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Table 2 Using the Com-B model to inform households/customer and drug shop staff intervention to improve antibiotic stewardship

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

Behaviour to change

Capability

Opportunity

Motivation

Households

Suboptimal health seeking

• Purchase drugs without prescription; sometimes ask for antibiotics by name since unqualified healthcare providers first point for health

• Use peer group prescribed antibiotic

Psychological

• Limited knowledge of difference between registered and unqualified physicians

• Self-prescription

• Accessibility, cost, symptom severity drive health seeking behaviour

Physical

• Easy access to (free) health advice from drug shop staff

Physical

• Need information on who and where are registered physicians

• Registered physician/population is low

Social

• Males are decision makers on expenditure, visit drug shop

• Social norm to visit drug shop first

Reflective

• Want quality healthcare for the family at reasonable cost

• Want adequate information

Automatic

• Sometimes question advice

Antibiotics are stopped

• When symptoms disappear

• When patients consider that they don’t work

Psychological

• Don’t know what an antibiotic is/ its use

• Limited understanding of how antibiotics work

Physical

• Full course not purchased

Physical

• Need information about the importance of why drug is prescribed

• Need information on dosage and timing, need for full course

• Cost barrier to full course

Social

• Social norm to stop medications when disease is ‘cured’

Reflective

• Empower to ask about treatment, cost

Automatic

• Trust drug shop staff

Drug shop staff

Antibiotic dispensing

• Without government licensea

• Without prescription from registered physicianb

• Without seeing the patient/animal, prescribe over phone

• By unqualified staff/ with short (6 weeks) or no traininga

• Follow elite doctor prescriptions when asked for advice

• Do not always give dosing instructionsa

• Not familiar with antibiotic resistance

Psychological

• Limited knowledge of the policies, rules and penalties

• Need information on policy for prescribing and minimum staff qualification

Physical

• Educate drug sellers on antibiotic resistance

• Address financial implications on their businesses

• Intervention can replace medical representatives as a source of trusted, unbiased information on antibiotics

• Policy is specific about staff qualification

Reflective

• Respected in the community

Automatic

• Dispense multiple times during longer illnesses

  1. aas outlined in the Bangladesh Model Pharmacy initiative [24]; bas outlined in the Bangladesh National Drug Policy, 2016