Combatting anti-microbial resistance with behavioural science

Anti-microbial resistance (AMR) is a major public health challenge of our time. AMR occurs when bacteria lose their sensitivity to antibiotics, which can lead to life threatening infections.


The Antibiotic Prescribing in Primary Care Insight Report has been published on 20 March 2018. This report outlines the findings from the prescriber and stakeholder survey and makes recommendations for policy makers and practice managers. 

How can we use behavioural science to enable a GP and a patient to manage a suspected viral infection appropriately?

The challenge of AMR is being tackled from many angles, including research and development work on finding clinical solutions to AMR.

However, there is a behavioural element to this challenge in terms of changing GP prescribing behaviour and perhaps even patient behaviour during a consultation.

This project aims to address these behavioural challenges by looking for solutions grounded in academic theory of behavioural science.

Our objectives

  • generate and test hypotheses about antibiotic prescribing behaviour
  • facilitate stakeholders to develop a shared structural understanding of their problem
  • identify new and novel ideas to test
  • conduct a desirability / feasibility / viability test on ideas selected for further development
  • trial and implement ideas selected by the sponsor, users and stakeholders
  • provide monitoring and evaluation of trials

We expect to deliver the following high level outcomes

  • we will find and test ideas which have the potential to reduce the inappropriate prescribing of antibiotics in Northern Ireland
  • we will identify the value and likely impact of those ideas

Phases of this project

Insight phase


  1. systematic literature review of current AMR interventions trialled in primary care.
    • status: ongoing
    • outcome: pre-registration of systematic review submitted March 2018
  2. stakeholder survey designed to gather and document stakeholders’ perceptions of the challenge and potential solutions.
    • status: complete
    • outcome: report for stakeholders combined with prescriber survey completed 20 March 2018
  3. GP/primary care prescriber survey – based on the Mitchie et al.(2011) COM-B model[1] of behaviour change, this survey has been created to identify all the pressures and influences on a prescribers’ decision to prescribe antibiotics.
    • status: complete
    • outcome: report now available
  4. in-depth analysis of patient experience.
    • status: approach to be decided
    • outcome: insight report will present findings

Design and experimentation phases - early spring 2018

Design phase

Intervention design based on the results of the surveys and the systematic review and will be designed to affect the prescribing of antibiotics. An intervention may be multi-faceted and target both patients and prescribers. An intervention will be coded with Mitchie et al "Behaviour Change Techniques" within specific intervention functions so that any behaviour change observed can be replicated across other sites.

Service design: if the intervention requires the delivery of a new or improved service, service design techniques will be used to make sure the user is the centre of the service

Experimentation phase

We will first pilot the new intervention in one practice before conducting a randomized controlled trial.

We will randomly assign the new intervention to some practices (or prescribers) and assign others to a control group so that we can compare outcomes and have a degree of certainty about the utility of the intervention.


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