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Table 1 An overview of the included studies: intervention aims, components, and reporting

From: Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

  Context Intervention elements Implementation  
First author, year Target illness/condition Country Last month of data collected Setting Target drivers/factors Name Slogan Target audience Healthcare providers Healthcare consumers BCT-provider BCT-consumer Behavioral Change Wheel Theory-based Intervention adaption/development Implementation strategy Implementer(s) Unit of intervention Dose/intensity Design Costs Duration Data sources Formative or process evaluation studies
Inappropriate use of antibiotics
Belongia, 2001 RTIs USA June 1998 Community and primary care setting Knowledge (including awareness), cultural, and doctor-patient relationship None Community and healthcare providers Physician education (parent education pamphlets, parent information sheets, a sample letter, “prescription pad,” CDC fact sheets Public education materials: programs, pamphlets and posters, presentations and “Cold kits” 4.1
4.2
5.1
8.2
12.5
4.1
4.2
5.1
8.2
12.5
Education Yes Yes Yes Community Partially reported NR NR 4 months Medical records + self-reports, lab testing  
Belongia, 2005 Not specified USA December 2003 Community Knowledge (including awareness) Wisconsin antibiotic resistance network “There’s no excuse for overuse!” and “Get smart about antibiotics!” Community and healthcare providers Physician education (mailings, susceptibility reports, practice guidelines, satellite conferences, and presentations) Mass media campaign (television, radio, newspapers, press conference; paid ad); Patient education materials 4.1
4.2
5.1
12.5
4.1
4.2
5.1
12.5
Education Yes Yes Yes Community Yes Access expired NR 5 years Medical records
Bernier, 2014 Not specified France December 2010 Community Knowledge (including awareness) “Antibiotics are not automatic!” and “antibiotics, used unnecessarily, lose their potency!” Community Guidelines, seminars, academic detailing, letters Pamphlets and posters, print media, radio, television, website 4.1
4.2
5.1
12.5
4.1
4.2
5.1
12.5
Education NR NR Yes Community NR NR NR 6 months (ongoing) Medical records
Cebotarenco, 2008 RTIs Moldova March 2004 School setting Knowledge (including awareness) peer None Community-students and guardians Peer-education, parents’ meetings, booklet, vignette video, newsletter, poster, and poster contest 4.1
4.2
6.1
12.2
Education Social cognitive theory Yes Yes Yes Community Yes Yes NR 1 year Self-reports
Finkelstein, 2001 RTIs USA December, 1998 Community & primary care setting Knowledge (including awareness), doctor-patient relationship, peer leader Community and healthcare providers Guideline dissemination, small-group education, educational materials, and prescribing feedback. Educational materials for parents by mail and in primary care practices, pharmacies, and childcare settings 2.2
3.2
4.1
4.2
5.1
8.2
9.1
4.1
4.2
5.1
8.2
9.1
Education Yes Yes Yes Community NR NR NR 1 year Medical records [30]
Finkelstein, 2008 RTIs USA August 2003 Community Knowledge (including awareness), doctor-patient relationship Reducing antibiotics for children in Massachusetts (REACH Mass) None Community and healthcare providers Guideline dissemination, small-group education, educational materials, “prescription pad”, and prescribing feedback. Educational materials for parents by mail and in primary care practices, pharmacies, and childcare settings 2.2
3.2
4.1
4.2
5.1
8.2
4.1
4.2
5.1
8.2
Education Social marketing Yes Yes Yes Community Partially reported NR NR 3 winters (Oct-March) Medical records [30]
Formoso, 2013 RTIs Italy March 2012 Community Knowledge (including awareness), cultural, and doctor-patient relationship Antibiotics, solution or problem “Antibiotics, solution or problem?” Community and healthcare providers a newsletter on local AMR. campaign materials (highlighting how to deal with patients’ expectations, occurrence of AMR and of side effects.) mass media spaces (television, radio, newspapers) written materials (brochures, posters, newsletters) 4.1
4.2
5.1
5.2
12.5
4.1
4.2
5.1
5.2
12.5
Education/persuasion Social marketing Yes Yes Yes Community Partially reported Access expired $60,800 4 months Medical records + self-reports
Fuertes, 2010 Not specified Canada December 2008 Community Knowledge (including awareness) Do bugs need drugs? None Community and healthcare providers Television campaign Television campaign 4.1
4.2
5.1
5.2
8.2
4.1
4.2
5.1
5.2
8.2
Education NR Yes Yes Community NR NR NR 5 months Medical records
