Results: Attitudes towards antibiotics and Vaccinations amongst 15-18 year olds

1. Results:Attitudes towards antibiotics and Vaccinations amongst 15-18 year olds Meredith Hawking, Public Health England

2. Presentation Outline • Final Sample • Vaccination results • Agree Learning Objectives • 3. Antibiotics results • Agree Learning Objectives • 4. Resource Suggestions • Final Recommendations for educational resource • 5. Introduction to discussion group topics 15-18 years project qualitative results

3. Vaccination Results cancer cause cervical coming decision disease doctors effects even fear friends girls good happen hurt important informed injection issue make mean much need needle okay pain parents people personally pressure prevent protect quite reasons scares school side still stop students taking talk thought time told vaccines well worry year young 15-18 years project qualitative results

4. Solutions • Include information about vaccines, how they work and the vaccines they need • Link to relevant examples e.g. outbreaks amongst 15-18 year olds • Include debate about side effects and critique of media coverage around vaccines Vaccines: Attitudes • Dislike having vaccinations • Low knowledge • Not sure if they work • Don’t consider them in everyday life • Concerns about side effects Not having vaccinations Subjective Norms & Normative Beliefs Control Beliefs & Perceived Behavioural Control “There are vaccines that seem unnecessary…I am not being vaccinated because I do not see the point.” Student, FR 15-18 years project qualitative results

5. Solutions • Include case studies and viewpoints around vaccines • Resource should be available for students when they need vaccines, via website and vaccine clinics and link to travelling, university and work placements • Include parents by take-home resources and links to school campaigns Vaccines: Subjective Norms Attitude towards behaviour & behavioural beliefs • Perceived objections in society • Peers don’t think they are important • Parents influence views and withhold consent Not having vaccinations Control Beliefs & Perceived Behavioural Control “Young people are not particularly interested.” Student, CY 15-18 years project qualitative results

6. Solutions • Include phobia reducing resources, such as a video of having a video • Information and guidance on where and how students can get vaccines and find out their vaccine history • Focus on the news coverage around vaccines and how it influences the public, e.g. MMR leading to measles outbreaks today. Vaccines: Control Beliefs Attitude towards behaviour & behavioural beliefs Subjective Norms & Normative Beliefs Not having vaccinations • Fear of needles and foreign bodies • Organisational factors – cost, accessibility, communication • Negative media coverage “The worst bit is actually the needle” Student, UK 15-18 years project qualitative results

7. Vaccines: Learning Objectives 1 • Understanding Vaccines • Why vaccines are important to young people • How vaccines work • The important diseases prevented by vaccines, and why these are important to young people including you. • Why some vaccinations need boosters when you are a teenager and later. • That a vaccine is only introduced by Ministries of Health if it is effective • Natural immunity is not better than a vaccine induced immunity, and comes with the risk of severe disease due to the infection. • Vaccines prevent against many different infections or many types of a single infectious disease in one injection • How new vaccines are made. 15-18 years project qualitative results

8. Vaccines: Learning Objectives 2 • Vaccine Controversy • How media can affect vaccine uptake positively and negatively • Be able to evaluate different views about vaccines and the reasons for them • Understand their future role if they become parents • The role of herd immunity. • That major side effects are very rare • Having Vaccinations and Practical help • The importance of getting the correct vaccines for travel • How/where to access vaccines (including non-standard vaccines), your vaccine history, and which vaccinations you need • There is no need to be afraid of vaccines, the process is almost painless 15-18 years project qualitative results

9. actually always antibiotics anything aware bacteria better course doctor effects enough explain feeling finish follow friends given going happen important infection informing instructions issue laugh medications medicine parents people persuade probably problem properly quite realise reasons remember resistance school sometimes starts still student tablets taken taking vaccines whole worry young Antibiotics Results 15-18 years project qualitative results

10. Low knowledge • Worry about side effects • Don’t like taking medication Why don’t students finish their course? Solutions • Increase knowledge through educational resource • Information on how to manage common side effects • Explain how antibiotics work and the consequences if you don’t finish the course Not finishing the course of antibiotics Subjective Norms & Normative Beliefs Control Beliefs & Perceived Behavioural Control “We are cured, why continue?” Student, SA 15-18 years project qualitative results

11. Why don’t students finish their course? Attitude towards behaviour & behavioural beliefs Solutions • ‘Normal’ to not finish course • Not an interesting or important topic to their peers Not finishing the course of antibiotics • Challenge the belief that it is normal to not finish the course via peer education and case studies • Make the resource and examples relevant to students and available for when they are taking them (and are more open to information). Control Beliefs & Perceived Behavioural Control “They don’t talk about it because it is not important for them” Student, SA 15-18 years project qualitative results

12. Attitude towards behaviour & behavioural beliefs Solutions Why don’t students finish their course? • Suggestions to help them swallow, e.g. practicing with TicTacs, breaking tablets in half • Simple ways to remind students, e.g. phone app • Include information on alcohol and antibiotics • Information on what to do if they forget a tablet Subjective Norms & Normative Beliefs Not finishing the course of antibiotics • Taking tablets is difficult, e.g. swallowing and taste • Forget when they feel better • Think they are too busy “A lot of young people have so much on their plate… so they forget” Student, UK 15-18 years project qualitative results

