Behavioural Insights into Tackling Antimicrobial Resistance and Urinary Tract Infections during Pregnancy

Background Antimicrobial resistance (AMR) is a global threat linked to excessive antibiotic use. It is concerning in pregnancy because of the limited range of treatment options and transmission of resistant pathogens to the baby during birth. Antibiotics are the most frequently used medication during pregnancy, with urinary tract infections (UTIs) being the most common indication. The aim was to explore how AMR can be tackled in the context of UTIs during pregnancy using behavioural science. Method Multiple methods were used for the research collection in this thesis. The first study was a systematic review of measures to prevent UTIs during pregnancy. Second and third studies focused on qualitatively exploring women’s perspectives using data from an online forum and semi-structured interviews. The fourth and fifth studies explored professionals’ practice through an audit of antibiotic prescribing and qualitative interviews with prescribers. Results The systematic review highlighted that preventative behaviours are associated with a reduced incidence of UTIs during pregnancy. The second study showed that women’s decision-making is primarily influenced by pre-natal attachment to the baby causing them to favour antibiotics whilst undermining the risks from AMR. The third study adds that they view UTIs through a biomedical model and perceive preventative behaviours as ineffective leading to low selfefficacy in managing personal health and tackling AMR. The audit reveals that prescribers frequently issue empirical broad-spectrum antibiotics and the fifth study indicates that they are highly cautious during pregnancy which might lead to antibiotic overprescribing. Prescribers also view UTIs through the biomedical model and therefore may not emphasise prevention or self-care advice. Conclusion Prevention of UTIs through behavioural measures is an effective approach to reducing antibiotics during pregnancy. Interventions targeting women and healthcare professionals require focus on encouraging preventative behaviours which can minimise infections and reduce antibiotic use in response to AMR