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Through four inter-related work streams, STEP-UP will take a socio-ecological perspective to invesetigate key interventions acting at organisational, inter-personal and individual levels, involving healthcare-commissioners, GPs/Practices and patients in England. These have been chosen to provide a diverse set of exemplars,  incorporating elements known to increase effectiveness, and exploiting cross-disciplinary expertise in quantitative and qualitative methods across the two NIHR AMR Health Protection Research Units.

For evaluations to inform policy and practice, emphasis is needed not only on whether (behaviour change) interventions and (health economic) methods 'work' but how they work, in terms of the mechanisms which are targeted and assumptions that are made, how they are implemented, and how effects may differ from one context to another. Our underpinning hypothesis is that general assumptions that interventions and methods work as intended hold only partially; by conducting indepth investigations of structural and contextual barriers to change and of evaluation frameworks, we can understand the multiple factors which influence intervention implementation, and identify ways to increase their update and support sustainability. 

We will address 4 specific research questions at different organisational level:

  • Work stream 1: What are the mechanisms and mediators of a high-cost health-system level intervention, the 'antibiotic prescribing quality premium'?
  • Work stream 2: Why have strategies to delay prescribing antibiotics not been more widely adopted, and how can we facilitate their uptake?
  • Work stream 3: Why have strategies to avoid prescribing antibiotics not been more widely adopted, and how can we facilitate their uptake?
  • Work stream 4: How can consideration of long-term effects of ARM influence decision-making at an individual and policy level?