The feasibility, acceptability and perceived impact of a theory-based intervention on non-medical prescribing students’ antibiotic prescribing behaviour: an experimental study
Authors: Slade S , Khan F , Lim R H M 
Published: November 2024

Abstract

Introduction
Acute upper respiratory tract infections (URTI) are one of the most common infections. URTIs usually resolve spontaneously but 60% of all prescriptions issued in UK primary care are for URTIs1 contributing to antimicrobial resistance. Non-medical prescribers are a growing group of prescribers but there are few if any antimicrobial stewardship (AMS) interventions to support their prescribing practices. Introducing AMS interventions when learning to prescribe can play an important role to embed appropriate practice at the start of a prescribers’ journey.

Aim
To test the feasibility, acceptability and perceived impact of a theory-based electronic learning intervention on the antibiotic prescribing behaviour of non-medical prescribing students.

Methods
Non-medical prescribing students registered at the study setting (university) were recruited via email and word of mouth. Following consent, participants completed an online pre-intervention questionnaire that explored their perceived prescribing behaviour and confidence in treating patients with URTIs. Participants then completed the intervention, accessible from any internet-enabled device via a weblink. The intervention was previously developed2 using the behaviour change wheel and comprised an animation of a prescriber opting against prescribing antibiotics for an adult with self-limiting URTI using a motivational interviewing approach. The patient felt satisfied and confident about their care. Four questions followed the scenario. Participants then completed an online post-intervention questionnaire that explored the usefulness of the intervention, and the same pre-intervention confidence questions. A one-to-one online audio-recorded semi-structured interview followed, exploring participants’ experiences of using the intervention. Questionnaire and interview questions were informed by the Capability Opportunities Motivation-Behaviour model. Questionnaire data were analysed using descriptive statistics. Interviews were transcribed verbatim and analysed using thematic analysis3. Ethical approval was given by the School Research Ethics Committee where the researchers were based.

Results
Twelve participants (of 50 approached) consented to take part. Eight completed the pre- and post-intervention questionnaires and the intervention. Seven completed all stages of the study. 87.5% of participants worked in a hospital setting. All were qualified for at least two years. Interviews lasted between 9-15 minutes. Participants’ confidence in treating patients with URTI increased in all statements; gain information on patient expectations, support patients’ comprehension of health information, build rapport, communicate effectively, help patients to see and examine different viewpoints (highest mean increase) and patients understand and are happy with their prescribing decision. These increases aligned with qualitative accounts. Participants agreed that the intervention would be useful to them and would change their practice positively. Participants found the intervention easy to use; access was straightforward and took between 5-20minutes to complete. The addition of a wider range of complex, challenging scenarios to the intervention were suggested.

Discussion/conclusions
The intervention was feasible to complete and acceptable to the participants. Participants’ confidence in treating patients increased; even though many were familiar with AMS, the intervention gave them further confidence to support a no antibiotic prescribing strategy. Participants suggested including more complex patient scenarios; this will be considered in a future study. Study limitations includes a small sample size and most participants worked in hospital settings but the intervention was set in primary care.

References
1. Gulliford MC, van Staa T, Dregan A, et al. Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT study). Ann Fam Med 2014;12:344–51.
2. Courtenay M, Lim R, Deslandes R, et al. Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol. BMJ Open 2019;9:e028326. doi:10.1136/ bmjopen-2018-028326
3. Braun, V., & Clarke, V. Thematic analysis: A practical guide. Sage; 2022.