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, though long-term effects and direct behavior outcomes were rarely measured.
The review, which included research published since 2000, analyzed 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 (RTIs). Seven studies tested 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 addressed through education on illness management and rational antibiotic use. Opportunity was shaped by providing resources and influencing community norms. Motivation was targeted through shared decision-making and, in some cases, fear-based messaging about the risks of antibiotic misuse.
Study populations ranged from parents and guardians to older adults and culturally specific groups, with sample sizes from fewer than 50 patients in qualitative studies to 1,500 in multisite trials.
Limitations included reliance on knowledge, attitudes, or prescribing rates rather than direct behavior outcomes, lack of long-term evaluation, and limited applicability to low- and middle-income countries.
“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 authors reported no conflicts of interest.
Source: BMJ Open