Prf Darren Langdridge

Public-facing mass media interventions are planned across Scotland and the rest of the UK. These seek to improve antimicrobial stewardship through raising awareness of AMR as an issue and subsequently to change antimicrobial stewardship behaviours. Whilst a few reviews and evidence syntheses already exist which broadly address these topics, to date no systematic attempt has been made to identity how awareness is defined, how stewardship is defined and equally the central questions of what works, how such interventions work, in which contexts, and with whom. An evidence synthesis is now required that addresses these key questions in turn and works towards identifying the best possible candidate intervention(s) that have the greatest chance of improving antimicrobial stewardship amongst the public and reducing the AMR threat. Antimicrobial stewardship interventions, targeted at the public, in other words, ‘non-prescribers’, are complex interventions often with multiple inter-related components. To date these interventions have been delivered in a range of ways (e.g., posters, leaflets, radio, TV). They are also likely to be increasingly delivered through the social media (e.g., Twitter, YouTube). Currently, little is known about which modes of delivery or combinations of modes of delivery are used most commonly, how use is changing over time, or indeed which approach works best. Equally with regard to the content of effective interventions, currently little is known about which components, or active ingredients of interventions, are most commonly used and critically which work best in relation to changing the public’s awareness and stewardship behaviours. Equally, no attempt has been made to understand how within the whole populations, public-facing interventions target particular sub-populations or key identities (or roles) such as ‘mothers’ or ‘carers’ for example. We propose a systematic review focussing upon identifying effectiveness amongst interventions that aim to improve antimicrobial stewardship through raising awareness of the issue and/or subsequently changing antimicrobial stewardship behaviours. We seek to use the available evidence to identify any patterning of effectiveness in relation to intervention content (what works), theoretical base (how does it work), mode of delivery (how does it work) and population (who and within which contexts). Five key research questions will shape our analysis: 1) How is awareness conceptualised and measured? 2) How are stewardship behaviours conceptualised and measured? 3) Are interventions effective at changing awareness and stewardship? 4) Are there discernible patterns of interventions associated with effectiveness? 5) What are the key components of interventions that seek to improve antimicrobial stewardship? 6) Is there evidence of unanticipated negative effects of interventions? The pre-specified intervention components of interests are: o the mode(s) of delivery; (individual, multiple, details of sequential/staggered delivery) o theoretical base and proposed mechanism of action; o the number of behaviour change techniques (BCTs); o the type of BCTs, and; o theory-congruent clusters of BCTs o affective components o narrative components o population factors o contextual factors This evidence synthesis will provide novel, specific, systematically generated knowledge capable of shaping future intervention development. It will achieve this using the most rigorous available methods that are appropriate to use (e.g., meta-analysis, meta-synthesis, narrative methods)