What is the active content of interventions that target the public's engagement with antimicrobial resistance?

Objectives: Recent international policy suggests that changing public awareness of antimicrobial resistance (AMR) represents a global public health priority. We conducted a systematic review of the effectiveness of interventions that targeted the public and aimed to change AMR awareness and associated behaviour. Here we focus on identifying the active content of such interventions and explore potential mechanisms of action. Design: Systematic review. Methods: The project took a novel approach to intervention mapping utilising the following steps: (i) systematic review of the literature; (ii) coding of behaviour change techniques (BCTs) using the BCT Taxonomy v1 from intervention descriptions alone; (iii) an exploration of explicit and tacit theory and theoretical constructs using the theory coding scheme and the Theoretical Domains Framework (TDF), and (iv) an examination of the added value of BCT coding of intervention materials rather than intervention descriptions. Results: Nineteen studies utilising 14 BCTs were included. The most commonly used BCTs were ‘information about health consequences’ (79% of studies), ‘credible source’ (68% of studies), and ‘instruction on how to perform the behaviour’ (58% of studies). These represent theory congruent BCTs when mapped onto the TDF domains of knowledge and skills. An explicit theoretical framework for the interventions was reported in only four of the 19 studies. Conclusions: The study highlights the need for innovation in methods around intervention mapping. The current methodological approach provided a novel and useful way of mapping theoretical constructs and BCTs when reviewing studies that provide limited information on theory and intervention content.