experts to better understand the potential impact of each behaviour, and we surveyed 285 people in the general public to understand the current adoption rates and the likelihood they would adopt the behaviour in the near future.

What did we find?

 The12 behaviours were plotted on an Impact Likelihood Matrix, with five target behaviours identified as offering the best opportunity to reduce antimicrobial resistance (in red);

Based on their position within the matrix, along with their current adoption rates, the following behaviours appear to offer the best opportunity to target through intervention:

●     Do not pressure your doctor for antibiotics

●     Returning unused antibiotics to a pharmacy

●     Contact council to find out where you can safely dispose of household cleaning products with antimicrobial marketing

●     Lobby supermarkets to only sell antibiotic-free meat products

What’s next?

Nearly40% of those surveyed indicated they wanted to know more about antimicrobial resistance, which represents a high level of engagement. Many were unaware how important this topic was. Moving forward researchers and practitioners can now deep dive into understanding the drivers and barriers to these important behaviours and exploring ways to encourage behaviour change.

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