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 |