GADSA: gamified Antimicrobial Stewardship (AMS) decision support app for prescribing behaviour change
Lead Research Organisation:
University College London
Department Name: Institute for Risk and Disaster Reductio
Abstract
Antimicrobial resistance is a global problem. Implementing appropriate antimicrobial prescribing policies and stewardship in clinical and community healthcare settings is one of the powerful ways to reduce antibiotics overuse. This is of great importance in Nigeria and other Low and Middle Income countries (LMIC) where clinical practice is less regulated. In these countries, due to resource constraints, a widespread over the counter availability of antibiotics and counterfeits create a very challenging environment for implementing antimicrobial stewardship. The Infection Control Africa Network (ICAN), with 28 African member states, has launched the Antimicrobial Stewardship Education Initiative in July 2016 to tackle this issue across the continent.
The aim of this interdisciplinary project is to investigate the use of gamified apps on mobile phones and tablets for changing prescription rates through improving compliance with prudent antimicrobial prescription policies, supporting professionals in prescription decision making around three key conditions (urinary tract infections, single dose surgical prophylaxis and upper respiratory track infections). Based on previous study with ICAN and the international Infection Control Resource (iNRIC, www.nric,org,uk) delivering policies and guidance to infection professionals at the point of care, it was identified that African experts preferred accessing policies in a graphical gamified format over their mobile devices compared to text-based guidelines.
The app will be co-authored and developed jointly with healthcare professionals from two settings (national teaching hospital in Lagos and a community hospital) and evaluated to assess usability and prescribing behaviour change over a period of 3 months. The cutting edge game-based training technology will enable a customisation support to localize the gamified app to new settings by healthcare professionals themselves. This pilot will demonstrate a new innovation approach with a potential to be cost-effectively scaled up and expanded to cover other AMS policies and settings to support professionals across ICAN member states across the African continent.
Our multi-disciplinary team, consisting of computer scientists, epidemiologiest, infection control experts , and a behavioural scientist is ideally placed to develop an app based AMS intervention. We have expertise in app development, AMS guideline translation, and behaviour change, ideally placing us to deliver the proposed programme of work. Moreover, we will co-design our app with users in Nigeria, utilising our existing partnership with ICAN and The College of Medicine of the University of Lagos - affiliated to the national Lagos University Teaching Hospital (LUTH) and regional Obafemi Awolowo University hospital.
The aim of this interdisciplinary project is to investigate the use of gamified apps on mobile phones and tablets for changing prescription rates through improving compliance with prudent antimicrobial prescription policies, supporting professionals in prescription decision making around three key conditions (urinary tract infections, single dose surgical prophylaxis and upper respiratory track infections). Based on previous study with ICAN and the international Infection Control Resource (iNRIC, www.nric,org,uk) delivering policies and guidance to infection professionals at the point of care, it was identified that African experts preferred accessing policies in a graphical gamified format over their mobile devices compared to text-based guidelines.
The app will be co-authored and developed jointly with healthcare professionals from two settings (national teaching hospital in Lagos and a community hospital) and evaluated to assess usability and prescribing behaviour change over a period of 3 months. The cutting edge game-based training technology will enable a customisation support to localize the gamified app to new settings by healthcare professionals themselves. This pilot will demonstrate a new innovation approach with a potential to be cost-effectively scaled up and expanded to cover other AMS policies and settings to support professionals across ICAN member states across the African continent.
Our multi-disciplinary team, consisting of computer scientists, epidemiologiest, infection control experts , and a behavioural scientist is ideally placed to develop an app based AMS intervention. We have expertise in app development, AMS guideline translation, and behaviour change, ideally placing us to deliver the proposed programme of work. Moreover, we will co-design our app with users in Nigeria, utilising our existing partnership with ICAN and The College of Medicine of the University of Lagos - affiliated to the national Lagos University Teaching Hospital (LUTH) and regional Obafemi Awolowo University hospital.
Planned Impact
Who will benefit from this research?
The research community around AMS, infection control, epidemiology, digital health, game-based training, behaviour change, evidence-based policy dissemination, update and compliance, surveillance and prescribing.
Patients will benefit directly by reducing their stay in hospitals, cost of care, cost of prescription enabling improved health outcomes.
How will they benefit from the research?
While the focus of this project is on Nigeria and our app will be developed / co-authored with local experts, the research is ultimately scalable across LMIC countries. We will develop a novel cutting edge customisation of the app design making it possible to localise the policy and artwork, language to your needs. This will pilot a long terms sustainable solution.
We will be also empower local professionals in terms of healthcare training and involvement in the design and co-authoring of the technology.
We will strengthen professional collaboration between the UK and Africa in a strategic domain of AMS and infection and aim to change prescription behaviour.
