Suggested intervention strategies identified by applying the TDF and BCT taxonomy (V.1) to the study findings11
| TDF domain | COM-B | BCT taxonomy | BCT label | Strategy examples (with intervention function in italics) |
|---|---|---|---|---|
| Behavioural regulation Goals. Intentions Social/professional roles and identity | C-(Psych.) M-(Refl.) | Goals and Planning | Goal setting (outcome). Action planning. Review outcome goals | Enablement: Set targets for antibiotic usage Use antibiotic ‘Care Bundles’ |
| Knowledge. Memory, attention and decision-making processes. Behavioural Regulation Beliefs about capabilities Optimism | C-(Psych.) C-(Phys.) M-(Refl.) | Shaping knowledge, Natural consequences, Comparison of outcomes | Instructions on how to perform behaviour. Information about health consequences. Credible source | Education: information about antibiotics, guidelines and AMR Persuasion: Present information to emphasise importance of not prescribing antibiotics inappropriately. Persuasive communication of information, supported by consultant microbiologists and geriatricians |
| Environmental context Memory, attention and decision-making processes | O-(Phys.) C-(Psych.) C-(Phys.) | Antecedents, Associations | Restructuring the physical environment. Prompts/cues. Adding objects to the environment | Environmental restructure/enablement: Reduce/remove LTCF stock of non-first-line antibiotics (Restriction). Provide copies of the guidelines and supporting evidence. Use antibiotic ‘Care Bundles’ |
| Knowledge. Memory, attention and decision-making processes. Behavioural Regulation | C-(Phys.) C-(Psych.) M-(Auto.) | Repetition and substitution | Behavioural practice/rehearsal | Training: Practise referring to the guidelines in daily practice |
| Social influences | O-(Soc.) | Social support | Social support (practical) | Persuasion and Enablement: Encourage doctors, nurses and pharmacists to promote guideline and ‘Care Bundle’ implementation |
| Goals. Beliefs about Consequences and Capabilities. Memory, attention and decision-making processes. Behavioural Regulation. Social/professional roles and identity. Social influences | M-(Refl.) C- (Psych.) O-(Soc.) | Feedback and Monitoring, Comparison of outcomes, Identity | Feedback on outcome of behaviour Discrepancy between current behaviour and goal Incompatible beliefs. Information about others’ approval Social comparison | Persuasion: Audit and feedback of antibiotic prescribing and ‘Care Bundles’ Enablement: Outline deviations from guidelines/evidence-based practice Persuasion: Benchmark antibiotic usage against other LTCFs. Consultant review of antibiotic prescribing |
| Reinforcement. Knowledge. Beliefs about Capabilities. Social/professional roles and identity | C-(Psych.) M-(Refl.) | Reward and threat, Scheduled consequences | Knowledge Incentive (outcome) Reward approximation/completion | Incentivisation: Positive reinforcement from consultants of audit results Financial incentive will be provided if antibiotic prescribing targets met/‘care bundles’ implemented |
COM-B components: C-(Psych), psychological capability; C-(Phys), physical capability; O-(Soc), social opportunity; O-(Phys), physical opportunity; M-(Refl), reflective motivation; M-(Auto), automatic motivation.
Care bundle: A care bundle is a collection of processes needed to effectively and safely care for patients undergoing particular treatments with inherent risks. Several interventions are ‘bundled together’ and, when combined, significantly improve patient outcomes.26