As part of the 2014 European Antibiotic Awareness Day, an online pledge system was launched in the UK to increase people’s commitment to reduce Anti-microbial Resistance (AMR).The aim of this evaluation was to determine whether the Antibiotic Guardian (AG) campaign improved AMR awareness and behaviour.

1. Evaluation of the Antibiotic Guardian
(AG) campaign
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope
The National Institute for Health
Research Health Protection Research
Unit in Evaluation of Interventions at
University of Bristol
Katerina Chaintarli, DVM, MSc

2. Background-Aims
• Aim of European Antibiotic Awareness Day (EAAD): Raise awareness
towards antibiotic use
• England has participated in EAAD activities since 2008
• UK EAAD 2014:
• Move from raising awareness to increasing engagement and changing behaviour
• Public Health England developed the Antibiotic Guardian campaign available all
year round
online pledge system
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

3. Pledge system (http://antibioticguardian.com)
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

4. Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

5. Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

6. Background-Aims
• Purpose of Antibiotic Guardian (AG) campaign:
• Increase engagement with the rising threat of Antimicrobial Resistance (AMR)
• Concrete personal and collective action to help keep antibiotics active
• Provide a system to measure behaviour change
• First example of online pledge system to improve AMR related knowledge
and behaviour amongst healthcare professionals and the general public
• Aim of current evaluation: assess whether the AG achieved its goals
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

7. Methods - Questionnaire
• Online questionnaire: Evaluation of the Antibiotic Guardian campaign
2014
• Sent via e-mail to 9016 out of all 11833 Antibiotic Guardians who consented
for follow up (3rd of February 2015)
• Survey included questions on:
• Type of pledge & Motivation
• Change in behaviour (acting according to pledge)
• Knowledge acquired
• Clarity of promotion materials
• Demographics (age, sex, health-related profession, use of social media)
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

8. Methods – Statistical Analysis
• Distribution of demographic variables
• Questions analysed as the outcomes of interest:
• Change in behaviour: “Since you became an Antibiotic Guardian, have you acted
in line with your pledge?” (categorical)
• Change in knowledge: “After becoming an Antibiotic Guardian, do you feel that
you have acquired more knowledge on what antibiotic resistance is?” (binary)
• Promotion of the AG campaign: “Indicate your agreement with the statement: “I
think the AG campaign is well promoted” (categorical)
• Logistic and Ordinal Logistic regression models, adjusted for age, sex
and pledge group used to estimate associations
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

9. Results - Respondents
• 2478 AGs responded: 27.5% response rate
• 1696 pledged as healthcare professionals (68%)
• 782 pledged as members of public (32%)
↓
similar to proportions at total population of 11,833 AGs
• 76.9% were connected to the healthcare system
• 96.3% had prior knowledge of AMR
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

10. Results - Demographics
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope
• 73.5% female
• 27.5% 45-54
years old

11. Results - Behaviour
• 43.9% remembered completely the meaning of their pledge
• 63.4% reported always acting according to their pledge
• Members of public more likely to act according to their pledge than
healthcare professionals (OR=3.60, CI: 2.88-4.51)
• Respondents without positive pre-campaign pledge behaviour less likely to
have positive post campaign pledge behaviour (OR=0.23, CI: 0.16-0.34)
• AGs that remembered the pledge more likely to have positive post
campaign behaviour (OR=1.96, CI: 1.63-2.36)
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

12. Results - Knowledge
• 44.5% acquired more knowledge about AMR post campaign
• Sense of personal responsibility towards tackling AMR increased by
12.2% post campaign
• People confused about AMR prior to the AG campaign acquired more
knowledge after the campaign (OR =3.10, CI: 1.36 – 7.09)
• Respondents without pre-campaign knowledge more likely to acquire
knowledge on AMR post campaign (OR=4.21, CI: 2.04 – 8.67)
• Members of the public less likely to have acquired more knowledge post
campaign than healthcare professionals (OR= 0.79, CI: 0.66 – 0.96)
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

13. Results - Promotion
• 61.7% agreed to different extents that the AG campaign was well
promoted
• 56.7% seemed to think that the website itself was the best source of
information
but
more than half of AGs have not seen most promotion materials
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

14. Conclusion
• Good response of an overall representative sample in terms of proportions
of different pledge groups
• Effective in achieving positive changes in behaviour and an increase in
knowledge amongst people with prior awareness of the topic
• Less successful in engaging people without previous professional or
personal experience of AMR
• Majority thought the campaign was well promoted but most materials were
not seen
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

15. Recommendations
• Regular communication with pledgees via e-mails or newsletters to
remind their pledge and provide information
• Engage wider members of public → initiatives for alternative promotion
methods to get the public aware and engaged with the campaign
• Evaluations should be built into the design of future campaigns → capture
pre and post campaign effects
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

16. Next steps
• Qualitative methods applied to explore the results from the quantitative
analysis
Qualitative interview study will seek to identify how the AG campaign was engaged
with and the mechanisms of impact from the perspective of those who became AG
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope

17. Thank you
Acknowledgements
•Public Health England, AMRs and HCAI Programme Team, London: Dr Diane Ashiru-Oredope, Alex
Bhattacharya
•Public Health England, Field Epidemiology Services, Bristol: Dr Maya Gobin, Dr Isabel Oliver
•Health Protection Research Unit in Evaluation of Interventions, School of Social and Community
Medicine, University of Bristol: Dr Suzanne M. Ingle
The study was supported by the NIHR Health Protection Research Unit in Evaluation of Interventions. The views expressed are
those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.
Combating AMR (CPC Conference) Dr Diane Ashiru-Oredope