Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Area of Science:

• Public Health
• Behavioral Science
• Infectious Disease Epidemiology

Background:

• Antimicrobial resistance (AMR) is a critical global health issue, worsened by improper antimicrobial drug use, especially in low-resource nations like Uganda.
• Inappropriate antimicrobial prescribing practices in Ugandan hospitals contribute significantly to the AMR crisis.

Purpose of the Study:

• To develop and evaluate a culturally sensitive behavioral intervention using a "nudge" strategy to enhance healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016).
• To assess the impact of behavioral nudges on antimicrobial prescribing practices within five Ugandan hospitals as part of broader antimicrobial stewardship efforts.

Main Methods:

• A mixed-methods approach combining formative research (key informant interviews) and a behavioral intervention.
• Interventions included perceived monitoring, ward leaderboards, and educational workshops, guided by the Deloitte Behavioral Insights Framework.
• Impact was evaluated using World Health Organization (WHO) point prevalence surveys (PPS) at pre-intervention, immediate post-intervention, and one-month post-intervention stages.

Main Results:

• The behavioral intervention package significantly increased compliance with UCG 2016 for antimicrobial prescriptions from 27% at baseline to 50% immediately post-intervention.
• The positive effect on adherence diminished by the one-month follow-up assessment.

Conclusions:

• Behavioral nudges offer a feasible, cost-effective, and sustainable strategy for improving antimicrobial prescribing and combating AMR in low- and middle-income countries.
• While immediate improvements in adherence were observed, the attenuation of effects at one-month follow-up indicates a need for sustained or adapted interventions.