. 2021 Jun 17;3(2):dlab083. doi: 10.1093/jacamr/dlab083

Table 2.

Identifying what needs to change to discourage patients from asking for antibiotics during a general medical/dental consultation, mapping to COM-B component and to theoretical domains framework, intervention ‘function’ and components

What needs to change?	COM-B model component	Theoretical Domains Framework	Intervention function (BCW)	Intervention component/content	BCT (using 93 BCT taxonomy v1)³³
Lack of awareness of the benefits of avoiding antibiotics	Capability (psychological) Beliefs about what is good—motivation (Reflective)	Knowledge Beliefs about consequences	Education Enablement	Provide information: About the existence of normal the flora (‘helpful bacteria’) and their importance for health. That avoiding antibiotics reduces damage to ‘helpful bacteria’.	5.1 Information about health consequences
Lack of awareness of the normal bacterial flora (‘helpful’ bacteria) living in the body that are important for health	Capability (Psychological)	Knowledge	Enablement	Provide information: On ‘helpful bacteria’. That antibiotics increase the risk of AMR infections.	5.1 Information about health consequences
Lack of awareness about the effects of antibiotics on our helpful bacteria	Capability (Psychological)	Knowledge	Enablement	Provide information: Antibiotics damage normal flora (‘helpful bacteria’) as well as treating bacteria causing infection. Antibiotics increase the risk of AMR infections.	5.1 Information about health consequences
Belief that antibiotics do not affect the body’s helpful bacteria and do not lead to AMR	Motivation (Reflective)	Beliefs about consequences	Persuasion (create negative feelings about asking for antibiotics)	Provide information that antibiotics increase the risk of AMR infections through their effect on the body’s normal flora and that avoiding antibiotics reduces this risk	5.1 Information about health consequences
Lack of acceptance that AMR is relevant/bad	Motivation (Reflective)	Beliefs about consequences	Education Persuasion (create negative feelings about asking for antibiotics)	Create a sense of personal jeopardy by using language in the second person to explain how AMR occurs, is of personal relevance and is a bad thing. Use visual imagery to evoke fear of AMR (skull image Figure S2 and colour red).	5.2 Salience of consequences
Lack of concern about antibiotic resistance	Motivation (Reflective)	Beliefs about consequences	Education	Provide information about how the risk of AMR can be avoided	5.2 Salience of consequences
Incorrectly believing that antibiotics are effective/ necessary for non-severe infections	Motivation (Reflective)	Beliefs about consequences	Education Persuasion (create negative feelings about asking for antibiotics)	Provide reassurance that not all infections require antibiotic treatment and you may feel better without antibiotics	5.6 Information about emotional consequences
Lacking trust in healthcare professional’s judgement	Motivation (reflective)	social/professional role and identity	Persuasion	Provide reassurance that clinicians know when to use antibiotics	5.6 Information about emotional consequences
Lack of concern about having an adverse antibiotic reaction during treatment	Motivation (Reflective)	Beliefs about consequences	Persuasion (create negative feelings about asking for antibiotics)	Provide information on antibiotic side effect/harms	5.1 Information about health consequences
Trust in health care providers’ advice if they don’t prescribe antibiotic	Motivation (Automatic)	Reinforcement	Persuasion (create positive feelings about advice not to take antibiotics)	Provide reassurance that GP/GDP will prescribe antibiotics if they are clinically indicated	5.1 Information about health consequences
Intention to avoid antibiotics if possible	Motivation (Reflective)	Intention	Persuasion	Provide encouragement that it is OK to avoid antibiotics if a GP/GDP advises this	5.6 Information about emotional consequences
Sufficient time to discuss antibiotic harms versus benefits with a doctor/dentist	Opportunity (physical)	Environmental context and resources	Enablement (allow/encourage discussion about avoidance of antibiotics)	Time in consultation. (Design intervention to minimally impact on consultation time but promote discussion.)	12.2 Restructuring of social environment (this was not considered to be feasible)

AMR, antimicrobial resistance; AMR, antimicrobial resistance; BCW, behaviour change wheel; GP, general practitioner; GDP, general dental practitioner; BCT, behaviour change techniques.