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Luedtke S, Wood C, Olufemi O, Okonji P, Kpokiri EE, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa A, Ekumankama C, Theophilus A, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Birjovanu G, Lefevre C, Petrou S, Ogunsola F, Kostkova P. Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study. Antimicrob Resist Infect Control 2023; 12:141. [PMID: 38053212 PMCID: PMC10699010 DOI: 10.1186/s13756-023-01342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.
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Affiliation(s)
- Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Caroline Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chibuzo Ekumankama
- Department of Ophthalmology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ayibanoah Theophilus
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Infectious Diseases Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Stylianos Petrou
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
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Wood CE, Luedtke S, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa AO, Ekumankama CB, Ogunsola F, Okonji P, Kpokiri EE, Ayibanoah T, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Soriano D, Birjovanu G, Lefevre C, Olufemi O, Kostkova P. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac044. [PMID: 35445194 PMCID: PMC9015911 DOI: 10.1093/jacamr/dlac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.
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Affiliation(s)
- Caroline E. Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
- Corresponding author. E-mail: ; @PattyKostkova, @UCL_dPHE, @AnwarMusahAM, @LASUOfficial, @UnilagNigeria, @ekpoks, @suluedt, @DrCaroline_Wood
| | - Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Oludotun Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Folasade Ogunsola
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E. Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Theophilus Ayibanoah
- Department of Pharmacy, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Delphine Soriano
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, London, UK
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