What is the problem?

To combat the growth in antimicrobial resistance, different people need to change their behavior in many different ways. For example, clinicians and vets may need to prescribe fewer antibiotics or different antibiotics, or prescribe then for shorter durations. Members of the public may need to be persuaded not to expect or ask for antibiotics for themselves, their family members or their animals unless they are really needed. The need for antibiotics can also be reduced by behaviour that prevents the spread of infection, such as good hand and food hygiene. Behaviour cannot be changed simply by giving people information or guidance – it is necessary to understand and address all the influences on those behaviours, especially the physical and social environment, and people’s beliefs, emotions and habits.

What is the solution?

Professor Lucy Yardley has pioneered the ‘person-based approach’ to developing effective interventions to change behaviour. This approach identifies the key barriers to behavior change and how to overcome them, and uses co-design and in-depth mixed methods research to ensure that the interventions are accessible, supportive, engaging and useful.

Using these methods, working closely with clinical colleagues, she has successfully developed interventions that:

• Reduced the transmission of infection in a trial in 20,000 homes by means of an online intervention to support better hand hygiene - ‘Germ Defence’
  

This was the first intervention worldwide to prevent infection transmission in the home 

• Reduced antibiotic prescribing across six European countries by means of a brief online motivational module for GPs and a booklet for patients.
  

More recently, she has led the development of the 'ARK’ (Antibiotic Review Kit) intervention to reduce antibiotic usage in hospitals by improving the ‘review and revise’ process; University of Oxford is now carrying out a step-wedge trial of this intervention in 36 hospitals.

Outcome and next steps

Prof Yardley continues to work with teams across the UK and internationally to develop further interventions to combat the rise in AMR. For example, she is now co-leading an MRC-funded study with Dr Christie Cabral to use these methods to develop and trial an intervention to reduce antibiotic use in China. She is also working with teams at Imperial College and University of Edinburgh to automate behavioural interventions to reduce antibiotic prescribing by embedding them in electronic systems in primary and secondary care. 

Prof Yardley is actively engaged in using her interventions and expertise to achieve real-world behavior change; for example, ‘Germ Defence’ is now an educational resource endorsed by NICE, her European intervention has been used for GP education in Belgium and Australia and the ARK intervention has been adopted for national rollout by the British Society for Antimicrobial Chemotherapy. She was an expert topic contributor to the NICE guidance on ‘Antimicrobial stewardship – changing risk-related behaviours in the general population’ and is a member of the Longitude Prize Advisory Panel (Antibiotics).