Behavior Change Communication

In this module, you will explore the behaviors and practices of healthcare providers and patients that drive the progression of antimicrobial resistance (AMR). You will gain insights into the critical role healthcare providers play in fostering a culture of responsible antibiotic use and stewardship in clinical settings. Additionally, this module offers strategies for effectively communicating with patients to encourage prudent antibiotic use and adherence to prescribed treatments, ensuring they manage these medications responsibly for themselves and their families. Remember, patients are essential partners in the healthcare system, and their engagement is vital for combating AMR on a global scale.

Why is it crucial to discuss behavior change? Antimicrobial resistance is a multifaceted, cross-cutting issue that is largely driven by the behaviors of various groups—healthcare workers, patients, and the broader community, including those involved in agriculture and veterinary practices. This module specifically focuses on patients’ behaviors in managing antibiotics and outlines the actions that an ideal healthcare provider should take to positively influence these behaviors. These behaviors include adherence to prescribed antimicrobials, hand washing, safe sex, and vaccination.

Adherence to Prescribed Antimicrobials

Patients are vital partners in healthcare, and their behavior regarding health issues and adherence to treatment plans significantly impacts clinical outcomes. This highlights the importance of adherence. While adherence is often narrowly viewed as how well patients follow prescribed medication regimens, it encompasses much more. The World Health Organization (WHO) defines adherence as “the extent to which a person’s behavior—taking medication, following a diet, and/or making lifestyle changes—corresponds with agreed recommendations from a healthcare provider.” This definition underscores the need for healthcare providers to not only educate patients on how to properly take antibiotics but also to address other lifestyle factors that may contribute to the development of antibiotic resistance.

To improve adherence to antibiotic prescriptions, it is essential to educate patients thoroughly about their medications, including the type of antibiotic, duration, and frequency of use. Clearly explaining that they are receiving a specific and critical medication to treat their condition can enhance adherence. Healthcare providers should also emphasize that deviating from the prescribed instructions could lead to antibiotic resistance, a serious issue where bacteria become resistant to treatment, potentially resulting in a future infection caused by a “superbug.” Unlike many other drugs, antibiotics face the unique challenge of bacterial adaptation, where bacteria can develop mechanisms to resist the effects of the drug.

Research has demonstrated the importance of adhering to prescribed antibiotic dosages to maintain the necessary drug concentration in the bloodstream to effectively eliminate pathogens. Missing doses can lower the drug concentration, rendering it insufficient to kill the bacteria. Not only do the bacteria survive, but they may also develop the ability to withstand the antibiotic. Over time, this can lead to the evolution of resistant strains. A healthcare provider committed to antimicrobial stewardship should communicate these points clearly when prescribing, dispensing, administering, or discharging a patient to prevent misuse and ensure the effectiveness of antibiotic treatments.

Tutorial Video: Educating Patients About Antibiotic Use (7 minutes and 41 seconds)

Hand Washing

Hand hygiene is a fundamental practice that should be embraced by both patients and healthcare providers to prevent a wide range of infections, including those caused by antibiotic-resistant bacteria. Effective hand hygiene not only helps curb the spread of antimicrobial resistance (AMR) but also prevents other communicable diseases transmitted through pathogens commonly found on our hands. Research indicates that proper handwashing can prevent one in three cases of diarrhea and one in five cases of respiratory infections. By fostering a culture of hand hygiene among patients, a significant number of infections, including those involving resistant bacteria, could be avoided. For instance, a patient may unknowingly carry resistant pathogens on their hands after contact with another patient or a contaminated surface, potentially leading to self-infection or spreading resistant strains.

Patients should be regularly educated on effective hand hygiene practices, whether it involves handwashing with soap and clean running water or hand-rubbing with alcohol-based solutions, depending on the resources available. Handwashing requires washing hands thoroughly with soap and water for 40 to 60 seconds, which effectively removes most germs. On the other hand, hand-rubbing involves using an alcohol-based hand sanitizer with an adequate concentration to kill most bacteria, taking 20 to 30 seconds. Although hand-rubbing became widely practiced during the COVID-19 pandemic due to the frequency of hand hygiene requirements, handwashing remains the preferred method for comprehensive infection prevention. Encouraging consistent and correct hand hygiene practices is a critical component of global health strategies to reduce the spread of infections and combat AMR.

Tutorial Video: How to Handwash? With soap and Water ( 1 minute and 27 seconds)

Safe Sex

Did you know that more than 1 million sexually transmitted infections (STIs) occur every day across the globe? The growing overuse and misuse of antimicrobials have led to an alarming rise in resistance to STIs, making them harder to treat. With globalization increasing human mobility, people are more frequently exposed to diverse bacterial strains, including drug-resistant ones, which further exacerbates the spread of resistant STIs.

The World Health Organization (WHO) has highlighted a rapid increase in antimicrobial resistance in gonorrhea, significantly limiting treatment options. Gonorrhea remains a critical global public health issue, with WHO estimating 82.4 million new cases among adolescents and adults aged 15–49 years in 2020. The resistance of Neisseria gonorrhoeae (the bacteria causing gonorrhea) to antibiotics began almost as soon as these drugs were introduced, and over the past 80 years, resistance has developed against several classes of antibiotics, including tetracyclines, macrolides (such as azithromycin), sulphonamides, trimethoprim combinations, and more recently, quinolones. Cases of drug-resistant gonorrhea that do not respond to recommended treatments are often referred to as “super gonorrhea” or “gonorrhea superbugs,” presenting a serious challenge to global health efforts in controlling STIs.

Vaccination

The discovery of vaccines has been a monumental success in human health, comparable to the discovery of antibiotics. Both antibiotics and vaccines have saved countless lives globally. Some diseases, such as smallpox and rinderpest, have been eradicated entirely due to the effective use of vaccines. Vaccines protect against more than 25 debilitating diseases, including measles, tetanus, meningitis, and typhoid. Every disease prevented by vaccination is one less instance where antimicrobial medicines are needed (WHO).

You might wonder how the effective use of both vaccines and antimicrobials can create a win-win situation. Often, when patients develop a medical condition, they visit clinics expecting to receive antibiotics (often considered “magic pills”) because they believe antibiotics can cure almost everything. This increases the pressure on healthcare providers to prescribe antibiotics, and some may even be bought over the counter, heightening the risk of misuse and overuse, which leads to resistance.

When the population adheres to vaccination schedules, most common diseases are prevented, significantly reducing the number of people seeking medical care and, consequently, the number of antimicrobials prescribed.