Table 2.

Details of Interventions.

Study	Country	Design	Intervention	Outcome Measures	Messaging/Use of Social Media	Results
The drugs don’t work: Evaluation of educational theatre to gauge and influence public opinion on antimicrobial resistance	United Kingdom	Before–After (Pre–Post) Study with No Control Group	Pre-questionnaire to record audience knowledge, attitudes, and opinions on AMR—educational play (presented on three separate occasions at the Birmingham think tank science museum in April 2017 and the Cheltenham science festival in June 2017)—post-questionnaire to record audience knowledge, attitudes, and opinions on AMR.	The audience would record their responses that would reflect their knowledge and understanding of AMR through pre and post questionnaires to the play.	No use of social media; however, the intervention recording is available on YouTube now	An innovative, simple way such as an educational theatre can have a positive impact on the knowledge, understanding, and attitudes towards AMR.
Peer-education as a tool to educate on antibiotics, resistance and use in 16–18-year-olds: A feasibility study	United Kingdom	A feasibility study of a peer-education evaluation using a cluster Randomised Control Trial design	A student-led antibiotic PE sessions in schools for 16–18-year-old biology students, as well as the biology students’ future delivery of these teachings to their 16–18-year-old non-biology peers. It also tested the feasibility of measuring reported student antibiotic use through questionnaires and text messaging.	Students were asked to fill a knowledge questionnaire—pre-knowledge questionnaire, immediately post-knowledge questionnaire, and 3-month follow-up questionnaire.	No use of social media. Text messaged were used	The study demonstrates that cascading the activities from university health students to 16–18-year-old biology students, and then to their non-biology year group, is feasible and may increase antibiotic knowledge.
The effects of gamification on antimicrobial resistance knowledge and its relationship to dentistry in Saudi Arabia: A randomized controlled trial	Saudi Arabia	Single-blinded parallel group randomised controlled trial design	The participants in the study group (SG) received information about AMR by playing a board game aiming to improve AMR knowledge. The participants in the control group (CG) received the same information but by a conventional lecture titled “Antimicrobial Resistance”, which consisted of a Power-Point presentation given by a member of the research team.	The participants were assessed three times: (T1) prior to the intervention, (T2) immediately after the intervention, and (T3) one month later to assess their recall of the information.	Social media was not used	Gamification with a board game can increase AMR knowledge dramatically, with better retention than a traditional lecture. It is a promising way to raise public awareness about AMR and its connection to dentistry.
Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics	United Kingdom	Randomised Control Trial	Impact of intervention in the form of a short animated video was assessed. The “behavioural change wheel approach” was used to construct the intervention.	Differences in knowledge, attitude/beliefs and intentions between the intervention and control conditions at Time 1 and at Time 2 (6 week follow up) using a questionnaire.	Social media was not used	* Doctor/dentist continued to receive requests for antibiotics. * The animated film showed promise as a tool for preventing patients from requesting antibiotics. * It resulted in a sustained increase in knowledge, but by 6 weeks, the effects on intentions not to ask for antibiotics had faded.
Reducing expectations for antibiotics in primary care: A randomized experiment to test the response to fear-based messages about antimicrobial resistance	United Kingdom	Randomised experiment	To evaluate if fear-based messages with empowering information are more effective than fear based alone.	Online survey measuring participants likelihood to visit a doctor for ILI, request antibiotics, and if antibiotics helped in ILI (influenza-like illness).	Messaging used—‘Antibiotic resistance happens when an antibiotic no longer kills or controls growing bacteria. It is an increasingly serious threat to public health. Without antibiotics that work well, many routine treatments will become increasingly dangerous. Setting broken bones, and even basic operations, rely on access to antibiotics that work. Antibiotic resistance is believed to be caused by unnecessary use of antibiotics, and inappropriate use, such as not taking them as prescribed, skipping doses, or saving them for later use.’	Fear-based messaging can be effective in public campaigns to reduce inappropriate antibiotics use but should be combined with empowering messaging.
‘The Mould that Changed the World’: Quantitative and qualitative evaluation of children’s knowledge and motivation for behavioural change following participation in an antimicrobial resistance musical	United Kingdom	Quantitative study	To enhance children’s knowledge of antibiotic resistance via a musical. Quantitative: online pre-questionnaire then musical workshop intervention then post-questionnaire two weeks after the performance. Qualitative: 29 children randomly picked from each school to participate in a semi-structured focus group before the musical intervention and two weeks after the performance.	Via a quantitative study: the students would answer questions in pre and post questionnaires that reflect their knowledge gain after watching the musical. Via the qualitative study: the students implied better understanding for antimicrobial resistance and the risks of overuse of antibiotics.	Social media was not used	For the quantitative part: 1. knowledge gain was reflected by the children’s ability to answer questions correctly on the post-intervention questionnaire. 2. long term knowledge gain was reflected by a level of correct answers that is consistent between the 2-week and 6-month post-musical questionnaire. For the qualitative part: the children showed better understanding of antimicrobial resistance and the risks of antibiotic overuse and talked about the motivation to decrease the personal use of antibiotic and the influence on friends and family attitudes to antibiotics use.
