Banks, Duncan

Charitonos, Koula

Giri, Santoshi

Langdridge, Darren

McMullan, Rachel

Olupot-Olupot, Peter

Vaidya, Abhinav

Virhia, Jennika

Open Research Online (The Open University)

PROSPEROInternational prospective register of systematic reviews Work-based learning interventions for antimicrobial stewardship: a systematic review CitationDarren Langdridge, Rachel McMullan, Jennika Virhia, Duncan Banks, Koula Charitonos, Santoshi Giri, Peter Olupot-Olupot, Abhinav Vaidya. Work-based learning interventions for antimicrobial stewardship: a systematic review.PROSPERO 2023 CRD42023447115 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023447115 Review questionThe aim of the review is to provide the best quality evidence regarding the effectiveness of post-qualification work-based learning interventions designed to improve antimicrobial stewardship (AMS). AMS improvement is to beidentified but likely to include increased knowledge, greater awareness, and changed behaviour. The specific objectives are to assess:(1) The nature and scope of extant post-qualification work-based learning interventions designed to improve AMS(2) How effectiveness is operationalised (as e.g., greater awareness, increased knowledge, changed behaviour)(3) The effectiveness of post-qualification work-based learning education interventions on target stewardship outcomes(4) Whether technology-supported learning interventions are effective in improving AMSThe review will address the following research questions:(1) What educational resources are used in post-qualification, work-based education for AMS?(2) How is antimicrobial stewardship conceptualised and measured?(3) Are there discernible patterns of post-qualification work-based learning interventions associated with effectiveness?(4) Is there any evidence of the value of technology-supported educational interventions? SearchesSearches will be conducted in three stages:1. Electronic databases will be searched for published work. The following databases will be searched: CINAHL;Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; MEDLINE (via PubMed); PsycINFO; Scopus;Web of Science (SSCI).The specifications of the electronic search will involve controlled vocabulary (e.g., MeSH or indexing terms) and searchstrategies will be tailored for each database.2. Trials registers will be searched for ongoing and recently completed trials.3. Reference lists of published studies will be searched, and citation searches of key studies and any other reviews will beconducted. Google Scholar will be added at this stage of the search process as an additional check. Authors of included studies will be contacted for further information where necessary (for example, missing data,training manuals, intervention manuals, detailed descriptions, fidelity measures). Time period - 2013 – 2023 and publication in English only. Searches will be re-run prior to final analysis and any further studies identified, retrieved for inclusion.                               Page: 1 / 6PROSPEROInternational prospective register of systematic reviews Types of study to be includedThe review will consider a range of experimental designs, including, but not limited to, randomised trials, interruptedtime series studies and quasi-experimental designs such as non-randomised trials, controlled before and after studies.Because this review aims to provide the best quality evidence regarding the effectiveness of antimicrobial interventionsto enhance professional learning, study designs listed above will be prioritised. Non-controlled before and after studieswill potentially be included in the review depending on search results and the number of relevant studies. Qualitative studies will also be examined where part of the programmatic work separately tests effects of post-qualification work-based learning interventions.Thus, final decision regarding inclusion of this design in the review will be made following the search. Condition or domain being studiedAntimicrobial stewardship Participants/populationThe review will consider all studies that target professionals in receipt of post-qualification work-based learninginterventions.  Intervention(s), exposure(s)The review will consider all post-qualification work-based learning interventions designed to improve antimicrobialstewardship for human health. This will include educational interventions whether combined with other interventioncomponents or not. If combined with other interventions, there must be a clear mechanism of evaluation of theeducational component alone. To be included, studies must include an educational intervention described in sufficientdetail to ascertain mode of delivery and outcome.  Comparator(s)/controlThe review will consider all studies with any of the following control conditions:• Time bound or geographical controls• No exposure ContextStudies concerned with post-qualification work-based learning to improve AMS in relation to human health.  Main outcome(s)The review will consider all studies which have relevant short, medium or long-term outcomes related to antimicrobialstewardship behaviours, including but not limited to:(1) Knowledge/awareness of antimicrobial resistance.(2) Learning - antimicrobial resistance knowledge; antimicrobial skills; antimicrobial health literacy.(3) Changed behaviour – prescribing practice; lab processes.                               Page: 2 / 6PROSPEROInternational prospective register of systematic reviews Additional outcome(s)The review will consider unanticipated or negative consequences of interventions designed to improve antimicrobialstewardship among professionals (such as, but not limited to: resistance to compulsory education, clashes with existingsetting practice, cross-cultural tensions; loss of autonomy; fear of withholding antimicrobials; disagreement withguidelines). Data extraction (selection and coding)Inclusion and exclusion criteria will be applied successively to titles and abstracts. Full reports will be obtained for thosestudies that appear to meet the criteria or where there is insufficient information from the title and abstract. Screening oftitles and abstract and full texts will then be performed by a reviewer with assistance from other team members.Decisions will be double-checked. A third reviewer will be asked to resolve any discrepancies where consensus cannot bereached between the two reviewers at this stage. Covidence will be used to record decisions. A standardised framework will be devised for data extraction. This framework will be applied to all full text papers thatfulfil the eligibility criteria. The following data will be extracted:• Study design: trial design and quality, data collection methods, modes and techniques, validity of tools, adherence toprotocol (attempts will be made to retrieve protocols from searches, including by contacting the authors), statistical andother analyses.