Dr Vicki Young Public Health England e-Bug: An educational resource for children and young people on microbes, hygiene and antibiotics Dr Vicki Young Public Health England

What is e-Bug? A health education resource for 4-18 years about microbes, antibiotic resistance, and the spread, treatment and prevention of infection. Established in 2006 by the Health Protection Agency; 60% funded by DG Sanco; now operated by Public Health England. e-Bug www.e-bug.eu

Why is education on Antibiotic resistance important? Antibiotic resistance is one of the biggest threats facing us today. Without effective antibiotics many routine treatments will become increasingly dangerous. “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics." (Dame Sally Davies, 2015). Education is a key part of the UK Five Year Antimicrobial Resistance Strategy 2013-2018 e-Bug www.e-bug.eu

Why target children and young people? Young people are our future generation of antibiotic users But as important Half of children consulting their GP have an infection Antibiotics are the most common childhood medicines If we reduce childhood infections we reduce antibiotic use e-Bug www.e-bug.eu

Why is e-Bug important? e-Bug educates children and young people on microbes, the spread, treatment and prevention of infection and antibiotic use. By educating children on these health topics we can: Increase the knowledge of our future antibiotic users and prescribers Reduce spread of childhood infections Reduce absenteeism in schools Reduce antibiotic use Reduce antibiotic resistance e-Bug www.e-bug.eu

Education in schools can help break the chain of infection Primary mode of illness transmission via contaminated hands Hand washing interventions reduce illnesses and absenteeism Respiratory transmission important especially during flu season Master et al. Fam Med 1997;29(5):336-9 e-Bug www.e-bug.eu

How was e-Bug developed? 2006-2009: DG-Sanco EU grant Research, design and produce a teaching pack and website for junior and senior schools Covering: Prudent antibiotic use Hand hygiene Respiratory hygiene Importance of vaccines Translate and disseminate across EU Belgium CR Denmark France GB Greece Italy Poland Portugal Spain Croatia Finland Hungary Ireland Latvia Lithuania Slovakia Slovenia 10 associate partners & 8 collaborating partners. e-Bug www.e-bug.eu

2006:Needs assessment In 2005 no ‘European’ campaigns No school campaigns on antibiotic use Lack of respiratory hygiene campaigns that focus on spread of infection Results showed that not enough is being done across Europe to educate children and young people about antibiotic use and resistance. e-Bug www.e-bug.eu

Focus groups with teachers MUST link closely to the National Curriculum MUST be adaptable Important to have IT links Cover a range of teaching styles Student and teacher friendly e-Bug www.e-bug.eu

e-Bug development The e-Bug teaching pack and website content was discussed and agreed with teachers and the 18 partner countries in 2007 e-Bug www.e-bug.eu

2009 e-Bug packs launched e-Bug www.e-bug.eu

Evaluation of the teaching packs The evaluation was carried out in 3 countries with first versions of the packs France Czech Republic United Kingdom Control and Intervention Schools Students completed knowledge questionnaires before, immediately after and 6 weeks after teaching England France Czech Republic London Gloucester Bordeaux Nice Prague Ostrava e-Bug www.e-bug.eu

Evaluation of activities - results The junior e-Bug teaching pack demonstrated a significant improvement in student’s knowledge in all sections No significant decrease in student knowledge after 6 weeks Knowledge improvement with the senior e-Bug pack varied between regions. Updated were made based on the results and feedback. England - junior Lecky et al. JAC 2010, 65: 2674-2684 e-Bug www.e-bug.eu

e-Bug Worldwide

e-Bug Partners *Saudi Arabia not shown Portugal Spain France Ireland UK Italy SK CZ Poland Finland SL LV LT Cyprus Norway Sweden Germany BE NL DK Hungary Romania Bulgaria Turkey CH AU HR BA SE MA AL Iceland Russia Ukraine Belarus ES Greece Partner country Partner required. Resources translated. MD *Saudi Arabia not shown Partner required. Resources not translated. e-Bug www.e-bug.eu

