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