• Participants (intervention and control): demographic characteristics (e.g., age, ethnicity); target learner group.• Intervention: purpose and aim of intervention; setting and recruitment methods, components of the intervention, detailsof modes of delivery (e.g., use of educational technology) and any other aspects of content, frequency, intensity andduration of the intervention, educational framework employed in intervention design; any concomitant interventionsincluded in the study.• Outcomes: all short, medium and long-term outcomes (described above). Data extraction will be conducted by oneindependent reviewer and checked by a second reviewer. Any discrepancies will be resolved through discussion betweenthe two reviewers or by adjudication by a third reviewer when necessary.A minimum of two requests will be made to study authors for any missing data and intervention materials. Risk of bias (quality) assessmentThe risk of bias in individual studies will be assessed by one reviewer and checked by a second reviewer using standardEPOC risk of bias criteria (EPOC, 2015). Any disagreements will be subject to checks from a third reviewer. Eligible studies will not be excluded based on the quality assessment, but the strengths and limitations of the evidencebase will be highlighted in a narrative discussion. Strategy for data synthesisIndividual study characteristics and outcomes will be summarised and presented in an evidence table. The study willidentify and summarise the existing evidence on post-qualification work-based learning interventions designed toimprove AMS among professionals working in human health.A narrative synthesis will be employed due to the likelihood of different types of interventions being deployed in theincluded studies. A narrative synthesis is the most appropriate mode of synthesis because, with the broad inclusioncriteria of the study designs, there will likely be high levels of heterogeneity resulting from variations in the definitions,measures, sample designs, modes of data collection, time of data collection, and populations. Due to this, Popay’s four-stage framework will be used to increase the robustness, transparency, and consistency of the narrative synthesis process(Popay et al., 2006). This involves summarizing and organizing the extracted data thematically, identifying patterns, andexploring relationships between different factors. This synthesis approach will provide a coherent and comprehensive                               Page: 3 / 6PROSPEROInternational prospective register of systematic reviewsunderstanding of the key factors within the literature.We shall adopt the analytic strategy of Price et al., (2018). As such, studies will be grouped into those meeting or notmeeting the EPOC criteria and categorized according to the target population. In order to identify patterns ofeffectiveness, identified studies will be mapped across five categories of intervention effectiveness. In addition, if sufficient interventions are suitable and materials are made available, intervention descriptions andmaterials will be systematically analysed for their affective components following the method developed by ProfessorLangdridge (Langdridge et al., 2019; Langdridge et al., 2021). References:Langdridge, D., et al., (2019). The effectiveness of interventions to increase antimicrobial stewardship: a visual affectiveanalysis. British Journal of Health Psychology, 24, 66-87.Langdridge, D., et al., (2021). A qualitative examination of affect and ideology within mass media interventions toincrease HIV testing with gay men garnered from a systematic review. British Journal of Health Psychology, 26(1),132-160.Popay et al., (2006). Guidance on the conduct of narrative synthesis in systematic reviews. ESRC Methods Programme. Price L., et al., (2018). Effectiveness of interventions to improve the public’s antimicrobial resistance awareness andbehaviours associated with prudent use of antimicrobials: a systematic review. Journal of Antimicrobial Chemotherapy,73(6), 1464-1478. Analysis of subgroups or subsetsDependent on availability of data, the following subgroups will be considered for separate analysis using the strategydescribed above: interventions delivered in low- and middle-income countries (LMICs); technology supported learninginterventions.  Contact details for further informationDarren Langdridgedarren.langdridge@open.ac.uk Organisational affiliation of the reviewThe Open University Review team members and their organisational affiliationsProfessor Darren Langdridge. The Open UniversityDr Rachel McMullan. The Open UniversityDr Jennika Virhia. The Open UniversityDr Duncan Banks. The Open UniversityDr Koula Charitonos. The Open UniversityMs Santoshi Giri. Nepal Public Health Research Development CenterProfessor Peter Olupot-Olupot. Mbale Clinical Research InstituteProfessor Abhinav Vaidya. Kathmandu Medical College Type and method of review                               Page: 4 / 6PROSPEROInternational prospective register of systematic reviewsNarrative synthesis, Systematic review Anticipated or actual start date02 August 2023 Anticipated completion date22 December 2023 Funding sources/sponsorsThe Open Societal Challenges (OSC) Fund, The Open University, Walton Hall, Milton Keynes, MK7 6AAGrant number(s)State the funder, grant or award number and the date of awardThe Open Societal Challenges (OSC) Fund, The Open University, Walton Hall, Milton Keynes, MK7 6AA Conflicts of interest LanguageEnglish CountryEngland Stage of reviewReview Ongoing Subject index terms statusSubject indexing assigned by CRD Subject index termsMeSH headings have not been applied to this record Date of registration in PROSPERO24 July 2023 Date of first submission20 July 2023                                Page: 5 / 6PROSPEROInternational prospective register of systematic reviewsStage of review at time of this submissionThe review has not started Stage Started CompletedPreliminary searches No NoPiloting of the study selection process No NoFormal screening of search results against eligibility criteria No NoData extraction No NoRisk of bias (quality) assessment No NoData analysis No NoThe record owner confirms that the information they have supplied for this submission is accurate and complete and theyunderstand that deliberate provision of inaccurate information or omission of data may be construed as scientificmisconduct.The record owner confirms that they will update the status of the review when it is completed and will add publicationdetails in due course. 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Work-based learning interventions for antimicrobial stewardship: a systematic review

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Work-based learning interventions for antimicrobial stewardship: a systematic review

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