A scoping review of 38 studies found that behavior change interventions in primary and community care reduced unnecessary antibiotic treatment-seeking for respiratory tract infections, although long-term effects and direct behavior outcomes were rarely measured.
The review examined research published since 2000 targeting patient and caregiver behaviors in antibiotic use. Studies included randomized controlled trials, cluster trials, randomized experiments, cross-sectional studies, qualitative investigations, and quasi-experimental designs.
Educational resources were the most common interventions, appearing in 15 studies. These included interactive booklets, information leaflets, and targeted materials for parents of children with respiratory tract infections. Seven studies used digital interventions such as online modules and animated films, while six examined community campaigns, including national awareness programs in Canada and Australia.
Findings showed reductions in unnecessary antibiotic requests and prescriptions. Digital tools improved knowledge about antimicrobial resistance by 35% to 50% and reduced inappropriate requests by up to 30%. Parental expectations for antibiotics fell between 20% and 28% following educational initiatives. Community campaigns were associated with prescription reductions of 20% to 40%. Interactive booklets and the TARGET leaflet reduced reconsultation rates by 20% to 32% and antibiotic prescribing by 15% to 25%.
The interventions were analyzed using the COM-B (Capability, Opportunity, Motivation, Behavior) framework. Capability was targeted by improving understanding of illness management and rational antibiotic use. Opportunity was addressed by providing patients with accessible resources and community campaigns to influence norms. Motivation was shaped by interventions such as shared decision-making and, in some cases, fear-based messaging about risks of antibiotic misuse.
Study populations ranged from parents and guardians of children to older adults and culturally specific groups. Sample sizes varied from fewer than 50 patients in qualitative studies to 1,500 in multisite trials.
Despite positive outcomes, several limitations were reported. Few studies directly measured behavior change, with many relying on knowledge, attitudes, or prescription rates. Long-term sustainability of interventions was rarely assessed. Most were conducted in high-income countries, with only one in a low- or middle-income setting, limiting applicability to these settings, where access and patterns of antibiotic use differ. Outcome measures varied across studies, complicating comparisons.
“Very few studies actually measured behavior as an outcome, making it hard to judge how effective these interventions were in changing real-world behavior,” wrote lead study author Anthony Maher, PhD, of the School of Psychology at the University of Galway, and colleagues.
The review concluded that behavior change interventions such as educational tools, digital resources, and community campaigns reduced unnecessary antibiotic use for respiratory tract infections. However, the evidence base was limited by inconsistent measures, lack of long-term evaluation, and underrepresentation of low- and middle-income countries.
The authors reported no conflicts of interest.
Source: BMJ Open
