Title: AntiMicrobial Stewardship: Training and Education to deliver behaviour CHange (AMS: TEACH)
Funder: Department of Health and Social Care

Abstract: 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 &ldquo;antibiotic stewardship&rdquo; (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.

Lay abstract: Antibiotics have transformed our ability to treat bacterial infections allowing us to live healthier, longer lives. But people have been misusing antibiotics for decades to treat infections that could get better on their own. Antibiotic overuse makes bacteria evolve so they can survive the effects of antibiotics. To keep antibiotics working for future generations, we need to use antibiotics carefully, only when really necessary. This is called &ldquo;antimicrobial stewardship&rdquo; (AMS). However, AMS can be challenging in practice, as healthcare workers know AMS is important, but also know that not giving antibiotics to patients with an infection can cause serious problems like sepsis. Education and training can help healthcare workers to perform AMS, but we do not currently know the best way to deliver this training or what should be included. For example, do healthcare workers respond best to online courses, classroom teaching or &ldquo;on the job&rdquo; training? Should they learn about different types of antibiotics or how to talk to patients about antibiotics? Should we have different training for different types of healthcare workers? In this project, we will explore &ldquo;what works&rdquo; to improve AMS by identifying published research studies that include education and training. We will describe what the training includes, how it was delivered and assess why some types of training were successful while others failed. We will also explore how much training costs. We want to learn about what UK NHS hospitals are doing to educate their staff about AMS because hospitals are where many healthcare workers learn about antibiotics. We will use surveys and interviews to ask people who work in hospitals about what types of AMS education and training is provided. We will also ask about what challenges they face when delivering training. Finally, we will use what we have learned from our research to consider whether AMS training that is currently being delivered in UK hospitals is likely to work. This will help us identify areas for improvement and make recommendations. We will discuss our recommendations with patients, the public, policy makers, educators, and healthcare workers at a 2 day workshop, and develop tools to help educators deliver better AMS training. Our team is jointly led by an experienced team of researchers from the University of Manchester and University College London, bringing together skills in behaviour change, AMS, health economics, systematic reviews and health professional education and training.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE