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Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention
  1. Erika A Saliba-Gustafsson1,
  2. Michael A Borg2,3,
  3. Senia Rosales-Klintz1,
  4. Anna Nyberg4,
  5. Cecilia StålsbyLundborg1
  1. 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
  3. 3 Faculty of Medicine and Surgery, University of Malta, Msida, Malta
  4. 4 Department of Marketing and Strategy, Stockholm School of Economics, Stockholm, Sweden
  1. Correspondence to Erika A Saliba-Gustafsson; erika.saliba{at}


Introduction Antibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research on effective strategies targeting general practitioners’ (GPs) knowledge and behaviour is needed. Multifaceted behaviour change (BC) interventions are likely to be effective. Social marketing (SM) can provide the tools to promote sustained BC; however, its utilisation in Europe is limited. This paper aims to describe the design and methods of a multifaceted SM intervention aimed at changing Maltese GPs’ antibiotic prescribing behaviour for patients with acute respiratory tract infections (aRTIs).

Methods and analysis This 4-year quasiexperimental intervention study will be carried out in Malta and includes three phases: preintervention, intervention and postintervention. The preintervention phase intends to gain insight into the practices and attitudes of GPs, pharmacists and parents through interviews, focus group discussions and antibiotic prescribing surveillance. A 6-month intervention targeting GPs will be implemented following assessment of their prescribing intention and readiness for BC. The intervention will likely comprise: prescribing guidelines, patient educational materials, delayed antibiotic prescriptions and GP education. Outcomes will be evaluated in the postintervention phase through questionnaires based on the theory of planned behaviour and stages-of-change theory, as well as postintervention surveillance. The primary outcome will be the antibiotic prescribing rate for all patients with aRTIs. Secondary outcomes will include the proportion of diagnosis-specific antibiotic prescription and symptomatic relief medication prescribed, and the change in GPs stage-of-change and their intention to prescribe antibiotics.

Ethics and dissemination The project received ethical approval from the University of Malta’s Research Ethics Committee. Should this intervention successfully decrease antibiotic prescribing, it may be scaled up locally and transferred to similar settings.

Trial registration number NCT03218930; Pre-results.

  • public Health
  • clinical Audit
  • qualitative Research

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  • Contributors All authors were all involved in the conception, planning and design of this study as well as the development of all data collection instruments. EAS-G managed the project; she recruited all participants, led data collection and analysis, designed educational materials and coordinated their printing, delivered an educational session and liaised with the various stakeholders involved. EAS-G wrote the first draft of this manuscript and made all necessary amendments after review. MAB delivered one educational session. MAB, SR-K, AN and CSL were involved in manuscript review and critique, and all authors contributed to the final approval of the manuscript. All authors are in agreement that they are accountable for all aspects of the work and that all questions related to its accuracy have been appropriately investigated and resolved.

  • Funding This work is financially supported by Karolinska Institutet funding for doctoral students (KID-funding) and Karolinska Institutet travel funds. It was also supported by funding available to CSL at Karolinska Institutet. Otherwise this research received no specific grant from any public, commercial or not-for-profit funding agencies.

  • Competing interests None declared.

  • Ethics approval The University of Malta’s Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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