AntiMicrobial Stewardship: Training and Education to deliver behaviour CHange (AMS: TEACH)

Research question: What elements of antimicrobial stewardship education and training are most (cost-)effective, and to what extent are these included in training currently delivered in the UK?

Background:Overuse of antibiotics across healthcare settings has contributed to the growing threat of antimicrobial resistance.

Numerous interventions to date, in both research and practice, have educated and trained healthcare professionals to improve antimicrobial use, known as “antibiotic stewardship” (AMS). These interventions can be designed and delivered in various ways. It is unclear which components and modes of delivery are most effective and cost-saving.

Aims and objectives: To identify what works for AMS education and training, specifically: 1.

To synthesise the components and modes of delivery of published AMS education and training interventions, and assess their (cost-)effectiveness 2.

To identify and specify the content and mode of delivery of AMS education and training currently delivered in UK secondary care, and barriers/enablers to intervention delivery 3.

To triangulate research findings and co-produce evidence-based recommendations for improving AMS education and training.

Methods: Mixed methods programme of research including three work packages (WP) corresponding to each objective, involving stakeholders, patients and the public across all stages of the research.

WP1:Systematic review of published AMS education and training interventions in secondary care, primary care, and care homes. Behaviour change techniques (BCTs), target behaviours, recipients, and modes of delivery will be extracted. Meta-regressions will explore which intervention components and characteristics are most effective and cost-effective.

WP2: Survey and semi-structured qualitative interviews with providers of AMS education and training in UK NHS organisations to explore the content and modes of delivery of existing training/education programmes.

We will include questions based on the COM-B model to explore barriers/enablers to educating and training secondary care healthcare professionals in AMS.

WP3: Integration of WP1+WP2 research findings to explore extent to which current secondary care AMS training and education incorporates components and characteristics shown to be (cost-)effective in the research literature.

Findings will be discussed with policy makers, educators, healthcare practitioners, patients and the public in a two-day stakeholder workshop, using nominal group technique to reach consensus on which recommendations are most feasible; to prioritise interventions for implementation; and generate a core outcome set for evaluation.

Timelines: Overall duration: 21 months.

WP1: Screening for inclusion and data extraction (months 1-8); narrative synthesis and statistical analysis (m9-12); health economic analysis (m2-12).

WP2: Identifying current training providers in UK hospitals (m1-3); telephone interview and surveys with concurrent analysis (m4-12). Interim report writing for WP1 and WP2 (m13).

WP3: Triangulating research findings (m13-15); stakeholder workshop (m16); stakeholder and PPI meetings (months 1-16); developing dissemination reports and toolkits (m17-19); final report writing (months 20-21).

Anticipated impact and dissemination: Findings from this research will be disseminated to stakeholders through academic publications/conferences, tailored technical reports for educators, evaluation frameworks, and policy briefings.

This research will produce theory and evidence-based recommendations for optimising the design and delivery of AMS education and training, to support implementation of the national AMR strategy.