23 languages, including Welsh e-Bug www.e-bug.eu

The e-Bug resources

e-Bug Resources 4-7 yrs 7-11 yrs 11-15 yrs 15-18 yrs Online Science Show 7-11 yrs Junior school lesson plans Student website 11-15 yrs Senior school lesson plans 15-18 yrs Young adult lesson plans Peer education resources Launched in 2011 Launched in 2009 Launched in 2014/15 e-Bug www.e-bug.eu

5 activities for 4-7 year olds e-Bug Topics 11 Junior lesson plans 7-11 year olds 10 Senior lesson plans 11-15 year olds 1. Micro-organisms An Introduction Useful Microbes Harmful Microbes 2. Spread of Infection Hand Hygiene Respiratory Hygiene Food Hygiene Farm Hygiene 3. Prevention of Infection The Body’s Natural Defences Vaccinations Oral Hygiene 4. Treatment of Infection Antibiotic Use and Medicine 1. Micro-organisms An Introduction Useful Microbes Harmful Microbes 2. Spread of Infection Hand Hygiene Respiratory Hygiene Sexual Transmission Chlamydia 3. Prevention of Infection The Body’s Natural Defences Vaccinations 4. Treatment of Infection Antibiotic Use and Medicine 5 activities for 4-7 year olds 2 lesson plans for 15-18 year olds Microbes Hand Hygiene Respiratory Hygiene Food Hygiene Antibiotics Antibiotics Vaccinations All lessons link to the National Curriculum e-Bug www.e-bug.eu

Peer Education Resources Peer education is a popular learning tool, due to the benefits for all involved: For peer educators, benefits include positive changes in attitudes, confidence, self-esteem, communication and knowledge. For those receiving the education, peer education can be more effective in improving knowledge and changing attitudes and behaviours compared to adult-led teaching programmes. e-Bug has peer education materials for: Science shows Young adults to teach on antibiotics e-Bug www.e-bug.eu

Peer Education Science Show Evaluation Peer Educators 4 Senior schools 476 students Parents Develop a range of skills 7 Junior schools 589 students Feeder Primary school students Parents Learning from their peers Knowledge questionnaire before, after and 8 weeks later Qualitative data through focus groups e-Bug www.e-bug.eu

Peer Education Science Show Evaluation A significant improvement in knowledge for all topics, for both primary and secondary students. No significant decline in knowledge 8 weeks post workshop. For some topics, peer educators had a higher level of knowledge retention compared to non-peer educators. Teachers commented on peer educators behaviour : “their confidence just grew throughout the day” “I think they’re more responsive to some of their learning [since the workshop]…I think there’s a better behaviour, better focus and generally they’re, they’ve improved, some of them, in their skills” e-Bug www.e-bug.eu

Beat the Bugs

Beat the Bugs Beat the Bugs is a fun and interactive community course which aims to increase awareness and change behaviour around hygiene, self-care and antibiotics. Each session has a range of activities to suit different ages and abilities. The course covers: 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 e-Bug www.e-bug.eu

Beat the Bugs pilot A pilot course was undertaken with 7 adults with learning disabilities. Participants and course leader gave feedback, and sessions were observed for fidelity, and to look for opportunities for improvement 3 month follow up Overall participants enjoyed the course Results suggest knowledge had improved. At the follow up, participants reported: washing their hands more often using the 6 steps of hand washing brushing their teeth more often consuming less high sugar drinks e-Bug www.e-bug.eu

Managing Your Infection leaflet e-Bug www.e-bug.eu

What’s next for e-Bug?

e-Bug Train the Trainer Training programme for teachers, school nurses and other educators to learn about e-Bug and how to deliver the activities. On completion of the course, participants would become Accredited e-Bug Trainers. Pilot over the next few months. e-Bug www.e-bug.eu

Thank you! Any questions? www.e-Bug.eu The e-Bug team in England: Dr Cliodna McNulty Project Lead Dr Vicki Young Project Manager Charlotte Eley Research Assistant Cath Hayes Project Assistant Stephen Cooper Website developer Any questions? www.e-Bug.eu e-Bug www.e-bug.eu vicki.young@phe.gov.uk