Gonzales, 2004 RTIs USA February 2002 Community & primary care setting Knowledge (including awareness) and doctor-patient relationship Minimizing antibiotic tesistance in Colorado Be SMART about antibiotics Community and healthcare providers Antibiotic prescribing profiles and practices guidelines Waiting room materials, examination room posters; mailing campaign packets: household- and office-based patient education materials 1.3
12.5
4.1
4.2
5.1
9.1
12.5
Education Yes Yes Yes Community Access expired Access expired NR 1 year Medical records [31]
Gonzales, 2005 RTIs USA February 2002 Community & primary care setting Knowledge (including awareness) and doctor-patient relationship Minimizing antibiotic resistance in Colorado Be SMART about antibiotics Community and healthcare providers antibiotic prescribing profiles and practices guidelines Waiting room materials, examination room posters; mailing campaign packets: household- and office-based patient education materials 1.3
12.5
4.1
4.2
5.1
9.1
12.5
Education Yes Yes Yes Community Access expired Access expired $63,745 1 year Medical records (see Gonzales, 2004)
Gonzales, 2008 Not specified USA December 2003 Community Knowledge (including awareness) Minimizing antibiotic resistance in Colorado “Get amart: use antibiotics wisely.” and “Use antibio´ ticos solo si un doctor se lo receta” Community and healthcare providers Primary care physicians Mass media campaign, educational events and written educational materials 4.1
4.2
5.1
12.5
4.1
4.2
5.1
12.5
Education Social marketing Yes Yes Yes Community Yes Yes $196,710 4 months Medical records + self-reports
Hennessy, 2002 RTIs USA December 2000 Community Knowledge (including awareness) Community and healthcare providers Workshops and follow-up visits Printed information and newsletters 4.1
4.2
4.1
4.2
5.1
Education Yes Yes Yes Community Access expired Access expired NR 6 months Medical records + lab testing + self-reports
Kliemann, 2016 Not specified Brazil December 2012 Community Socioeconomic determinants; access to non-prescription antibiotics Community and healthcare providers Restriction on sale of antibiotics without prescription Restriction on sale of antibiotics without prescription 12.1 12.1 Restriction, environmental restructuring NA Yes Yes Community NA NA NA Ongoing Medical records
Lambert, 2007 RTIs UK February 2005 Community Knowledge (including awareness) Antibiotics – tracking down the trust Community and healthcare providers Professional education and prescribing support Mass media with printed materials 4.1
8.2
12.5
4.1
8.2
12.5
Education NR Yes Yes Community NA Partially reported £25,000 2 winters Medical records + self-reports
Lee, 2017 RTIs Singapore Not specified Primary care setting Knowledge (correcting misconceptions) Community - patients Educational pamphlets and verbal counseling 4.1
4.2
Education NR NR Yes Individual NR NR NR 2 weeks Medical records
Mainous, 2009 Not specified USA June 2008 Community Knowledge (including misconceptions); cultural “Solo Con Receta” (only with a prescription) Community Culturally sensitive community intervention with multiple media sources 4.1
5.1
Education NR Yes Yes Community Partially reported NR NR 9 months Medical records + self-reports
McNulty, 2010 RTIs UK January 2009 Community & primary care setting Knowledge (correcting misconceptions) Community - patients NICE guidance on the primary care management of common, acute, self-limiting RTIs Three posters displayed in magazines and newspapers 4.1
4.2
8.2
4.1
4.2
Education NR NR Yes Individual NR Yes NR 2 months Self-reports [32]
Perz, 2002 RTIs USA April 1999 Community Knowledge (including awareness); peer Antibiotics and your child Community and healthcare providers Educating peer leader presentations Public education via printed material 4.1
4.2
4.1
4.2
8.2
Education Yes Yes Yes Community Partially reported Partially reported NR 1 year Medical records
Sabuncu, 2009 RTIs France December 2007 Community Knowledge (including awareness) Keep antibioticsworking “Les antibiotiques c’est pas automatique” (“Antibiotics are not automatic”) Community Guidelines, seminars, academic detailing, letters Pamphlets and posters, print media, radio, television, website 4.1
4.2
5.1
12.5
4.1
4.2
5.1
12.5
Education NR NR Yes Community NR NR NR 5 years Medical records (see Bernier, 2014)
Santa-Ana-Tellez, 2013 Not specified Brazil and Mexico June 2012 Community Access to non-prescription antibiotics Community and healthcare providers Restriction on sale of antibiotics without prescription in pharmacies, and introduction of fine on owners of pharmacies for non-compliance. Restriction on sale of antibiotics without prescription 12.1
