Table 1

Multidimensional interventions designed to reduce the use of antibiotics among children

Targeted groupTheoretical domainsBehaviour change techniques, modes and content of delivery
Provider side (doctors)
  1. Knowledge

  2. Skills

  3. Beliefs about capabilities

Techniques: information provision.
Mode 1: operational guidelines.
Content: URI management work flow, methods of diagnosis of URI and other common diseases among children, communication skills between clinicians and patients.
Mode 2: facilitated training/workshop.
Content: rational antibiotics use especially for childhood URI (using lectures, case discussions and Q&A (participatory and interactive)).
Behaviour regulationTechniques: monitoring and feedback.
Mode: antibiotics prescribing appraisal.
  • (1) Monthly antibiotic prescriptions collected by research team at the beginning of every month; (2) Feedback sent back to township hospital after calculating the APR by research team; (3) Antibiotics use appraisal according to APR feedback in monthly hospital staff meeting; (4) Meeting memo written down by the township coordinator; (5) Township coordinator sends the memo to trial manager.

  1. Beliefs about consequences (caregivers)

  2. Knowledge (caregivers)

  3. Social influence (caregivers)

Techniques: information provision and persuasive communication.Mode: health education to patient caregivers during clinical consultations.
Content: specific short messages, eg., definition of antibiotic, rational antibiotic use for childhood URIs, plus simple printed educational materials.
Consumer side (parents/caregivers)
  1. Beliefs about consequences (caregivers)

  2. Knowledge (caregivers)

  3. Social influence (caregivers)

Techniques: information provision.
Mode 1: Educational messages from doctors, and educational material/leaflets.
Content: explanation about antibiotics, the impacts of antibiotic resistance and rational antibiotics use for childhood URIs (using leaflets with simple words and pictures).
Mode 2: educational videos played at township hospitals (5–8 min).
Content: explanation about antibiotics, the situation of irrational use of antibiotics in China, and the impact of antibiotic resistance (using a local TV show).
  • Eligible participants include all outpatient prescriptions for children, aged between 2 and 14 years, diagnosed with URIs.

  • Intervention package for doctors includes: operational guidelines, training, peer-review meetings, consultation (with educational leaflets); and for parents/caregivers includes: messages from doctors, educational leaflets and videos.

  • Usual care refers to healthcare as per routine practice at discretion of individual doctors.

  • Baseline data: 3 months before intervention; outcome data: the past 3 months of the intervention.

  • URIs, upper respiratory infections.