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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

Behaviours 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