Background: South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals, a lack of compliance with policy among healthcare providers, high population density and high infectious disease burden. This paper describes development of social and behavioural change communication (SBCC) to increase appropriate use of antibiotics.
Methods: We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) qualified physicians and 4) pharmaceutical companies/medical representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, to prioritize audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings.
Results: Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritized as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change; suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek qualified physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, several antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions; referring them to qualified physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course.
Conclusions: We prioritized drug shops for intervention delivery to drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and should address the impact on profit and livelihoods for drug shop staff for optimal compliance.