Changing Patient and Public Beliefs About Antimicrobials and Antimicrobial Resistance (AMR) Using a Brief Digital Intervention	United Kingdom	Pre- and post-intervention study	Participants were given a fictitious case of cold and flu symptoms before being exposed to the intervention. The online intervention included three components: (1) a profiling tool that identified individual beliefs (antibiotic necessity, concerns, and knowledge) that were driving inappropriate antibiotic demand; (2) messages designed to change beliefs and knowledge (i.e., reduce antibiotic necessity and increase antibiotic concerns and knowledge); and (3) an algorithm that linked specific messages to specific beliefs and knowledge.	An online survey containing statements assessing participants’ beliefs about antibiotics and AMR were adapted from the Beliefs about Medicines questionnaire (BMQ), a widely used and validated questionnaire that identifies individual’s beliefs about treatment.	Participants selected via an online survey platform	This is the first study to show that a brief, personalised online intervention can influence patient perceptions about antibiotics and AMR related with inappropriate demand. This has implications for future efforts aimed at reducing antibiotic overuse.
Aston University’s Antimicrobial Resistance (AMR) Roadshow: Raising awareness and embedding knowledge of AMR in key stage 4 learners	United Kingdom	Before and after study without no control group (pre–post)	To develop an interactive collection of workshops at Aston University (Birmingham, UK), which offered Learning Outside the Classroom (LOtC) to Key Stage 4 KS4 ages (14–16) students with the aim of raising awareness and understanding of AMR.	Student questionnaire responses relating to knowledge and understanding of AMR through Likert Scale and Multiple-Choice Type Questions (MCQs) questions over time.	Authors attached video link on YouTube	* The level of pre-existing knowledge and awareness about antibiotics and AMR among the KS4 academy cohort differed significantly. * Findings show that young learners are aware of core AMR issues such as MRSA (Methicillin Resistant Staphylococcus aureus) and the significance of handwashing, but they are less knowledgeable of ‘how’ to correctly wash hands or ‘how’ AMR occurs. Many students believed that ‘people’ become resistant to antibiotics, which is a frequent misunderstanding, and were unaware of the possible utility of natural medicines, such as Manuka Honey, in infection therapy.
Effect of didactic educational intervention on improving knowledge of antibiotics use and resistance in Yogyakarta Community	Indonesia	Quasi-experimental study	To see how effective a pharmacist-led educational intervention is at promoting appropriate antibiotic usage and reducing antibiotic self-medication.	A quantitative study: a total of 268 participants would answer. Pre and 2 weeks post questionnaire that would reflect their knowledge on antibiotics use and resistance.	Social media was not used	The educational intervention, initiated by pharmacists, positively improved the public’s knowledge and practice regarding antibiotics use in Yogyakarta.
Impact of community-based educational intervention on antibiotic use and resistance awareness among the people living in Ras Al Khaimah, United Arab Emirates	Ras Al Khaimah, United Arab Emirates	Pre-test–post-test experimental design	A community-based interventional study was conducted among 100 people. The World Health Organization’s antibiotic resistance: multi-country public awareness survey was used to assess pre-intervention awareness of antibiotics and antibiotic resistance. Following the baseline knowledge assessment, the study participants were provided an educational intervention. After four weeks, the same questionnaire was utilised to assess the impact of the intervention.	To explore the usefulness of a community-based educational intervention in raising awareness about AMR a pre and post questionnaire was given to the participants.	Social media was not used	Antibiotic-related awareness improved dramatically after the intervention. More efforts should be taken to ensure that this increased awareness is translated into long-term health behaviour changes.
