1. Dr Vicki Young Catherine Hayes Prof Cliodna McNulty
Pilot evaluations 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

2. Development of Beat the Bugs
e-Bug is an educational resource for 4 to 18 year olds about hygiene, infection and antibiotics
e-Bug expanded its educational resources into the community with the Beat the Bugs course
Beat the Bugs aims to increase awareness and change behaviour around hygiene, infections and antibiotic use in an interactive and fun way
6 week course or independent sessions
Delivered;
BY a range of community leaders
TO a range of community groups
Adaptable with a range of activities
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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

3. Pilot Evaluations of Beat the Bugs
8 participants
Adults who are generally vulnerable with a variety of learning, physical and/or mental health difficulties
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
Pilot 2
4-6 participants
Young parents from a children’s centre with a variety of learning levels and English Language
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
Questionnaires were called ‘quizzes’ to participants
Quizzes had 6 knowledge based statements
Participants circled whether statements were ‘right’, ‘wrong’, or ‘not sure’
*Sessions observed by researcher
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

4. Average correct scores
Meet the Bugs: Overview of microbes and explores types and shapes of microbes, and discusses useful and harmful microbes.
Knowledge
Pilot 1
Average correct scores
Pilot 2
Baseline
36%
23%
Post Intervention
89%
63%
Change
53%
40%
Yeast Races
6 week follow up
Participants could recall the
three types of microbes.
“The parents really liked the visual activities; the arts and crafts especially, you had it spot on with the activities.” (Course Leader, Pilot 2)
What are the 3 types of 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
“It will be bacteria, virus and fungi.” (Participant, Pilot 1)
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

5. Why is it important to wash our hands?
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.
Snot Gun
Knowledge
Pilot 1
Average
correct scores
Pilot 2
Baseline
57%
61%
Post Intervention
69%
94%
Change
12%
33%
6 week follow up
Participants recalled why
we wash our hands.
Participants reported an
Increase in appropriate
hand washing behaviour.
Why is it important to wash our hands?
“ The snot gun was a visual activity and everybody understood how far a sneeze goes and it really caught the parents eyes. I think they enjoyed that one.” (Course Leader, Pilot 2)
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
“So we don’t get any germs to our foods or anywhere that you may catch a cold.” (Participant, Pilot 1)
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

6. Average correct scores
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
Fridge Raiders
Knowledge
Pilot 1
Average correct scores
Pilot 2
Baseline
64%
75%
Post Intervention
Change
11% 0%
6 week follow up
Participants retained knowledge on
where certain foods should be stored
in the fridge.
Where should certain foods go in the fridge?
“Also the meats shouldn’t touch between like dairy or raw meat because it will contain salmonella or food poisoning.” (Participant , Pilot 1)
“The meat has to be in the bottom… otherwise it would be leaking down”
(Participant , Pilot 2)
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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

7. Mouth Bugs: Covers how to prevent tooth decay through limiting sugar intake and brushing teeth twice a day
Knowledge
Pilot 1
Average
correct scores
Pilot 2
Baseline
50%
Post Intervention
72%
75%
Change
22%
25%
How much sugar?
6 week follow up
Participants recalled what drinks
contained the most sugar.
Participants reported an increase in
appropriate tooth brushing behaviour.
Why do we brush our teeth?
“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, Pilot 1)
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
“I’ve started brushing [child’s] teeth too” (Participant, Pilot 2)
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

8. Antibiotics: Right or Wrong?
Bug Busters: An overview on what antibiotics are, when to take antibiotics and how to take antibiotics correctly
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.
Knowledge
Pilot 1
Average correct scores
Pilot 2
Baseline
44%
75%
Post Intervention
83%
100%
Change
39%
25%
6 week follow up
Participants in Pilot 1 struggled
to explain what antibiotics are
and when we should take them.
Participants in Pilot 2 still had
high knowledge.
“I am still not convinced they know what antibiotics are but I really got a sense during the course that they understood they didn’t keep tablets, take tablets they didn’t know what they were for and that they would take them back.” (Course Leader, Pilot 1)
“Antibiotics doesn’t
kill flu.”
(Participant,
Pilot 2)
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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

9. Average correct scores
Know Your Bugs: 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.
Managing Your Infection leaflet:
Knowledge
Pilot 1
Average correct scores
Pilot 2
Baseline
70%
75%
Post Intervention
97%
88%
Change
27%
13%
6 week follow up
Participants had retained
Knowledge around
self-care; particularly
getting bed rest and
drinking water.
What can we do to help make ourselves better?
“How long illnesses last
and when they should and shouldn’t go to the doctors were the key learning points.” (Course Leader, Pilot 2)
“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, Pilot 1)
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

10. Summary of results
Questionnaires showed an improvement in participant knowledge in each session
Pilot 1: The microbes and antibiotics sessions reported the highest improvement in knowledge
Pilot 2: The microbes and spreading bugs session reported the highest improvement in knowledge
Participants had retained knowledge in both pilots; particularly around self-care
Participants reported positive behaviour change including an increase in appropriate hand washing and tooth brushing for themselves and their children
Although two very different settings both pilots worked well
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

11. Implications and Conclusion
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
Antibiotics session will be modified with a broader range of activities to aid participant understanding
Flexible sessions; suitable for many different settings and different groups
Further evaluation of Beat the Bugs is required with different community groups and on a larger scale to determine transferability of the course
Further promotion of Beat the Bugs is required; through training workshops. Contact if you are interested in receiving Beat the Bugs training!
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics