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Table 1 Behaviour change and intervention components for the four groups from the intervention design workshop

From: Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel


Proposed intervention messages**

Current practice/contextual drivers*

Selected behaviours to change



• 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


• 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

  1. *data from formative studies; **data from workshop working groups