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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