1. 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

2. 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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

3. 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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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
Pilot evaluation of Beat the Bugs: A community education course on hygiene, self-care and antibiotics

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