Dr Vicki Young Catherine Hayes Prof Cliodna McNulty Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics Charlotte Eley Primary Care Unit, Public Health England Gill Parkinson Katie Tucker Dr Nick Francis Dr Nina Gobat Dr Vicki Young Catherine Hayes Prof Cliodna McNulty Dr Sally Weston-Price

Development of Beat the Bugs e-Bug is an educational resource for 4 to 18 year olds teaching about hygiene, infection and antibiotics e-Bug expanded its educational resources into the community with a hygiene and self-care course called Beat the Bugs Beat the Bugs was developed by e-Bug and Kingfisher Treasure Seekers to help tackle inappropriate antibiotic use within the community The course aims to increase awareness and change behaviour around hygiene, infections and antibiotic use in an interactive and fun way www.e-Bug.eu/Beat-The-Bugs Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Beat the Bugs sessions www.e-Bug.eu/Beat-The-Bugs Builds on existing e-Bug activities Delivered as 6 week course or independent sessions 6 sessions cover: Introduction to microbes Hand and respiratory hygiene Food hygiene Oral hygiene Antibiotics Self-care and action planning for the future www.e-Bug.eu/Beat-The-Bugs Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Beat the Bugs Target Audience Can be delivered; BY a range of community leaders TO a range of community groups Each session is adaptable with range of activities for different ages and abilities Delivered by: Community leaders School Nurses Family practitioners Teachers Guiding/Scout leaders Youth group leaders Delivered to: Hard to reach groups Adult’s with learning difficulties Young parents Parents with English as an Additional Language Girl Guiding/Brownies Scouts/Cubs Youth groups After school clubs Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Pilot Evaluation of Beat the Bugs 8 participants Adults who are generally vulnerable Variety of learning, physical and/or mental health difficulties Course Leader Community leader who delivers training courses to vulnerable adults Before questionnaire Beat the Bugs Session* After questionnaire Action Plan Repeat process weekly for each session Follow up Conducted 6 weeks after the final session Participant focus group Course leader interview Conducted with seven adults with a variety of learning difficulties Used to make improvements to the draft course Used to inform future pilots Feedback from the preliminary pilot resulted in: A number of visual components being increased Amount of reading for participants decreased. Creation of posters for each session Provision of additional information for the course leader Development of a pictorial Managing Your Infection leaflet *Sessions observed by researcher Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Questionnaires Questionnaires were called ‘quizzes’ to participants Quizzes had 6 knowledge based statements Participants circled whether statements were ‘right’, ‘wrong’, or ‘not sure’ Conducted with seven adults with a variety of learning difficulties Used to make improvements to the draft course Used to inform future pilots Feedback from the preliminary pilot resulted in: A number of visual components being increased Amount of reading for participants decreased. Creation of posters for each session Provision of additional information for the course leader Development of a pictorial Managing Your Infection leaflet Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Meet the Bugs What is ‘Meet the Bugs’? Yeast Races What is ‘Meet the Bugs’? Overview of microbes and explores types and shapes of microbes, and discusses useful and harmful microbes. Learning outcomes There are three different types of microbes Microbes can be found everywhere Useful bacteria are found in and on our body Many of our useful microbes are put to good use every day to help keep us healthy We need to protect our useful microbes Sometimes the harmful microbes can make us ill Make Your Own Microbes Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Meet the Bugs Pilot feedback Lowest baseline knowledge Highest improvement in knowledge Participant knowledge improved the most on the following: Bacteria, Viruses and Fungi are the three main types of microbes It is important to protect our useful microbes Knowledge Average correct scores Baseline 36% Post Intervention 89% Change 53% 6 week follow up Participants could recall the three types of microbes. “It will be bacteria, virus and fungi.” (Participant) What are the 3 types of Microbes? Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Spreading Bugs What is ‘Spreading Bugs’? Horrid Hands What is ‘Spreading Bugs’? Overview of the spread of infection by learning how microbes are spread through sneezing and how proper hand washing with soap can break the chain of infection. Learning Outcomes Microbes, including antibiotic resistant bacteria, spread very easily Everyone carries microbes on their skin, mouth and gut You can stop your colds and flu spreading to others by catching your coughs and sneezes in a tissue We can stop harmful microbes spreading to others by washing our hands How, when and why to wash our hands Snot Gun Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Spreading Bugs Pilot feedback At baseline most participants did not know that microbes can spread from person to person At post intervention nearly all participants knew they should always use a tissue to catch a sneeze Knowledge Average correct scores Baseline 57% Post Intervention 69% Change 12% 6 week follow up Participants recalled why we wash our hands. Participants reported an increase in appropriate hand washing behaviour. “So we don’t get any germs to our foods or anywhere that you may catch a cold.” (Participant) Why is it important to wash our hands? Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Food Bugs What is ‘Food Bugs’? Overview of how easily potentially harmful microbes in raw food can transfer to humans, and how to store different foods in the fridge Learning Outcomes Microbes are found on most of our food Bacteria multiply very quickly To stop getting ill, it is important to wash your hands before and after preparing food Most foods should only be reheated once Where and how to store different foods The difference between ‘use by’ and best before Label Sort Fridge Raiders Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Food Bugs Pilot feedback Second highest baseline knowledge At baseline most participants did not know that harmful microbes are found on uncooked meat At post intervention all participants knew that microbes are found on most of our foods Knowledge Average correct scores Baseline 64% Post Intervention 75% Change 11% 6 week follow up Participants retained knowledge on where certain foods should be stored in the fridge. “Also the meats shouldn’t touch between like dairy or raw meat because it will contain salmonella or food poisoning.” (Participant) Where should certain foods go in the fridge? Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Mouth Bugs What is ‘Mouth Bugs’? Covers how to prevent tooth decay through limiting sugar intake and brushing teeth twice a day Learning Outcomes What dental plaque is and how it forms Which foods and drinks cause tooth decay The consequences of tooth decay How to brush teeth effectively That limiting sugary foods and drinks can reduce tooth decay How much sugar? How to brush your teeth Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Mouth Bugs Pilot feedback Baseline knowledge showed that ALL participants thought that you should rinse your mouth out with water after tooth brushing – this is incorrect! At post intervention all participants knew that dental plaque is a build up of bacteria on our teeth Knowledge Average correct scores Baseline 50% Post Intervention 72% Change 22% 6 week follow up Participants recalled what drinks contained the most sugar. Participants reported an increase in appropriate tooth brushing behaviour. “It’s important to brush your teeth so you don’t get any cavities in them and also you won’t get any holes so you won’t get your teeth damaged.” (Participant) Why do we brush our teeth? Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Antibiotics: Right or Wrong? Bug Busters What is ‘Bug Busters’? An overview on what antibiotics are, when to take antibiotics and how to take antibiotics correctly Learning Outcomes Most common infections will get better on their own Take antibiotics exactly as prescribed Do not use other people’s, or leftover antibiotics Only use antibiotics when you really need them If you over use antibiotics they might not work when you really need them for a severe infection Some bacteria can no longer be killed by antibiotics and this is called antibiotic resistance Remember, antibiotics kill our own useful bacteria Antibiotic resistant bacteria spread easily from person to person Glitter Microbes Antibiotics: Right or Wrong? My headache and flu symptoms are really getting me down. I think I need antibiotics! I don’t take antibiotics unless I really need them as they might not work in the future. Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Bug Busters Pilot feedback Second lowest baseline knowledge Second highest improvement in knowledge Participant knowledge improved the most on statements: You should only take antibiotics if your doctor has prescribed them to you You must not use other people’s antibiotics Knowledge Average correct scores Baseline 44% Post Intervention 83% Change 39% 6 week follow up Participants struggled to explain what antibiotics are and when we should take antibiotics. “I think there is still loads of work we need to do with antibiotics. It’s just a really difficult concept to teach in a literal way.” (Course Leader) Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Know Your Bugs What is ‘Know Your Bugs’? Managing Your Infection leaflet: A step-by-step guide on how to manage your infection What is ‘Know Your Bugs’? Know Your Bugs enables participants to learn how to self-care at home for common infections, and provides opportunities to make decisions on their own health and think about their own antibiotic use. Learning Outcomes How to self-care at home when they are ill When to go to the doctor Where to access health information What information can be gained from healthcare leaflets Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Average correct scores Know Your Bugs Pilot feedback Highest baseline knowledge Highest post-intervention knowledge At post intervention ALL participants knew that you can help make yourself better by getting plenty of rest and drinking enough fluids Knowledge Average correct scores Baseline 70% Post Intervention 97% Change 27% 6 week follow up Participants had retained knowledge around self-care; particularly getting bed rest and drinking water. “Always drink plenty of water, always get a good rest, and always wash your hands and use a clean tissue and use paracetamols if you need them.” (Participant) What can we do to help make ourselves better? Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Summary of results Questionnaires showed an improvement in participant knowledge in each session The microbes and antibiotics sessions reported the highest improvement in knowledge Participants had retained knowledge; particularly around self-care Participants reported positive behaviour change including an increase in appropriate hand washing and tooth brushing Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Implications Antibiotics session will be modified Further pilot Participants struggled to describe exactly what an antibiotic is and when an antibiotic is needed Provide simpler activities Broader range of activities to choose from Further pilot Currently undertaking a further pilot in a Children’s Centre with young parents Adapted the ‘quizzes’ To determine benefits, learning outcomes and transferability of the course Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Train the Trainer In response to feedback from the pilot course a Train the Trainer workshop has been developed The training gives community leaders the knowledge, confidence and skills to deliver the course in their community groups A variety of individuals have completed the training to date Beat the Bugs ‘Train the Trainer’ workshops will be delivered on a termly basis to further promote the course Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Summary www.e-Bug.eu/Beat-The-Bugs The Beat the Bugs community resource is a useful addition to the e-Bug materials The course supports the implementation of NICE guidance 63 in improving public knowledge and behaviour around hygiene, self-care and antibiotic use Flexible sessions; suitable for many different settings Further promotion of Beat the Bugs is required; through training workshops Further evaluation of Beat the Bugs is required with different community groups and on a larger scale www.e-Bug.eu/Beat-The-Bugs Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

Thank you for listening Charlotte. Eley@phe. gov. uk Contact e-Bug@phe Thank you for listening Charlotte.Eley@phe.gov.uk Contact e-Bug@phe.gov.uk for free training opportunities Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics