Table 1 Behaviour change and intervention components for the four groups from the intervention design workshop
Behaviours | Proposed intervention messages** | |
|---|---|---|
Current practice/contextual drivers* | Selected behaviours to change | |
Households | ||
• Don’t know what an antibiotic is • Don’t know what an antibiotic is for • Drug shops common first point for health advice • Purchase drug without prescription/ without doctor’s advice; sometimes ask for antibiotics by name • Underage purchaser and proxy for patient • Use peer group prescribed antibiotic • Antibiotics are stopped when symptoms disappear or if patients consider that they don’t work • Don’t reuse drugs for subsequent illnesses • Have high level knowledge of medicine expiry | • Consult registered physicians or health workers • Ask the healthcare provider if they have been given antibiotics and why • Buy full course of antibiotic and continue according to the prescription • Ask about dose frequency and duration/instruction on use • Choose a pharmacy that maintains quality drugs | • Consult with registered physician for prescription; (who are they and how do patients know if doctor is registered) • Buy full course of drugs and complete the course; Follow your prescription to recover • If you don’t follow instructions, it will cost you more ultimately • If you suffer from any adverse effects, consult your doctor immediately • Buy medicines from reputable company |
Drug shops | ||
• Most common source of medical advice; minor illness • Dispensing without government license • Unqualified staff dispensing antibiotics, with short (6 weeks) or no training • Dispense antibiotic without seeing the patient/animal, prescribe over phone • Follow elite doctor prescriptions when asked for advice • Do not always give a name to the type of illness • Often advise and sell drugs for livestock • Some drug sellers know antibiotic generation no. • Few drug sellers are familiar with antibiotic resistance” • No clear idea on consumer rights | • Ask for prescription before dispensing antibiotics • Refer customers to registered physicians • Increase awareness among patients; tell purchasers which is an antibiotic- stress importance of taking full course • Recruit qualified staff • Do not change the medicine when prescribed by a registered physician | • Stop selling antibiotic without registered doctor’s prescription • Tell customer that you are providing an antibiotic • Dispense full antibiotic course and give instructions for consumption • Unnecessary antibiotic use is harmful • Check expiry date before dispensing drugs |
Registered physicians | ||
• See patients with more severe disease • Give little time during consultation • Prescribe over telephone • Overprescribe antibiotics and provide unnecessary tests, to make profit • Prescribe to keep patients happy • Prescribe poor quality antibiotics • Follow prescriptions of senior/renowned doctors • Limited knowledge of antibiotic generations • Don’t request tests before prescribing antibiotics/prescribe for viral infections • Don’t counsel on antibiotic use or the consequences of overuse • Not up to date on current literature • Take incentives from pharmaceutical companies • Motivated by medical representatives to prescribe antibiotics | • Do not provide antibiotic prescription when not necessary; consult recent recommendation information • Resist prescribing later generation antibiotics • Reinforce that the full course is important to complete • Prescribe only when the patient presents at the consultation | • Follow knowledge and practice on up to date information on antibiotic resistance • Do not provide antibiotic prescription when not necessary • Provide instructions for consumption, include the need for a full course |
Pharmaceutical companies/medical representatives | ||
• Have regional offices and numerous staff for product promotion and distribution • Are aware of government policy • Have thorough understanding of antibiotic resistance • Purported provision of incentives to doctors to prescribe, drug shop staff to sell • Range of product quality • Representatives have monthly visit quotas for doctors to promote products, distribute sample medicines to physicians • Provide products to drug shops sometimes on credit, some with incentives (e.g. one free box) • Review prescriptions for marketing strategy | Companies • Modify business strategy • Deliver quality training • Package antibiotics according to course • Include warning messages on packet Medical representatives • Motivate the drug seller to sell full courses of antibiotic • Don’t review prescriptions at doctors’ offices, drug shops • Don’t motivate patients to purchase drugs in front of doctor’s offices, drug shops | • Promote full courses of antibiotic for better health • Ensure the proper use of antibiotics • Ensure profit, protect yourself and others • Do quality business for community health |