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Table 2 Proposed intervention functions and policy categories for the identified factors

From: Family doctors’ roles and perceptions on antibiotic consumption and antibiotic resistance in Romania: a qualitative study

COM-B Model Domains

Identified factors

Intervention functions

Policy categories and interventions identified by participants

Detailed interventions including examples of additional potential interventions or policies from other settings

Physical capability

Lack of diagnostics

Incentivisation

 

• Enhanced access to antibiograms

• Availability of rapid diagnostic tests

• Enhancing physical capability for parents to perform rhinopharyngeal clearance

Psychological capability

Different understanding of ABC and AMR magnitude

Enablement

• Periodic updates with statistics

• Enhanced surveillance networks

• Auditing and feedback mechanisms on GP prescriptions

• Newsletters with:

• statistics

• case studies of best practices

Interpretability of guidelines, reliance on experience and commodity

Education

Training

• Guidelines that are more precise

• Job aids, prescription pads and infographics

• Updated guidelines

Reflective motivation

Perceptions on easiness for patients to start treatment elsewhere (through pharmacies or emergency care)

Education

Persuasion

Coercion

Restriction

• Education campaign for the public

• Greater controls in pharmacies

• Education campaigns:

i) For the public:

TV, radio and social media clips/spots

Posters, leaflets, brochures, billboards, bus tails, bus stop posters, interior bus signs

Roadshows

Theatre plays

Interactive website with videos and other information materials, pledging system and competitions (e.g. for creating videos to disseminate educational messages)

Mobile Apps

ii) For health care providers:

Round tables and symposiums

Pledge campaigns (e.g. Antibiotic guardian)

Training courses

iii) For children and youth:

Games (such as ebug)

Special school classes delivered by healthcare professionals or peers (older students)

Wet and dry lab activities

Cartoon on TV

Science-show

iv) For patients:

GPs and pharmacist education sessions

Call-back by phone to check adherence to treatment

SMS based reminders

Antibiotic packaging with warning messages

• Greater control mechanisms in pharmacies and communication of findings (to check accuracy of different perceptions)

Patients’ lack of knowledge on risks and lack of adherence to treatment

Education

Training

Persuasion

• Education campaign for the public

Family Doctors have an important role as educators

Education

Training

Modelling

• Education campaign for the public

Automatic motivation

Maintaining good relations with patients and fear of losing them

Education

Persuasion

• Education campaign for the public

Physical opportunity

Lack of access or continuity of care in rural settings

Environmental restructuring

• Treatment individualisation

• Mobile clinic or pharmacy services

• Making use of eHealth apps to ensure follow-up

COVID pandemic brought higher ABC

Education

Coercion

Restriction

• COVID-19 treatment guidelines

• Education campaign for the public

• Clarity on COVID-19 treatment recommendations

• Increased surveillance for emergence of resistance to azithromycin

AMR occurs mostly due to hospital acquired infections

Environmental restructuring

 

• Antibiotic stewardship interventions for hospital setting

Patients may see antibiotics as preventive treatment and obtain medical advice from their social network rather than medical professionals

Education

Persuasion

Coercion

Restriction

• Education campaign for the public

 

Communities enable action to tackle ABC

Environmental restructuring

• Tailoring and piloting campaigns locally