The effectiveness of interventions to improve the public's antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review

Lesley Price, Lucyna Gozdzielewska, Mairi Young, Fraser Smith, Jennifer MacDonald, Joanna McParland, Lynn Williams, Darren Langdridge, Mark Davis, Paul Flowers

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Background: A global antimicrobial resistance (AMR) awareness intervention targeting the general public has been prioritised.
Objectives: To evaluate the effectiveness of interventions which aim to change AMR awareness and subsequent stewardship behaviours amongst the public.
Methods: Five databases were searched between 2000 and 2016 for interventions to change the public’s AMR awareness and/or antimicrobial stewardship behaviours. Study designs meeting the EPOC criteria: non-controlled before and after studies and prospective cohort studies were considered eligible. Participants recruited from healthcare settings and studies measuring stewardship behaviours of healthcare professionals were excluded. Quality of studies was assessed using EPOC risk of bias criteria. Data were extracted and synthesised narratively.
Results: Twenty studies were included in the review with nine meeting the EPOC criteria. The overall risk of bias was high. Nineteen studies were conducted in high-income countries. Mass media interventions were most common (n = 7), followed by school-based (n = 6) and printed materials interventions (n = 6). Seventeen studies demonstrated a significant effect on changing knowledge, attitudes, or the public’s antimicrobial stewardship behaviours. Analysis showed that interventions targeting schoolchildren and parents have a notable potential but for the general public the picture is less clear.
Conclusions: Our work provides an in-depth examination of the effectiveness of AMR interventions for the public. However, the studies were heterogeneous and the quality of evidence was poor. Well-designed, experimental studies on behavioural outcomes of such interventions are required.
Original languageEnglish
Number of pages35
JournalJournal of Antimicrobial Chemotherapy
Early online date14 Mar 2018
Publication statusPublished - 1 Jun 2018


  • global antimicrobial resistance
  • AMR
  • antimicrobials

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