14.2 (only Mexico)
12.1 Restriction, coercion, environmental restructuring NA Yes Yes Community NA NA NA Ongoing Medical records [33,34,35,36]
Santa-Ana-Tellez, 2015 Not specified Brazil and Mexico March 2012 Community Access to non-prescription antibiotics Community and healthcare providers Restriction on sale of antibiotics without prescription in pharmacies, and introduction of fine on owners of pharmacies for non-compliance. Restriction on sale of antibiotics without prescription 12.1
14.2 (only Mexico)
12.1 Restriction, coercion, environmental restructuring NA Yes Yes Community NA NA NA Ongoing Medical records (see Santa-Ana-Tellez, 2013)
Taylor, 2005 RTIs USA April 2002 Primary care setting Knowledge, doctor-patient relationship Puget Sound Pediatric Research Network Community - parents and children - Educational pamphlets and a video 4.1
9.1
Education Yes Yes Yes Community NR NR NR 1 year Medical records
Trepka, 2001 RTIs USA August 1998 Community & primary care setting Knowledge (including awareness), cultural, and doctor-patient relationship Your child and antibiotics Community and healthcare providers “Grand rounds” presentations, small-group academic detailing, and distribution of written materials (clinical practice guidelines, clinical fact sheets, and samples of patient education materials.) Public education materials: programs, pamphlets, and posters, presentations and newspapers 4.1
4.2
5.1
8.2
12.5
4.1
4.2
5.1
8.2
12.5
Education Yes Yes Yes Community Partially reported NR NR 4 months Self-reports
Wirtz, 2013 Not specified Chile, Colombia, Venezuela, Mexico September 2009 Community Access to non-prescription antibiotics Community and healthcare providers Restriction on sale of antibiotics without prescription Restriction on sale of antibiotics without prescription 12.1 12.1 Restriction, coercion, environmental restructuring NA Yes Yes Community NA NA NA Ongoing Medical records [33,34,35,36]
Wutzke, 2007 RTIs Australia August 2004 Community & primary care setting Knowledge, doctor-patient relationship; peer The NPS common colds community campaign “Common colds need common sense: they don’t need antibiotics.” Community and healthcare providers Prescription pads, patient information leaflets, prescribing software. newsletters, prescribing feedback, educational visiting, clinical audit with feedback and case studies (paper and peer group discussion). Mass media activity using billboards, television, radio, and magazines and small grants to promote local community education 2.2
3.1
4.1
4.2
8.2
12.5
4.1
4.2
8.2
12.5
Education/persuasion Yes Yes Yes Community Partially reported Yes NR 6 years Medical records + self-reports
Demand of brand name drugs
Beshears, 2013 Not specified USA October 2014 Community Knowledge (including awareness), peer influence Community - union members Informational letters with or without a testimonial from person with/without shared union affiliation 8.2
9.1
10.1
10.2
Education, persuasion NR Yes Yes Individual Partially reported NR NR 1 letter Medical records
O'Malley, 2006 Not specified USA December 2003 Community Knowledge (including awareness), incentives Community and healthcare providers Free generic drug samples, physician financial incentives Member mailings, advertising campaigns 3.2
4.1
8.2
10.1
10.2
12.5
4.1
8.2
10.1
10.2
12.5
Education, incentivization NR Yes Yes Community NR NR NR 4 years Medical records
Sedjo, 2009 Not specified USA December 2007 Community Knowledge (including awareness), incentives Community – health plan enrollees Targeted messaging to raise awareness regarding lower-cost generic alternatives (a phone call and quarterly letters) 4.1
8.2
10.1
10.2
Education, incentivization NR Yes Yes Individual NR NR NR 1 call and quarterly mails Medical records
Vallès, 2003 Not specified Spain February 2000 Primary care setting Knowledge (including awareness) chronic disorders patients who attended general practices Verbal information and handout materials on advantages and disadvantages of generic equivalents and brand-name drugs 4.1
8.2
9.2
Education NR Yes Yes Individual NR NR NR 1 session Medical records
Non-medical use of prescription drugs
Hasak 2018 Pain management (short-term USA September, 2017 Community Knowledge (including awareness), enabling Information brochure, website   4.1
4.2
5.1
5.2
12.1
Education; enablement Yes Yes Yes Individual Yes Yes NR 2 times Self-reports [37]
Lawrence, 2019 Pain management (short-term USA January 2019 Community Knowledge (including awareness), enabling Information brochure, video, Deterra bags   4.1
4.2
5.1
5.2
12.1
12.5
