GADSA: gamified Antimicrobial Stewardship (AMS) decision support app for prescribing behaviour change

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.

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!