Long-term will be aim to change the rates of antibiotics prescribing
What will be done to ensure that they have the opportunity to benefit?
We will work very closely with the Nigerian team and with the volunteers conducting the evaluation. Will be use multiple channels to engage and raise awareness - iNRIC portal and app, eNewsletter, ICAN newsletter, ICAN 2018 Workshop to present the app, and other networks affiliated with iNRIC.
Academic publications in interdisciplinary conferences (ACM Digital Health, IFIC, ICAN, IPC, ECCMID, FIS, ESCAIDE, SEGAD, CBC, Foundation of Digital Games, Games for Health etc ) and journals (e.g. Frontiers in Digital Health, BJIC, Lancet, IJIC, JMIR, JAMIA, JAC, etc).
Most importantly, beyond this pilot project we have a long-term plan: with ICAN we plan to apply for strategic funding to expand the development of the app, cover a wider selection of AMS policies and deploy these in multiple countries. We plan to run a cluster randomised RCT to evaluate their effectiveness in changing AMS practise and prescribing behaviour. Linking the app to the hospital prescription system would be another step enabling direct e-prescribing at the point of care and seamless cost effective surveillance. This is a highly impactful project with the potential to reduce prescribing across Africa over the next decade!
The research community around AMS, infection control, epidemiology, digital health, game-based training, behaviour change, evidence-based policy dissemination, update and compliance, surveillance and prescribing.
Patients will benefit directly by reducing their stay in hospitals, cost of care, cost of prescription enabling improved health outcomes.
How will they benefit from the research?
While the focus of this project is on Nigeria and our app will be developed / co-authored with local experts, the research is ultimately scalable across LMIC countries. We will develop a novel cutting edge customisation of the app design making it possible to localise the policy and artwork, language to your needs. This will pilot a long terms sustainable solution.
We will be also empower local professionals in terms of healthcare training and involvement in the design and co-authoring of the technology.
We will strengthen professional collaboration between the UK and Africa in a strategic domain of AMS and infection and aim to change prescription behaviour.
Long-term will be aim to change the rates of antibiotics prescribing
What will be done to ensure that they have the opportunity to benefit?
We will work very closely with the Nigerian team and with the volunteers conducting the evaluation. Will be use multiple channels to engage and raise awareness - iNRIC portal and app, eNewsletter, ICAN newsletter, ICAN 2018 Workshop to present the app, and other networks affiliated with iNRIC.
Academic publications in interdisciplinary conferences (ACM Digital Health, IFIC, ICAN, IPC, ECCMID, FIS, ESCAIDE, SEGAD, CBC, Foundation of Digital Games, Games for Health etc ) and journals (e.g. Frontiers in Digital Health, BJIC, Lancet, IJIC, JMIR, JAMIA, JAC, etc).
Most importantly, beyond this pilot project we have a long-term plan: with ICAN we plan to apply for strategic funding to expand the development of the app, cover a wider selection of AMS policies and deploy these in multiple countries. We plan to run a cluster randomised RCT to evaluate their effectiveness in changing AMS practise and prescribing behaviour. Linking the app to the hospital prescription system would be another step enabling direct e-prescribing at the point of care and seamless cost effective surveillance. This is a highly impactful project with the potential to reduce prescribing across Africa over the next decade!
Publications
Birjovanu G
(2019)
GADSA
Shallcross L
(2019)
Understanding non-compliance with surgical antibiotic prophylaxis prescribing guidance, in Nigeria
in European Journal of Public Health
Gray A
(2021)
Following Guidelines for Drug-Resistant Tuberculosis: "Yes, it's a challenge"
in Frontiers in Tropical Diseases
Wood CE
(2022)
Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria.
in JAC-antimicrobial resistance
Borda A
(2023)
Editorial: Digital interventions and serious mobile games for health in low- and middle-income countries (LMICs).
