Dr Kristen Reyher speaking at the BVA Congress in London last week.

What can social science tell us?

“We should not lose sight of the fact that the main driver of antimicrobial resistance (AMR) in humans remains the use of antimicrobials in humans,” said Dr Kristen Reyher from the University of Bristol, speaking at the BVA Congress in London last week.

“However, this does not reduce our responsibilities as stewards of antimicrobials in the wider context,” she added.

Kristen said the fundamental question that should always be asked is do we really need to use these antibacterials? And although a focus should be on the critically important ones, the same approach should be applied to the use of the more routine antibiotic agents.

She pointed out that his approach has to be implemented on a practice-wide basis and involve everyone, including receptionists and clients. In farm animal practice, it is possible to retain farmer confidence and to keep them on board.

Antimicrobial governance not only requires regulation, but also responsibility. It needs to take account of the differences and particular factors that exist in the different industry sectors.

Kristen introduced delegates to the concept of antimicrobial stewardship. She said that when practices – especially farm animal practices – initiate a stewardship policy, it is important to involve the farmers in the process, because they will often exceed our expectations.

It is interesting to carry out ‘motivation interviews’ and group meetings in order to find out what is “in the owners’ heads” rather than simply telling them what to do. By using that approach, the antimicrobial stewardship policy will consist of practical things that we know the farmers will carry out.

“We can know what the bugs are doing; but it is equally important to know what we humans are pushing the bugs to do,” Kristen concluded.

Turning to the psychology of tackling AMR, Professor Ian Donald, from the University of Liverpool, said that our focus tends to be on the biological aspects of the problem, but psychology and other social sciences must also be included. “You cannot take people and their behaviour out of the equation,” he said.

He explained how psychologists provide behavioural input and a link to a wider research. They can offer models, provide relevant input and work in partnership with natural sciences and medical and veterinary practitioners.

Psychologists have looked at norms/social context, attitudes, beliefs and perceptions; together with education and training, plus decision-making support systems.
Underpinning the importance of the subject of AMR, Ian pointed out that human medical doctors see the problem as a ‘greater threat’ than death from cancer.

He said that there is a need for a framework that looks at the relationship between AMR and human behaviour. He introduced delegates to a frequently used model embracing the ‘Theory of Planned Behaviour’, which looks at the three categories of behavioural beliefs (attitude), normative beliefs (subjective norm) and control beliefs (perceived behavioural control).

We should bear in mind that the whole area of AMR and the role of antibiotics are fast-moving subjects. Attitudes and approaches soon become out of date. Concluding, Ian said that veterinary professionals must reflect seriously on their prescribing behaviour, especially their prescribing habits. “There is no use addressing the biological aspects without taking the human behavioural factors into account.”