Development of evidence-based behavioural interventions to reduce inappropriate use of antibiotics beyond clinical settings

Human use of antibiotics in China accounts for a quarter of worldwide antibiotic consumption and mainly occurs in outpatient and community settings. Non-clinical factors for antibiotic use are main drivers of its excessive consumption. To date, almost every intervention has focused exclusively on antibiotic prescribing behaviours, with little attention being paid to antibiotic consumer’s usage behaviours in the community. This PhD study aimed to develop an evidence-based, theory-informed behavioural change intervention to reduce inappropriate use of antibiotics in the Chinese communities. To conduct this programme of research, I employed a mixed-methods approach throughout the study phases, which included: 1) systematic literature reviews on determinants of antibiotic use in China and on behavioural change interventions to reduce unnecessary or inappropriate use of medical interventions, 2) secondary data analyses of large-scale population data on antibiotic use-related knowledge and practice, 3) formative interviews to ensure acceptability and feasibility of proposed interventions, and finally 4) a mixed-methods feasibility evaluation of the pilot intervention. The systematic reviews identified non-clinical factors and potential pathways influencing public’s antibiotic use, and the components of promising behavioural change interventions. Using the survey data, some of the pathways were quantitatively assessed to inform the development of a context-appropriate intervention - reducing access to non-prescription antibiotics in rural China was identified to be a priority. Additionally, (mis-)perceived antibiotic efficacy for upper respiratory tract infections (URTIs) was found to be associated with increased odds of antibiotic use in the community. The new knowledge contributed to the design of the proposed intervention. Working with local partners, I developed and conducted a feasibility assessment of a pilot antibiotic take-back programme aiming to reduce household antibiotic storage and unsafe disposal in rural China. The proposed intervention was deemed feasible and appropriate.