Title: Developing ways to evaluate process during the clinical trial of a dental antibiotic stewardship intervention
Funder: The Academy of Medical Sciences

Abstract: Background: Infections resistant to antibiotics are a problem, posing a significant threat to global health and wellbeing. Antibiotic stewardship (ABS) aims to tackle resistance by reducing unnecessary prescribing and is an important element of WHO’s Global Action Plan and the UK 20-year Vision for tackling resistance. Dentistry is responsible for >10% antibiotic prescriptions across NHS primary healthcare (and more in private dentistry), with 50-80% unnecessary use. The ‘Step-by-step guide to fixing your toothache’ intervention was developed with patients and dentists to reduce antibiotic prescribing during urgent dental appointments. The intervention is underpinned by behavioural science (notably the Capability-Opportunity-Motivation-Behaviour (COM-B) model) and consists of a worksheet for use at point-of-care and an accompanying online motivational training module for dentists. A clinical trial to evaluate the intervention is planned, but first work to address specific uncertainties is required. How to undertake the process evaluation is one such uncertainty. A generic, six-item questionnaire (developed for self-evaluating capabilities, opportunities and motivations) could provide a suitable starting point. Aim: To develop a process evaluation approach for assessing our dental antibiotic stewardship intervention, and to evaluate it at point-of-care. Objectives: 1) To develop a process evaluation approach which can be embedded in a clinical trial of our antibiotic stewardship intervention, by adapting a generic six-item questionnaire; 2) To test the adapted questionnaire through a service evaluation of the intervention during urgent dental appointments; 3) To seek feedback through interviews with the dentists about acceptability of the questionnaire and of the intervention, including suggestions for further refinement.

Lay abstract: Aim: To develop and test ways to show how our intervention works, in preparation for a trial about reducing dental antibiotic prescribing Background: Dentists prescribe around 10% of antibiotics across England. Reducing the estimated 80% overprescribing could represent a saving of over £6 million per year to the NHS. Furthermore, reducing overprescribing sits at the heart of the Government's approach to tackling antibiotic resistance. Our ‘Step-by-step guide to fixing your toothache’ intervention aims to improve care quality for adults with dental pain or infection by reducing unnecessary antibiotic prescribing. This study will help prepare for a trial to test our intervention during urgent dental appointments, by exploring how to measure how it works. Design and methods: A generic questionnaire has been previously designed and tested for assessing the impact of interventions on the behaviour of healthcare professionals. Working with dentists and patients, we will adapt it for use following urgent dental appointments. To test it, six dentists will each be invited to complete the adapted questionnaire after they have used the 'Step-by-step guide' during treatment of at least two adults with toothache. Each dentist will then be interviewed to provide feedback on the adapted questionnaire and about using the dental antibiotic stewardship intervention. Dissemination: The study's stakeholder group includes eminent specialists in their field who enjoy presenting their findings in innovative ways online (via social media and YouTube) and community festivals, as well as in more traditional ways (professional journals, conferences and grant applications, including for the trial).

Research activity codes: 6.1 PHARMACEUTICALS;6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION)
Health categories: ORAL AND GASTROINTESTINAL