Behavioral Change Techniques in Antimicrobial Stewardship: A Scoping Review of Pharmacist-Led Communication and Patient Engagement Interventions

Antimicrobial resistance is understood as a behavioural and communication challenge, not only a microbiological or prescribing issue, and pharmacists are well-placed to help implement antimicrobial stewardship (AMS) principles into patient-facing action, but the extent to which pharmacist-led interventions have utilised behavioural theory, Behaviour Change Techniques (BCTs) and patient engagement is poorly understood. This scoping review aimed to examine the ways in which pharmacist-led AMS interventions have incorporated behaviour modification and pataient involvement to change antibiotic-related practices, investigating which theories of behaviour have been applied and to what degree, what BCTs have been employed and which appear lacking, how communication strategies were designed, and in what settings and populations the interventions operated, Following Joanna Briggs Institute methods and the PRISMA-ScR guideline, a systematic search was undertaken across five databases (PubMed, Scopus, Web of Science, PsycINFO, CINAHL). There were 20 studies that met the inclusion criteria and were synthesised using a structured narrative synthesis, reporting numbers and percentages. These findings suggest that pharmacist-led AMS interventions have, in a small number of studies, demonstrated that applying behavioural theory and a wider range of BCTs can be meaningfully integrated into AMS practice, but this was not found to be a common practice, with patient engagement rarely extending to shared decision-making and evidence being found predominantly in UK community pharmacy. The next steps for research in this area could include investigating theory-informed design beyond the UK, examining the impact of the use of more active BCTs and investigating whether lack of shared decision-making reflects a limitation of antibiotic-related decisions or an area of practice that is underdeveloped.