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
Abstract Background Antimicrobial 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...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09559-5 |
| _version_ | 1797774322722406400 |
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| author | Rebecca Turner Jo Hart Diane Ashiru-Oredope Lou Atkins Christopher Eades Tim Felton Emily Howlett Stephen Rice Laura Shallcross Fabiana Lorencatto Lucie Byrne-Davis |
| author_facet | Rebecca Turner Jo Hart Diane Ashiru-Oredope Lou Atkins Christopher Eades Tim Felton Emily Howlett Stephen Rice Laura Shallcross Fabiana Lorencatto Lucie Byrne-Davis |
| author_sort | Rebecca Turner |
| collection | DOAJ |
| description | Abstract Background Antimicrobial 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. Methods Semi-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. Results A 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). Conclusion This 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. |
| first_indexed | 2024-03-12T22:19:21Z |
| format | Article |
| id | doaj.art-f7757f6f45bd43bd86d751e2b754d07f |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-12T22:19:21Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-f7757f6f45bd43bd86d751e2b754d07f2023-07-23T11:10:19ZengBMCBMC Health Services Research1472-69632023-07-0123111110.1186/s12913-023-09559-5A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based careRebecca Turner0Jo Hart1Diane Ashiru-Oredope2Lou Atkins3Christopher Eades4Tim Felton5Emily Howlett6Stephen Rice7Laura Shallcross8Fabiana Lorencatto9Lucie Byrne-Davis10Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, the University of ManchesterDivision of Medical Education, Faculty of Biology, Medicine & Health, the University of ManchesterClinical and Public Health Group, UK Health Security AgencyCentre for Behaviour Change, University College LondonDepartment of Infectious Diseases, Manchester University NHS Foundation TrustDepartment of Critical Care Medicine, Wythenshawe Hospital, Manchester University NHS FoundationVocal, Manchester University NHS Foundation TrustPopulation Health Sciences Institute, Faculty of Medical Sciences, the University of Newcastle UponInstitute of Health Informatics, University College LondonCentre for Behaviour Change, University College LondonDivision of Medical Education, Faculty of Biology, Medicine & Health, the University of ManchesterAbstract Background Antimicrobial 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. Methods Semi-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. Results A 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). Conclusion This 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.https://doi.org/10.1186/s12913-023-09559-5Antimicrobial StewardshipHealth Service ResearchBehavioual ScienceEducation and trainingHealthcare professionalsInterview study |
| spellingShingle | Rebecca Turner Jo Hart Diane Ashiru-Oredope Lou Atkins Christopher Eades Tim Felton Emily Howlett Stephen Rice Laura Shallcross Fabiana Lorencatto Lucie Byrne-Davis 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 Antimicrobial Stewardship Health Service Research Behavioual Science Education and training Healthcare professionals Interview study |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Antimicrobial Stewardship Health Service Research Behavioual Science Education and training Healthcare professionals Interview study |
| url | https://doi.org/10.1186/s12913-023-09559-5 |
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