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 |