ABSTRACT
Self-organization is prevalent in local agri-food systems (LAFS), which must often adapt rapidly to both internal and external pressures. This was evident during the COVID-19 pandemic, which required rapid self-organization in LAFS due to increased demand for smaller-scale and localized food producers and distributors. Previous research has explored drivers of self-organization in LAFS, often as an artifact of slow-boil socioeconomic or environmental crises. However, there is less research investigating the ingredients required for self-organization to successfully materialize. This paper argues that there is a gap in both the literature and practice that overlooks three core elements required for effective self-organization, or ideas that can transition from thought into action. These fundamental elements–agency, demand, and resource–must all be present and work in harmony for effective self-organization to occur and must be understood as a package. From evidence collected through "patchwork ethnographic” research in Oxford, UK and Freiburg, Germany this paper details how these elements impact decisions and actions taken by LAFS actors. Understanding these core elements can have practical ramifications for practitioners, facilitating better understanding of why ideas or actions may be (in)effective and how to foster effective self-organization, as well as highlighting avenues for self-organization research. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
ABSTRACT
BACKGROUND: Antimicrobial resistance (AMR) is affected significantly by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible use of antimicrobials, and is essential for limiting AMR. Nurses have an important role to play in this context. AIM: To investigate the determinants of nurse AMS behaviours and the impact of past training. METHODS: A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses {223 female; mean age 44.45 [standard deviation (SD) 10.77] years} of 10 nationalities, with individual survey links sent via professional networks in five countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were assessed quantitatively using the Theoretical Domains Framework (TDF), and mapped to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Analysis identified differences between nurses with and without AMS training. The influence of coronavirus disease 2019 (COVID-19) on AMS behaviour was investigated qualitatively using free-text data. FINDINGS: Nurses performed all nine AMS behaviours, which were significantly higher [t (238) -4.14, P<0.001] among those who had received AMS training [mean 53.15 (SD 7.40)] compared with those who had not received AMS training [mean 48.30 (SD 10.75)]. Nurses who had received AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with 'Skills' and 'Behavioural regulation' (e.g. ability to self-monitor and plan) shown to be the most predictive of AMS actions. Both of these domains are situated in the 'Capability' construct of the COM-B model, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since the COVID-19 pandemic, regardless of previous training. Six core themes were linked to AMS: (1) infection prevention and control; (2) antimicrobials and antimicrobial resistance; (3) diagnosis of infection and use of antibiotics; (4) antimicrobial prescribing practice; (5) person-centred care; and (6) interprofessional collaborative practice. CONCLUSION: Nurse training has a significant beneficial effect on AMS behaviour and its determinants. Nurses who had received AMS training scored higher in all TDF determinants of behaviour compared with those who had not received AMS training, resulting in higher capability, opportunity and motivation to perform AMS behaviour. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimize AMS behaviour, with a focus on developing skills and behavioural regulation.