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      An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the Preserving Antibiotics through Safe Stewardship (PASS) Research Programme

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          Abstract

          Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions.  We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design.

          The project includes three work-packages (WP):

          WP1 (Identifying patterns of prescribing):  analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public.

          WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework.  Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory.  Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care.

          WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions. 

          Outputs will inform development of new AMS interventions and/or optimisation of existing interventions.  We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.

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          Most cited references 17

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          Developing and implementing a triangulation protocol for qualitative health research.

          In this article, the authors present an empirical example of triangulation in qualitative health research. The Canadian Heart Health Dissemination Project (CHHDP) involves a national examination of capacity building and dissemination undertaken within a series of provincial dissemination projects. The Project's focus is on the context, processes, and impacts of health promotion capacity building and dissemination. The authors collected qualitative data within a parallel-case study design using key informant interviews as well as document analysis. Given the range of qualitative data sets used, it is essential to triangulate the data to address completeness, convergence, and dissonance of key themes. Although one finds no shortage of admonitions in the literature that it must be done, there is little guidance with respect to operationalizing a triangulation process. Consequently, the authors are feeling their way through the process, using this opportunity to develop, implement, and reflect on a triangulation protocol.
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            Nominal group technique: an effective method for obtaining group consensus.

            This paper aims to demonstrate the versatility and application of nominal group technique as a method for generating priority information. Nominal group technique was used in the context of four focus groups involving clinical experts from the emergency department (ED) and obstetric and midwifery areas of a busy regional hospital to assess the triage and management of pregnant women in the ED. The data generated were used to create a priority list of discussion triggers for the subsequent Participatory Action Research Group. This technique proved to be a productive and efficient data collection method which produced information in a hierarchy of perceived importance and identified real world problems. This information was vital in initiating the participatory action research project and is recommended as an effective and reliable data collection method, especially when undertaking research with clinical experts. © 2012 Blackwell Publishing Asia Pty Ltd.
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              Antibiotic stewardship: does it work in hospital practice? A review of the evidence base

               J.M. Prins (2017)
              Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding AcquisitionRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: Project AdministrationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: Funding AcquisitionRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: Funding AcquisitionRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Funding AcquisitionRole: MethodologyRole: Writing – Review & Editing
                Role: ConceptualizationRole: Funding AcquisitionRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: Funding AcquisitionRole: SupervisionRole: Writing – Review & Editing
                Journal
                Wellcome Open Res
                Wellcome Open Res
                Wellcome Open Res
                Wellcome Open Research
                F1000 Research Limited (London, UK )
                2398-502X
                14 January 2020
                2020
                : 5
                Affiliations
                [1 ]University College London, London, UK
                [2 ]University of Leicester, Leicester, UK
                [3 ]Royal College of Art, London, UK
                [1 ]City University London, London, UK
                [1 ]MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
                Author notes

                No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: I have very recently started working with Laura Shallcross in relation to co-chairing a subgroup to make recommendations for behavioural interventions on behalf of The Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI). Previously, I have been on an unsuccessful grant application with Carolyn Tarrant.

                Article
                10.12688/wellcomeopenres.15554.1
                7014923
                Copyright: © 2020 Shallcross L et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Product
                Funding
                Funded by: Economic and Social Research Council
                Award ID: ES-P008321-1
                Funded by: Wellcome Trust
                Award ID: 215742
                This work was supported by the Wellcome Trust through a Digital Innovator Award to FL [215742]. Funding for the project was received from the Economic and Social Research Council as part of a Antimicrobial Resistance programme grant [ES-P008321-1].
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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