A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care

BMC Health Services Research

Research

Lou Atkins¹  Fabiana Lorencatto¹  Diane Ashiru-Oredope²  Tim Felton³  Christopher Eades⁴  Lucie Byrne-Davis⁵  Jo Hart⁵  Rebecca Turner⁶  Laura Shallcross⁷  Stephen Rice⁸  Emily Howlett⁹ 

[1] Centre for Behaviour Change, University College London, London, UK;Clinical and Public Health Group, UK Health Security Agency, London, UK;Department of Critical Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation, Manchester, UK;Department of Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK;Division of Medical Education, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK;Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, the University of Manchester, Manchester, UK;Institute of Health Informatics, University College London, London, UK;Population Health Sciences Institute, Faculty of Medical Sciences, the University of Newcastle Upon, Tyne, UK;Vocal, Manchester University NHS Foundation Trust, Manchester, UK;

关键词: Antimicrobial Stewardship;    Health Service Research;    Behavioual Science;    Education and training;    Healthcare professionals;    Interview study;   

DOI  :  10.1186/s12913-023-09559-5

 received in 2023-02-01, accepted in 2023-05-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAntimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals.MethodsSemi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework.ResultsA total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals’ roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation).ConclusionThis study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1