Digital educational interventions for antimicrobial stewardship: A systematic review

Abstract

Background: Antimicrobial Stewardship programs (ASPs) help reduce antimicrobial resistance (AMR) by promoting responsible antibiotic use. However, implementation is often inconsistent, especially in low-resource settings. Digital health technologies (DHTs) provide scalable and flexible means to enhance ASPs, particularly through targeted educational interventions for clinicians, students, and the public.

Aim: This systematic review aimed to evaluate the effectiveness of digital educational within ASPs by enhancing knowledge and driving behavior change, with a specific focus on the educational strategies employed, their theoretical underpinnings, and their differential impact across populations and settings.

Method: This review followed PRISMA and Joanna Briggs Institute (JBI) guidelines, with a protocol registered in PROSPERO. A comprehensive search of four databases (PubMed, Web of Science, Scopus, and CINAHL) was conducted to identify primary peer-reviewed studies published in English that quantitatively evaluated digital educational ASPs. Risk of bias was assessed using standardized appraisal tools.

Results: Twenty-three studies, conducted in diverse contexts and targeting different stakeholders, were included in the review. All interventions reported positive impacts on knowledge enhancement and behavior change. Engagement-driven approaches, such as interactive modules, real-time feedback, and case-based simulations, were most common, and strategies were tailored to the specific target groups. However, theoretical underpinnings were rarely reported, with only two studies explicitly grounded in behavior change theory. Few studies included long-term follow-up assessments, and most lacked rigorous designs such as randomization. Risk of bias was assessed and varied across studies. The interventions varied widely in duration, frequency, and delivery format, limiting comparability.

Conclusion: Digital educational ASPs show strong promise in improving knowledge and driving behavior change across a wide range of settings and stakeholder groups. Their adaptability, scalability, and user-centered design underscore their potential as valuable tools in the global effort to combat antimicrobial resistance. To maximize their long-term impact, future interventions should be informed by behavioral theory, include follow-up beyond six months, and address contextual needs in low-resource settings.

Keywords: Antimicrobial; Behavior; Digital; Education; Intervention; SDG; Stewardship.