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

抗生素耐药性是一个全球性问题。在临床和社区医疗环境中实施适当的抗菌药物处方政策和管理是减少抗生素过度使用的有效方法之一。这在临床实践监管较少的尼日利亚和其他低收入和中等收入国家（LMIC）非常重要。在这些国家，由于资源限制，抗生素和假冒产品的广泛非处方可用性为实施抗菌药物管理创造了非常具有挑战性的环境。2016年7月，拥有28个非洲成员国的非洲感染控制网络（ICAN）发起了抗菌药物管理教育倡议，以解决整个非洲大陆的这一问题。这一跨学科项目的目的是调查移动的手机和平板电脑上的游戏化应用程序的使用情况，通过改善对谨慎的抗菌药物处方政策的遵守，支持专业人员围绕三个关键条件（尿路感染，单剂量手术预防和上呼吸道感染）进行处方决策。根据先前与ICAN和国际感染控制资源（iNRIC，www.nric，org，uk）在护理点向感染专业人员提供政策和指导的研究，发现与基于文本的指南相比，非洲专家更喜欢以图形游戏化格式访问政策，而不是他们的移动的设备。该应用程序将与来自两个机构（拉各斯的国家教学医院和一家社区医院）的医疗保健专业人员共同编写和开发，并进行评价，以评估3个月内的可用性和处方行为变化。尖端的基于游戏的培训技术将使定制支持本地化的游戏化应用程序，以新的设置由医疗保健专业人员自己。该试点项目将展示一种新的创新方法，并有可能以具有成本效益的方式扩大和扩展到其他AMS政策和设置，以支持非洲大陆ICAN成员国的专业人员。我们的多学科团队由计算机科学家，流行病学家，感染控制专家和行为科学家组成，是开发基于AMS干预的应用程序的理想选择。我们在应用程序开发，AMS指南翻译和行为改变方面拥有专业知识，使我们能够理想地提供拟议的工作计划。此外，我们将与尼日利亚的用户共同设计我们的应用程序，利用我们与ICAN和拉各斯大学医学院的现有合作关系-隶属于国家拉各斯大学教学医院（LUTH）和区域Obafemi Awolowo大学医院。

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.