Education; enablement; environmental restructuring; Yes Yes Yes Individual Yes Yes Partially reported ($5–7 per bag) 1 time Medical records, self-reports [38]
Maughan, 2016 Pain management (short-term USA October 2015 Community Knowledge (including awareness), enabling Information brochure, study hotline   4.1
4.2
5.1
5.2
12.1
12.5
Education; enablement; environmental restructuring; NR Yes Yes Individual Yes NR NR 1 time Self-reports  
Rose, 2016 Pain management (short-term Canada April 2015 Community Knowledge (including awareness), enabling Information brochure   4.1
4.2
5.1
5.2
12.1
Education; enablement Yes Yes Yes Individual Yes Yes NR 1 time Self-reports  
Spoth, 2008 Not specified USA December 2002 School setting Enhance protective factors
Family dynamics
Strengthening Families Program (ISFP) and Life Skills Training (LST) Community - students Universal preventive interventions implemented during middle school (strengthening families program and life skills training) 3.1
12.2
Education; enablement; environmental restructuring; Social development model NR Yes Yes Individual NR NR NR 6 2-h sessions + 1 family follow-up + boosters (cohort) Self-reports [39,40,41,42,43,44]
Spoth, 2013 Not specified USA December 2011 School setting Enhance protective factors
Family dynamics
Strengthening Families Program (ISFP) and Life Skills Training (LST) Community - students Universal preventive interventions implemented during middle school (strengthening families program and life skills training) 3.1
12.2
Education; enablement; environmental restructuring; Social development model NR Yes Yes Individual NR NR NR 6 2-h sessions + 1 family follow-up + boosters (cohort study 1:1993–2008; study 2: 1998–2011) Self-reports (see Spoth, 20080)
Elective cesarean section
Eden, 2014 Experienced previous cesarean birth USA May 2007 Community & primary care settings Knowledge (including awareness), enabling Community - pregnant women with one previous cesarean birth Evidence-base information brochure or facilitated decision analysis 4.1
5.1
9.2
Education; enablement Yes Yes Yes Individual NR NR NR 1 session Medical records + self-reports
Fraser, 1997 Experienced previous cesarean birth Canada November 1994 Primary care setting Knowledge (including awareness), Predisposing, enabling and reinforcing factors Community - pregnant women with one previous cesarean birth Educational pamphlet, prenatal education, and peer support program 3.3
4.1
5.1
Education; enablement The PRECEDE-PROCEED model NR Yes Yes Individual NR NR NR 2 sessions Medical records + self-reports
Hassani, 2016 Not specified Iran NR Primary care setting Knowledge (including awareness Community - primiparous pregnant women Instructional sessions in the form of speech, group discussions, questions and answers, and presentations   4.1 Education Health belief model NR Yes Yes Individual NR NR NR 6 sessions–50–60 min/session Self-reports
Montgomery, 2007 Experienced previous cesarean birth UK August 2006 Primary care setting Knowledge (including awareness), enabling Community - pregnant women with one previous cesarean birth Information program and facilitated decision analysis 4.1
5.1
9.2
9.2
Education; enablement Yes Yes Yes Individual NR NR NR 10 weeks Medical records + self-reports [45,46,47,48,49]
Navaee, 2015 Fear of childbirth Iran NR Primary care setting Knowledge (including awareness), emotions Community - primiparous pregnant women Education through role play about advantages and disadvantages 4.1
4.2
6.1
9.2
Education; modeling NR Yes Yes Individual NR NR NR 1 session–90 min Self-reports
Sharifirad, 2013 Primiparous pregnant women Iran NR Primary care setting Knowledge (including awareness), family dynamics Community—spouses of primiparous pregnant women Educational session about mechanism of natural vaginal and cesarean deliveries as well as their advantages and disadvantages. 3.1
4.1
5.1
9.2
Education; enablement NR Yes Yes Individual NR NR NR 1 session –90 min Self-reports
Shorten, 2005 Experienced previous cesarean birth Australia May 2003 Primary care setting Knowledge (including awareness), enabling Community—pregnant women with one previous cesarean birth Information materials and facilitated decision analysis 4.1
5.1
9.2
Education; enablement Yes Yes Yes Individual NR NR NR 1 session Medical records + self-reports [50]
Valiani, 2014 Primiparous pregnant women Iran NR Primary care setting Knowledge (including awareness) Community—primiparous pregnant women Childbirth workshops 4.1
4.2
5.1
6.1
9.2
Education; enablement NR Yes Yes Individual NR NR NR 3–4 h/week Medical records
  1. Note: NR not reported, RTIs respiratory tract infections, GP general practitioner, CS elective aesarean section