The effect of public health educational campaign regarding antibiotic use and microbial resistance on knowledge, attitude, and practice in Iran	Iran	Quasi-experimental study	Antibiotic resistance messaging crafted and designed which included clear and appealing imagery as well as cultural components throughout campaign regions to capture people’s attention. Five specialists were stationed at the sites after collecting data in the target locations (busy places in the city). Two banners with relevant educational material were put in each area’s principal squares. Over 2000 people visited the booths and received training over the course of a week. In public transportation such as buses and subways, posters with eight distinct educational elements were displayed. Furthermore, the campaign’s messages were broadcast on television to people with a variety of tastes and levels of access in various places.	To assess people living in Esfahan’s knowledge, attitudes, and practices about antibiotic resistance, as well as the impact of educational interventions.	Social media was not used; however, traditional mass media marketing channels such as TV were used which helped in reach a wider audience	The main results of this study demonstrated that after the educational campaign, people’s awareness of antibiotic resistance increased.
Using debate to educate young people in schools about antibiotic use and resistance: A before and after evaluation using a questionnaire survey	England	Before and after evaluation using a questionnaire survey	The purpose of this study was to see if the debate kit could improve secondary school students’ (aged 13–16 years) knowledge and understanding of antibiotics and antibiotic resistance.	To assess the increase in knowledge and awareness of antibiotic and antibiotic resistance, students were asked to complete a questionnaire before the lesson began and again immediately after the lesson.	Social media was not used	The findings indicate that the e-Bug antibiotic resistant debate kit can help young people gain a better understanding of antibiotics and antibiotic resistance. Furthermore, kids enjoyed the lesson; thus, this resource should be offered to instructors and schools more extensively.
The Consequences of AMR Education and Awareness Raising: Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR	Thailand	Educational activity assessed through census survey data	To assess a half-day educational activity that interspersed two rounds of complete census surveys, in two peri-urban villages, near a district capital city in Salavan.	To inform the awareness agenda from a social sciences perspective by assessing the outputs, outcomes, and behavioural impacts of an AMR-themed educational activity in the low-income setting through a survey.	Social media was not used	Participants’ awareness and understanding of “drug resistance” were influenced by the educational exercise, although the effects on attitudes were small. The evidence on behavioural effects was limited, but one likely outcome was a disproportionate uptake of antibiotics through professional healthcare practitioners.
Educational intervention to enhance adherence to short-term use of antibiotics	Malta	Randomised controlled trial	To check if a community pharmacist intervention accompanied by an educational leaflet improves adherence and lowers costs in terms of unused antibiotics among patients taking short-term antibiotics in the community, and to see if there is a link between adherence to short-term antibiotics and patients’ general beliefs about medicines.	Patients were asked to count the amount of leftover antibiotic tablets/capsules from the current course, and if any were left, they were termed non-adherent and questioned about why they had leftover antibiotics. Patients were also asked the name and quantity of any leftover antibiotics from past courses that they had at home, as well as the reasons for these unused antibiotics.	Social media was not used	Adherence to prescribed short-term antibiotics has improved dramatically, and waste has decreased as a result of an educational intervention. When distributing medications, telling patients about antibiotic resistance can help them stay on track with their treatment. Taking into account patients’ perceptions is another essential strategy for identifying patients who require additional assistance with antibiotic adherence.
Can Gaming Increase Antibiotic Awareness in Children? A Mixed-Methods Approach	United Kingdom	A mixed methodological approach—questionnaire and focus group	Students aged 9–11 years in primary schools and summer schools in the Bristol and Gloucestershire area played 3 e-Bug games for a total of 15 min. They completed a before and after questionnaire. Further, 48 students took part in 6 focus groups and think-aloud sessions with 4 students were conducted who played the game.	Measuring the change in knowledge after playing the 3 games. Students’ suggestions were also taken to improve the e-Bug games on the website.	Social media was not used	Two games had a significant impact on the knowledge levels of students post intervention. The engagement rate was also higher during the two games.
A mixed-method evolution of peer-education workshops for school- aged children to teach about antibiotics, microbes and hygiene	England	Mixed Methods (Quantitative: before and after + Qualitative: Interviews)	Students attended a science show which consisted of 5 stands covering the topics of microbes, hand hygiene, respiratory hygiene, food hygiene, and antibiotics.	Measurement of knowledge gained about hygiene, the spread of infection, and antibiotics through questionnaire, focus groups, and interviews.	Social media was not used	The study found peer education to be an effective tool for educating students about antibiotics and hygiene.
A literacy-sensitive approach to improving antibiotic understanding in a community-based setting	USA	A pilot pre-test post-test feasibility study	A 30 min live educational seminar about appropriate antibiotic use was showed to the participants. A USD 10 reward was given after completing the pre-test, attending the seminar, and completing the post-test questionnaire, to the participants.	Measurement change in knowledge through a questionnaire.	Social media was not used	The study found the educational seminar to be an effective tool to educate community participants about antibiotics and their role in antibiotic stewardship.