Development and User Feedback on Antimicrobial Stewardship Explainer Videos: A Collaborative Approach between the UK and Eight African Countries ^†

Abstract

Antimicrobial resistance is a growing, complex, and global threat. Health partnerships are working to address antimicrobial resistance through antimicrobial stewardship activities. To support this work, the Commonwealth Partnerships for Antimicrobial Stewardship programme developed four antimicrobial stewardship explainer animation videos in eight different accents, with input from over 50 stakeholders across eight African countries and the UK. The videos highlight different scenarios and explain AMS in easy-to-understand ways for both health practitioners and the public. Health partnerships piloted the videos in several ways, including in clinical waiting rooms, trainings, and AMS meetings, and provided feedback in a survey. In total, 94% of survey respondents gave the videos either a ‘5’ or ‘4’ for usefulness, with ‘5’ indicating ‘very useful’. Moving forward, through collaboration with the health partnerships, the videos will continue to be disseminated and adapted.

1. Project Overview

Background: Antimicrobial resistance (AMR) is a growing, complex, and global threat. Many factors have accelerated its spread, including overuse and misuse of medicines in humans, livestock, and agriculture, as well as poor access to clean water, poor sanitation, and poor hygiene [1]. Across Africa, AMR is particularly concerning and the impact is becoming more apparent, with healthcare-associated infections increasing, the ongoing high burden of communicable diseases, and weak and fragmented public and animal health systems [1,2]. Health partnerships are working to address AMR through antimicrobial stewardship (AMS), infection prevention and control (IPC), and developing pharmacy expertise and capacity.

The videos: To support AMS, the Tropical Health and Education Trust (THET) and the Commonwealth Pharmacists Association (CPA, as part of the Commonwealth Partnerships for the Antimicrobial Stewardship (CwPAMS) scheme, with funding from the Fleming Fund and input from more than 50 stakeholders across the UK and eight African countries, developed four AMS explainer animation videos with the video animation company Video Symmetry. The videos present different situations, stories, and information to help explain AMS in easy-to-understand ways.

The audience: the videos are designed for both the public and health practitioners.

Process of development: From 2021 to 2022, key stakeholders were engaged from a range of backgrounds and experience, including healthcare informants and external advisers (e.g., the Africa Centres for Disease Control and WHO). A brainstorming stakeholder workshop was held to determine the scope of the videos. The workshop concluded that English was the most useful language for the videos, but different accents were recorded so the characters could be relatable in multiple contexts. Scripts were developed through several iterations and reviewing sessions with stakeholders. Draft storyboard animations were developed by Video Symmetry and shared with the reviewers for further feedback on clinical accuracy, appropriateness, and ease of understanding. Several review phases were necessary to ensure that the videos were both technically and contextually accurate and appropriate. The main challenge was to make the complexity of AMS/AMR easily understandable to a wide audience. Following the completion of priority edits, three of the four videos were uploaded to YouTube and shared with the health partnerships to pilot in training sessions during May 2022. A feedback survey was shared with the partnerships to inform on the use, value, and next steps for the videos.

2. Outcomes and Impact

Outcome: Following the development process, four video topics were confirmed. As a result, the videos cover the following topics:

• The patient and doctor experience with antimicrobials. This video explores a mother and father’s experience with seeking medical help for their child’s illness, such as learning when it is appropriate to use antimicrobials or not, and the preventative actions one can take to reduce the chances of AMR.
• Continuum of care. This video explores the different roles involved in the whole journey of care. For example, for the doctor, the journey is about carrying out the appropriate test or using relevant tools/guidelines to assess the patient; for the pharmacist, providing advice to colleagues and dispensing the correct antimicrobials; for the nurse, providing the antibiotic on time and appropriately; and for the patient, taking the medicine correctly and not sharing antimicrobials with family, friends, or pets.
• Surgical prophylaxis. This video explores the journey of healthcare professionals (doctor, nurse, and pharmacist) in managing surgical-site infection, using the WHO Surgical Safety Checklist, and deciding on the appropriate use of antimicrobials in a patient’s journey to reduce the risk of AMR.
• Defining AMR and AMS. This video defines antimicrobial resistance and stewardship, reviews the global organisations involved in AMR prevention, assesses why it is important that we tackle it, and determines the actions that individuals (both patients and health professionals) can take to reduce AMR.

Impact: From the analysis of the 52 pilot-survey respondents, who were from a range of clinical cadres and civil-society organisations, the videos have demonstrated to be useful and positive for the health partnerships. For example, 49 (94%) survey respondents gave the videos either a ‘5’ or ‘4’ for usefulness, with ‘5’ indicating ‘very useful’. Respondents were also asked how they have used the videos thus far in their work. Some examples of responses include:

• Training workshops involving 50+ and 145+ people;
• Seminars of 20+ people and in AMS team meetings;
• One partnership bought a TV to share the videos with hospital staff/students in the clinical skills training room at the hospital. This room is used for small group teaching sessions;
• One partnership showcased the videos during training sessions and trainees then translated the videos into Swahili for future use.

In addition, respondents were asked how they expect to use the videos in their practice, institutions, and networks in the future; the data gathered for this question are represented in Figure 1.

Lastly, we assessed what respondents learned from the videos. When asked which video they learned from the most, 24 (47%) survey respondents stated they learned the most from the patient-experience video, 19 (37%) from the continuum of care, and 8 (15%) from the surgical prophylaxis. Respondents also provided qualitative feedback on the videos; for example, the feedback included “Get these out there, they are outstanding!”, “These are PERFECT for Public Health Promotion programmes”, and “Very strong videos-useful for a range of training situations”.

3. Future Development

All the videos are now available on YouTube [3]. To further develop and disseminate the videos, we plan to do the following activities:

• Continue to gather feedback from health partnerships and, where feasible, make priority edits to the videos regarding suggestions that were made in the survey. For example, adding more languages, improving existing accents where needed, and providing subtitles with local languages to improve accessibility;
• Disseminate the videos during future phases of the CwPAMS programme and encourage health partnerships to use the videos in training sessions and at the hospitals/clinics;
• Support health partnerships to disseminate the videos on a wider scale. Partnerships have expressed interest in sharing the videos on, for example, TV/radio shows, social media, and through printed screenshots of the videos on posters;
• Share the videos with a wider network of stakeholders, including, for example, the Africa CDC, Fleming Fund, and WHO, to support further antimicrobial stewardship.