13. Solutions Why do students take antibiotics for RTIs? • Low knowledge • Personal experience of taking antibiotics • Do not use viral/bacterial distinction but focus on symptoms instead • Information on how antibiotics work • Include information about illness duration, self-limiting illnesses and managing symptoms Taking antibiotics for an RTI Subjective Norms & Normative Beliefs Control Beliefs & Perceived Behavioural Control “He wasn’t sure whether it was viral or bacterial so he gave me antibiotics. After the first week I was still not better, but then after the second week I was better, so taking them must work.” Student, UK 15-18 years project qualitative results

14. Why do students take antibiotics for RTIs? Attitude towards behaviour & behavioural beliefs Solutions • Highlight the special nature of antibiotics and the difference between antibiotics and painkillers • Include parents by take-home resources and in consultations • Peers see them as ‘cure all’ • It is normal to take them • Parents agree with use Taking antibiotics for an RTI Control Beliefs & Perceived Behavioural Control “Friends talk about it because it is a treatment for everything, even anaemia.” Student, SA 15-18 years project qualitative results

15. Why do students take antibiotics for RTIs? Solutions Attitude towards behaviour & behavioural beliefs • Students are happy to re-consult so delayed prescribing or no-prescribing are options • This finding supports interventions for GPs to help manage patient expectations for antibiotics Taking antibiotics for an RTI Subjective Norms & Normative Beliefs • Easy to get from the GP (expect antibiotics) or Pharmacy “There is a reckless use, they can even get them from pharmacies without a prescription” Educator, CY 15-18 years project qualitative results

16. Antibiotics: Learning Objectives 1 • Understanding Antibiotics • Antibiotics are special they are not like other every day medicines • Bacteria are continually adapting to develop ways of not being killed by antibiotics, this is called antibiotic resistance. • Use of antibiotics affects all the bacteria in your body not just the ones causing an infection. • Antibiotic resistant bacteria remain in your body for at least a year • Antibiotic resistance spreads between our own different bacteria within our body, and between people. • We need to use antibiotics only when we are advised by a doctor or nurse • Development of new antibiotics takes at least 10 years, and there are very few new ones in the pipeline. 15-18 years project qualitative results

17. Antibiotics: Learning Objectives 2 • Understanding Antibiotics (Continued) • Bacteria and viruses have different structures. • As each antibiotic only works on specific parts of bacteria, each antibiotic only works against particular types of bacteria. • Antibiotics do not have any effect against your immune system • Taking antibiotics and practical help • Antibiotics should always be taken as instructed by a doctor or nurse. • If you forget an antibiotic dose, always take it as soon as you remember, even if it means taking two at once. Then finish the rest of the course as instructed. • You should care for yourself at home for most sore throats, earache, coughs, colds and flu using painkillers and other remedies to reduce your symptoms 15-18 years project qualitative results

18. Resource Suggestions 15-18 years project qualitative results

19. What can and should we create? • Websites - The internet is the first point of call for students, easily accessible, time to process information, hard to reach students • Peer Education – suggested by students so that they can relate to the person teaching them • Films and Animations – popular suggestions from students in all countries • Debate – engage their thinking and debating skills, hearing other peoples viewpoints and expressing opinions • Case studies – relevant to their lives, respond well to personal stories • Leaflets – suitable for different environments, practical health information • Reminder App – to tackle forgetfulness around taking antibiotics • Interviews or Q&A with experts – students wanted expert advice and visitors to teach them 15-18 years project qualitative results

20. Discussion Groups • There are 8 Discussion Packs • Please move on to the next topic when Amy gives the signal. 15-18 years project qualitative results

21. Resource Option 1: Lesson Plans • Is a 40-50 minute academic science lesson plan covering: 1) antibiotics and 2) vaccines relevant to the educational structure in your country? • Are shorter 10-20 minute flexible activities covering 1) antibiotics and 2) vaccines relevant to the educational structure in your country? 15-18 years project qualitative results

22. Resource Option 1: Activities • What are the pros and cons of each of these ideas? • Are there any other ideas you have for the activities? Peer Education Interviews with an Expert Films and Animations 15-18 years project qualitative results

23. “The student as the actor” French Teacher Peer Education Educators Learning for students Peers Peer Educators Parents Develop a range of skills Other students Parents Learning from their peers 15-18 years project qualitative results

24. Resource Option 2: Activities • What are the pros and cons of each of these ideas? • Are there any other ideas you have for the activities? Student Debate Case Studies 15-18 years project qualitative results

25. Resource Option 2: Leaflets and Apps • Should we create a leaflet? • Where and how do you think the leaflet could be used? • Should we link to a reminder app for taking medication? Reminder App Health Leaflets 15-18 years project qualitative results

26. Resource Option 3: Websites • Should we have an e-bug 16-18 year old website, or should we create links? • Which key functions are the most important? • Topics (a-z style) (e.g. AMR, immunity) or sections (revision section, lesson resources) • “Ask an expert” function or feedback/ contact us section (Example on Teenage Health Freak website) • Chat room style forum or links to social media (e.g. Twitter and Facebook) • Search function • App store links to download reminder apps (Example on S-Cool site) • ‘What’s new?’ section (like the news section on the teacher e-Bug site) • 3. Is there a well known website in your country young people go to for health? 15-18 years project qualitative results

27. Thank you • To collaborating partners for your hard work, and to educators and students for taking part. 15-18 years project qualitative results