The project

PASS aims to design antibiotic stewardship interventions that are tailored to specific healthcare environments.

Hundreds of initiatives to improve antibiotic prescribing have been developed, mainly in hospitals. Yet, they are not always successful or have only a small effect. We still have a limited understanding of why some interventions work and others fail. In particular, we do not always understand how human factors and the healthcare context contribute to the success or failure of interventions.

In PASS, we draw on theory and evidence from epidemiology, health psychology, ethnography and healthcare design to build a holistic picture of what drives prescribing behaviour across different healthcare settings.

We then integrate these findings with evidence from systematic reviews of existing behavioural interventions and user-centred design to make recommendations for new interventions/optimise existing interventions.

The work will be carried out in general practices, a teaching hospital, care homes and with members of the public and is split into three work-packages.

Work package 1: Identifying patterns of antibiotic prescribing

Data on antibiotic prescribing in England is poor. We know remarkably little about who gets antibiotics, what for and for how long. Using pre-existing electronic health records, we will study data on antibiotic prescribing in general practice, hospitals and care homes. We will also carry out an online survey, Bug Watch, to collect new data on why and when members of the public consult a doctor. This information will help us identify where problems lie and where intervening may have the greatest effect.

Work package 2: Identifying barriers and enablers to stewardship in context

In order to identify what influences antibiotic prescribing, we will carry out interviews with health-care workers and members of the public. We will also carry out observations in GP practices, hospitals and care homes to see what happens in practice. Finally we will carry out a systematic search of the research to identify stewardship interventions that were or were not successful. This will allow us to identify the ‘active ingredients’ of successful interventions.

Work package 3: Co-production of intervention bundles and dissemination

Co-production (involving consumers in the design of a product), is commonly used in industry. There is evidence that this leads to better quality and acceptability of the end-product. Using our findings from the first two work-packages will work with members of the public and healthcare workers to develop and/or optimise antibiotic stewardship interventions. This combines structured approaches commonly used by health psychologists and user-centred design.


PASS is funded by a grant of the Economic & Social Research Council (2017-2020).

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