in Frontiers in public health
Molnar A
(2023)
A Study Exploring Different Modalities to Integrate Learning Objectives in Games
in International Journal of Game-Based Learning
Description | The project team decided to focus on AMR for surgical site infections (SSI). We have investigated behavior barriers and situational analysis with regards to AMR compliance in Nigeria, developed a gamified decision support app piloted at the point of care in 3 hospital sites with over 60 surgeons recording around 300 prescription decisions and their change as a result of the advice given by the app. We demonstrated increased compliance with the WHO and Sanford guidelines, behaviour change at the point of care reducing unnecessary prescribing and the need for a local guidelines appropriate for low income settings. The project was recently awarded a number of awards and prizes. |
Exploitation Route | GADSA developed an innovative, first of its kind, app for decision support used at the point of care demonstrating behaviour change for SSI prescribing in surgeons that could be scaled up for other AMR policies and other countries across Africa and developed world. It contributes to the global fight against antibiotic resistance. |
Sectors | Digital/Communication/Information Technologies (including Software) Healthcare |
URL | https://www.ucl.ac.uk/risk-disaster-reduction/research-projects/2019/feb/gadsa-gamified-antimicrobial-stewardship-ams-decision-support-app |
Description | This innovative project demonstrated direct impact on prescription behaviour for AMR prescribing in surgeons in Nigeria at the point of care. This is the first decision support app demonstrating behaviour change sucess of its kind. The long term vision is to scale up the solution to support AMR stewardship in the continent and globally. Working with surgeons in Nigeria, and implementing the app has successfully improved the prescribing of antibiotics and the quality of healthcare services in Nigeria. Almost 300 prescriptions were recorded by the app: 69% non-compliant decisions about the risk of surgical procedures were changed following feedback and 10-15% non-compliant decisions on the type and length of antibiotic prescriptions were also changed after feedback. Delivering a prescription behaviour change at the point of care is a unique result which we can expect to lead to further scaling up of the project in the near future. |
First Year Of Impact | 2000 |
Sector | Digital/Communication/Information Technologies (including Software),Healthcare |
Impact Types | Societal Economic Policy & public services |
Description | EPSRC IAA Discovery-To-Use |
Amount | £14,676 (GBP) |
Funding ID | KEIF 2017-20 (B1.27) |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 04/2019 |
End | 11/2019 |
Description | EPSRC IAA Discovery-to-use 100k |
Amount | £100,000 (GBP) |
Organisation | University College London |
Sector | Academic/University |
Country | United Kingdom |
Start | 05/2017 |
End | 04/2020 |
Description | GADSA - deployment follow-up grant |
Amount | £39,000 (GBP) |
Organisation | University College London |
Sector | Academic/University |
Country | United Kingdom |
Start | 03/2022 |
End | 07/2022 |
Title | prescription data uisng mobile app |
Description | prescription decisions using mobile app at the point of care |
Type Of Material | Database/Collection of data |
Year Produced | 2023 |
Provided To Others? | Yes |
Impact | demonstration of prescription behaviour change at the point of care using gamified app |
Description | Adaptation of GADSA technology for DR-TB decision support |
Organisation | University College London |
Department | Institute For Global Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-writing of successful grant to adapt GADSA technology for development of DR-TB decision support tool |
Collaborator Contribution | Co-writing of successful grant to adapt GADSA technology for development of DR-TB decision support tool |
Impact | Multidisciplinary partnership: Computer Science, Behavioural Science, Global Health, Infection Control, Medicine Successful research proposal for GCRF funding |
Start Year | 2019 |
Description | NHS Trust Wittington |
Organisation | Whittington Hospital |
Country | United Kingdom |
Sector | Hospitals |
PI Contribution | collaboration to pilot the GADSA app in NHS Trust |
Collaborator Contribution | testing of the pilot app with local surgeons initiated |
Impact | too soon to report |
Start Year | 2022 |
Description | The International Pharmaceutical Federation |
Organisation | The International Pharmaceutical Federation |
Country | Netherlands |
Sector | Learned Society |
PI Contribution | collaboration with FIP started in 2019 and ways of joined future research have been investigated |
Collaborator Contribution | support and endorsement - exploring future collaboration |
Impact | multidisciplinary collaboration with the world largest society for pharmacists has been initiated and initial steps (such as presentation to their Digital Team and management) have been taken. No results to report yet. |
Start Year | 2019 |
Title | specification of new gamified AMR app |
Description | this is work in progress app and back end development to implement SSI AMR policies |
Type Of Technology | Webtool/Application |
Year Produced | 2018 |
Open Source License? | Yes |
Impact | too early to define impacts but the long term vision, when the project is completed, is to have the app deployed and scaled up |
Description | Invited talk at 7th Infection Control Network Congress |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | PK gave an invited talk at the 7th Infection Control Network Congress in Cape Town, South Africa. The talk prompted discussion and questions from the audience and led to further discussion afterwards. The talk led to ongoing working relationship with colleagues in Africa and ongoing work with the Infection Control African Network enabling progression of GADSA project work and evaluation of its impact on prescribing behaviour change. |
Year(s) Of Engagement Activity | 2019 |
URL | https://www.researchgate.net/publication/336891031_GADSA_Gamified_Antimicrobial_Stewardship_AMS_deci... |
Description | Poster presented at IRDR Conference 2018 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Postgraduate students |
Results and Impact | Poster presentation given at the UCL IRDR annual conference in 2018. The presentation prompted discussion amongst the conference audience with interest in finding out more about the project. Following the presentation, we were able to organise several meetings with new UCL-based colleagues to discuss expansion of the GADSA project work across Africa. |
Year(s) Of Engagement Activity | 2018 |