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

2. Presentation Outline 2 1.Final Sample 2.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 3 15-18 years project qualitative 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

4. Vaccines: Attitudes 4 15-18 years project qualitative results Dislike having vaccinations Low knowledge Not sure if they work Don’t consider them in everyday life Concerns about side effects Not having vaccinations 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 Solutions 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

5. Vaccines: Subjective Norms 5 15-18 years project qualitative results Attitude towards behaviour & behavioural beliefs Not having vaccinations Perceived objections in society Peers don’t think they are important Parents influence views and withhold consent Control Beliefs & Perceived Behavioural Control 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 Solutions “Young people are not particularly interested.” Student, CY

6. Vaccines: Control Beliefs 6 15-18 years project qualitative results Attitude towards behaviour & behavioural beliefs Not having vaccinations Subjective Norms & Normative Beliefs Fear of needles and foreign bodies Organisational factors – cost, accessibility, communication Negative media coverage 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. Solutions “The worst bit is actually the needle” Student, UK

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. 7 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 8 15-18 years project qualitative results

9. Antibiotics Results 9 15-18 years project qualitative results 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

10. Why don’t students finish their course? 10 15-18 years project qualitative results Low knowledge Worry about side effects Don’t like taking medication Subjective Norms & Normative Beliefs Control Beliefs & Perceived Behavioural Control Not finishing the course of antibiotics 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 Solutions “We are cured, why continue?” Student, SA

11. 11 15-18 years project qualitative results Why don’t students finish their course? Attitude towards behaviour & behavioural beliefs ‘Normal’ to not finish course Not an interesting or important topic to their peers Control Beliefs & Perceived Behavioural Control 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). Solutions “They don’t talk about it because it is not important for them” Student, SA

12. 12 15-18 years project qualitative results Why don’t students finish their course? Attitude towards behaviour & behavioural beliefs Subjective Norms & Normative Beliefs Taking tablets is difficult, e.g. swallowing and taste Forget when they feel better Think they are too busy Not finishing the course of antibiotics 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 Solutions “A lot of young people have so much on their plate… so they forget” Student, UK

13. Why do students take antibiotics for RTIs? 13 15-18 years project qualitative results Low knowledge Personal experience of taking antibiotics Subjective Norms & Normative Beliefs Control Beliefs & Perceived Behavioural Control Taking antibiotics for an RTI 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 Solutions “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

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

15. Why do students take antibiotics for RTIs? 15 15-18 years project qualitative results Attitude towards behaviour & behavioural beliefs Subjective Norms & Normative Beliefs Easy to get from the GP (expect antibiotics) or Pharmacy Taking antibiotics for an RTI 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 Solutions “There is a reckless use, they can even get them from pharmacies without a prescription” Educator, CY

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. 16 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 17 15-18 years project qualitative results

18. Resource Suggestions Academic LessonsAll students – cross curricular Website Structured lesson plans Independent research projects Links to evidence/research Presentations Books Take home resources Website (for access at home) Case studies Stimulus questions for debate Interactive films and animations Peer education (health promotion stands or conferences) Guest speakers from experts GP surgeries and self-careSchool nurses and support services Leaflet for consultations Reminders (phone app/ automated messaging) Guidance for GPs Leaflet for school support services/school nurse Guidance for vaccination campaigns in schools Resources for school nurses 18 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 19 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. 20 15-18 years project qualitative results Discussion topicTime 1. Lesson Plans10 minutes 2. Peer Education 40 minutes 3. Interview or Q&A with Experts 4. Films and Animations 5. Case studies 6. Debate cards 7. Leaflets and Apps15 minutes 8. Websites20 minutes

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

22. Resource Option 1: Activities 1.What are the pros and cons of each of these ideas? 2.Are there any other ideas you have for the activities? 22 15-18 years project qualitative results Films and Animations Peer EducationInterviews with an Expert

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

24. Resource Option 2: Activities 1.What are the pros and cons of each of these ideas? 2.Are there any other ideas you have for the activities? 24 15-18 years project qualitative results Student Debate Case Studies

25. 25 Resource Option 2: Leaflets and Apps 1.Should we create a leaflet? 2.Where and how do you think the leaflet could be used? 3.Should we link to a reminder app for taking medication? 15-18 years project qualitative results Reminder App Health Leaflets

26. Resource Option 3: Websites 1.Should we have an e-bug 16-18 year old website, or should we create links? 2.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? 26 15-18 years project qualitative results

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