The ESRC, in partnership with the National Institute for Health Research (NIHR), Arts and Humanities Research Council (AHRC), the Medical Research Council (MRC), the Department for Environment, Food and Rural Affairs (Defra) and the Veterinary Medicines Directorate (VMD) have supported the following Theme 4 research projects on the topic of behaviour relating to antimicrobial resistance (AMR).

Collaborative grants:

• Diagnostic innovation and livestock (DIAL): towards more effective and sustainable applications of antibiotics in livestock farming
  Principal Investigator: Professor Henry Buller, University of Exeter

• STEP-UP (Improving the uptake and SusTainability of Effective interventions to promote Prudent antibiotic Use in Primary care)
  Principal Investigator: Professor Ann Sarah Walker, University of Oxford
  
  STEP-UP aims to accelerate the uptake and maximise the sustainability of interventions to reduce antibiotic prescribing in primary care that previous research has already shown to be effective. The ultimate goal is achieving year-on-year overall reductions in unnecessary antibiotic prescribing in primary care in England over the next decade, and hence consequent reductions in antimicrobial resistance. We will do this by investigating two specific questions: “Why are we not using interventions we know to be effective in general clinical practice?” “How can we improve their uptake and sustainability?”. We will conduct studies in four exemplar areas, chosen to provide a diverse range of contexts with interventions targeted at organisational, inter-personal and individual levels, involving healthcare-commissioners, primary care clinicians, general practices and patients in England.

• Understanding and improving antimicrobial prescribing in care homes: a multidisciplinary approach
  Principal Investigator: Dr Charis Marwick, University of Dundee
  
  We will systemically examine social, cultural and behavioural determinants of antimicrobial use in care homes to inform development and optimisation of an intervention to safely reduce antimicrobial use, through novel multidisciplinary collaboration including epidemiology, sociology, social anthropology, behavioural health psychology, and implementation science.
  
  
• Anti-Microbials In Society (AMIS): a Global Interdisciplinary Research Hub
  Principal Investigator: Dr Clare Chandler, London School of Hygiene and Tropical Medicine

• Optimising antibiotic use along surgical pathways: addressing antimicrobial resistance and improving clinical outcomes
  Principal Investigator: Professor Alison Holmes, Imperial College London

• Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: a whole systems approach
  Principal Investigator: Professor Alison Grant, London School of Hygiene and Tropical Medicine 

• Preserving Antibiotics through Safe Stewardship: PASS
  Principal Investigator: Professor Andrew Hayward, University College London 

Pump-priming grants:

• Production without medicalisation: a pilot intervention in global protein production
  Principal Investigator: Professor Steve Hinchliffe, University of Exeter

• Community dialogues for preventing and controlling antibiotic resistance in Bangladesh
  Principal Investigator: Dr Rebecca King, University of Leeds

• Determinants of antibiotic prescribing in primary care in South Africa: studying patient-provider interactions in the private and public sectors
  Principal Investigator: Dr Mylene Lagarde, London School of Economics & Political Science

• Supporting Evidence-Based Policy: a longitudinal study of AMR risk behaviours among livestock keeping communities in India and Kenya
  Principal Investigator: Professor Claire Heffernan, University of Bristol

• Animal Husbandry, Prescribing Practices and the Control of Veterinary Medicines and AMR in Colombia's 'Livestock Revolution'
  Principal Investigator: Professor David Demeritt, King's College London

• Infection Prevention and Control and Antibiotic Stewardship to Avert Antibiotic Resistance in High-Risk Populations from Resource-Poor Settings
  Principal Investigator: Professor Mike English, University of Oxford

• GADSA: gamified Antimicrobial Stewardship (AMS) decision support app for prescribing behaviour change
  Principal Investigator: Dr Patty Kostkova, University College London

• Who gets what and when? Pathways of antibiotic use among people and animals in Bangladesh
  Principal Investigator: Dr Emily Rousham, Loughborough University

• Antibiotics and Activity Spaces: An Exploratory Study of Behaviour, Marginalisation, and Knowledge Diffusion
  Principal Investigator: Dr Marco Haenssgen, University of Oxford
  
  Our study aims to improve the understanding of patients’ antibiotic-related behaviour to support creative thinking about targeted and unconventional antimicrobial resistance (AMR) interventions in low- and middle-income countries (LMICs). We thereby explore three research questions:
  

  1) What are the manifestations and determinants of problematic antibiotic use in patients’ healthcare-seeking pathways?

  2) Will people’s exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices?

  3) Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?

  By surveying 4,800 villagers in Thailand and Lao PDR, we will be able to generate innovative and unprecedentedly detailed open-access survey data on antibiotic-related behaviour and its social, economic, and spatial determinants. As part of our capacity-building activities, we are also hosting placement students from the MSc International Health and Tropical Medicine (University of Oxford) and offer research internships for local candidates from Southeast Asia.

• Antimicrobial resistance as a social dilemma: Approaches to reducing broad-spectrum antibiotic use in acute medical patients internationally
  Principal Investigator: Dr Carolyn Tarrant, University of Leicester
  
  Adopting an international and interdisciplinary approach to tackling antimicrobial resistance, this 2-year project aims to investigate and compare antibiotic prescribing across the UK, Sri Lanka and South Africa. The project team comprises a diverse range of social scientists, microbiologists and medical doctors. Across all three project countries, we are planning to investigate barriers to appropriate antibiotic prescribing for acute medical patients in public and private hospitals. Semi-structured interviews with physicians will focus on the use of broad-spectrum antibiotics, which target a wide range of pathogens but are a strong driver of antimicrobial resistance, and narrow-spectrum antibiotics, which target a small range of pathogens but have a lesser effect on antimicrobial resistance. The results will be contextualised within a framework of social science theories (game theory; principal-agent theory) by comparing the medical decision context to a social dilemma situation. In such a situation, the interests of society—i.e., limited use of (broad-spectrum) antibiotics to maintain antibiotic effectiveness—are in conflict with those of the individual patient—i.e., generous use of (broad-spectrum) antibiotics to reduce the risk of treatment complications. Finally, the project aims to use agent-based modelling techniques to simulate the prescribing dilemma and make predictions about future developments as well as the likely effectiveness of targeted interventions.

• Corporate food retailers, meat supply chains and the responsibilities of tackling antimicrobial resistance (AMR)
  Principal Investigator: Dr Alex Hughes, Newcastle University
  
  Our project on 'Corporate food retailers, meat supply chains and the responsibilities of tackling AMR' makes a contribution to the agenda for tackling antimicrobial resistance (AMR) by focusing scoping research and networking events on a link that has so far been missing from academic and policy debate - the pivotal role of corporate food retailers. The aim of the project is to address the responsibility of retailers in tackling the AMR challenge in the context of their chicken and pork supply chains, and to investigate this evolving role and how it might be shaped in the future, in the UK and at a global scale. It is becoming clearer that while antimicrobials are a necessary tool to maintain health and welfare on the farm, the key issue is their inappropriate and disproportionate use in animals thereby reducing availability for humans. Our current, UK-focused project is in the early stages. Future research might explore more global dimensions of retailers’ roles.
  
  
• How do policymaker perceptions of antimicrobial resistance drive behaviour and policies for appropriate antimicrobial use? A case study of Pakistan
  Principal Investigator: Dr Johanna Hanefeld, London School of Hygiene and Tropical Medicine