Promoting behavioural and cultural insights to tackle drug-resistant infections
WHO is promoting behavioural and cultural insights (BCI) to tackle the development and spread of drug-resistant infections. When microorganisms such as bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines, infections become harder to treat and diseases spread, creating a threat to public health.
Bacterial infections resistant to antibiotics were associated with over half a million deaths in the WHO European Region in 2019. This is equivalent to the health burden of influenza, tuberculosis and HIV/AIDS combined, and has devastating impacts – particularly on those in vulnerable situations.
Behaviours can both drive and prevent the development and spread of resistant infections across all sectors. Relevant behaviours include antibiotic prescribing by doctors and veterinarians, antibiotic use by people and for animals and agriculture, and actions to prevent and control infection by hospital staff and by animal producers.
BCI is an approach that increases understanding of how behaviours can be effectively enabled, promoted or restricted in ways that help to reduce the development and spread of drug-resistant infections. It does so by systematically exploring the barriers and drivers to these behaviours, and by developing and evaluating evidence-based interventions.
A complex web of factors impacts people’s ability to take appropriate action. Variation in values, knowledge, perceptions, cultural contexts, social norms and financial incentives, as well as regulatory and legislative frameworks, influence behaviours in various ways. Knowing and understanding these factors helps overcome barriers and leverage enablers. The BCI approach offers evidence-based and people-centred methods to do this.
There is growing evidence on how to effectively support behaviours that reduce the health threat that drug-resistant infections pose. A more systematic use of evidence-based approaches to address behaviours can support a more effective response to prevent the development and spread of drug-resistant infections.
WHO response
In 2011 WHO/Europe established the dedicated Control of Antimicrobial Resistance (AMR) programme and the cross-programmatic AMR Working Group, which aims to ensure a comprehensive approach to building country capacity to address AMR.
In October 2023 Member States endorsed the new “Roadmap on antimicrobial resistance for the WHO European Region 2023–2030”, highlighting the need for urgent action. The Roadmap recognizes behavioural and cultural insights (BCI) as a high-impact intervention to be integrated into larger efforts to tackle AMR. The AMR Compass was then created to guide a tailored national AMR response and accelerate the implementation of action plans.
To advance the use of BCI, in September 2022 Member States of the WHO European Region adopted a regional resolution and a 5-year action plan including 5 strategic commitments:
- to build understanding and support for BCI among key stakeholders
- to conduct BCI research
- to apply BCI to improve outcomes of health-related policies, services and communication
- to commit human and financial resources for BCI and ensure their sustainability
- to implement strategic plans to apply BCI for better health.
A global resolution on behavioural sciences for health was also adopted in May 2023.
Available tools and methods
Evidence, theoretical frameworks and practical methods exist to help public health authorities apply more evidence-based and people-centred approaches to critical behaviours that can reduce the development and spread of resistant infections.
WHO/Europe’s Tailoring Antimicrobial Resistance Programmes (TAP) and the more broadly applied Tailoring Health Programmes (THP) approach provide step-by-step guidance, from problem definition to intervention design and evaluation. These guides have proven pivotal in, for example, understanding the factors that affect health workers in their prescription of antibiotics.
WHO has initiated a wide range of behaviourally informed projects to tackle AMR in the Region, including in:
- Ukraine – on controlling the spread of drug-resistant infections in hospitals;
- Sweden – on tailoring messages and communication pathways to target hard-to-reach groups with information about rational use of antibiotics;
- the United Kingdom – on out-of-hours primary care services and antibiotic prescribing practices;
- Hungary – on general practice paediatricians’ antibiotic prescribing behaviour for suspected respiratory tract infections (a qualitative study);
- Kazakhstan – on pharmacists’ behaviours regarding over-the-counter sale of antibiotics; and
- Georgia – on factors influencing health workers’ uptake of a pilot surgical antibiotic prophylaxis stewardship programme in selected Georgian hospitals.
