An interdisciplinary mixed-methods approach to developing antimicrobial stewardship interventions: Protocol for the preserving antibiotics through safe stewardship (PASS) research programme [version 1; peer review: 2 approved]

Laura Shallcross, Fabiana Lorencatto, Christopher Fuller, Carolyn Tarrant, Jonathan West, Rosanna Traina, Catherine Smith, Gillian Forbes, Elise Crayton, Patrick Rockenschaub, Peter Dutey-Magni, Emma Richardson, Ellen Fragaszy, Susan Michie, Andrew Hayward, PASS Research Group

    Research output: Contribution to journalArticlepeer-review


    Behaviour change is key to combating antimicrobial resistance. Antimicrobial stewardship (AMS) programmes promote and monitor judicious antibiotic use, but there is little consideration of behavioural and social influences when designing interventions. We outline a programme of research which aims to co-design AMS interventions across healthcare settings, by integrating data-science, evidence- synthesis, behavioural-science and user-centred design.
    The project includes three work-packages (WP):
    WP1 (Identifying patterns of prescribing): analysis of electronic health-records to identify prescribing patterns in care-homes, primary-care, and secondary-care. An online survey will investigate consulting/antibiotic-seeking behaviours in members of the public.
    WP2 (Barriers and enablers to prescribing in practice): Semi-structured interviews and observations of practice to identify barriers/enablers to prescribing, influences on antibiotic-seeking behaviour and the social/contextual factors underpinning prescribing. Systematic reviews of AMS interventions to identify the components of existing interventions associated with effectiveness. Design workshops to identify constraints influencing the form of the intervention. Interviews conducted with healthcare-professionals in community pharmacies, care-homes, primary-, and secondary-care and with members of the public. Topic guides and analysis based on the Theoretical Domains Framework. Observations conducted in care-homes, primary and secondary-care with analysis drawing on grounded theory. Systematic reviews of interventions in each setting will be conducted, and interventions described using the Behaviour Change Technique taxonomy v1. Design workshops in care-homes, primary-, and secondary care.
    WP3 (Co-production of interventions and dissemination). Findings will be integrated to identify opportunities for interventions, and assess whether existing interventions target influences on antibiotic use. Stakeholder panels will be assembled to co-design and refine interventions in each setting, applying the Affordability, Practicability, Effectiveness, Acceptability, Side-effects and Equity (APEASE) criteria to prioritise candidate interventions.
    Outputs will inform development of new AMS interventions and/or optimisation of existing interventions. We will also develop web-resources for stakeholders providing analyses of antibiotic prescribing patterns, prescribing behaviours, and evidence reviews.
    Original languageEnglish
    Article number8
    Pages (from-to)8
    JournalWellcome Open Research
    Publication statusPublished - 14 Jan 2020

    Bibliographical note

    Copyright: © 2020 Shallcross L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Grant information: This work was supported by the Wellcome Trust through a Digital Innovator Award to FL [215742].
    Funding for the project was received from the Economic and Social Research Council as part of a Antimicrobial Resistance programme grant [ES-P008321-1].


    • Antimicrobial-stewardship
    • Behaviour-change
    • Epidemiology
    • Ethnography
    • Interdisciplinary
    • User-centred design


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