The TAP Manual: An In-depth Guide for Planning and Implementing Tailoring Antimicrobial Resistance Programmes

"The TAP approach is based on the belief that people's health behaviours can change, and that health goals can be reached only if health programmes achieve a genuine understanding of people's needs, perspectives and the reasons why they do not always engage in recommended behaviours."

Antimicrobial resistance (AMR) is a public health challenge that threatens the effective prevention and treatment of a growing range of infections caused by bacteria, parasites, viruses, and fungi. Yet, guidelines, restrictive measures, and best practice advice designed to address the rise and spread of AMR are not always implemented effectively in practice. This policy challenge requires re-thinking how AMR interventions can be tailored to specific contexts. Developed by the World Health Organization (WHO) Regional Office for Europe, this Tailoring Antimicrobial Resistance Programmes (‎TAP)‎ manual is intended to be used by anyone interested in using a behavioural insights approach to design and plan interventions to reduce AMR in their national and local contexts.

The manual is aligned with a behavioural insights approach called Tailoring Immunization Programmes (TIP). This approach was developed by the WHO Regional Office for Europe to support countries in achieving high and equitable vaccination uptake through understanding the barriers to vaccination among population groups with suboptimal coverage.

Inspired by TIP, the TAP process provides a systematic approach to understanding and addressing drivers of, and barriers to, AMR-related health behaviour. It is based in part on the Behaviour Change Wheel (BCW) model, which is designed to help a range of users, including practitioners and researchers, apply behaviour change theory to their work. At the core of the BCW model is the Capability, Opportunity and Motivation for Behaviour change (COM-B) framework. The BCW links the COM-B factors to 9 common intervention functions and 7 policy categories to enable intervention development.

TAP offers an approach to project development that is broad at the outset and becomes increasingly focused at each step of the process to result in a targeted intervention. It is:

• Evidence-based: The TAP approach is rooted in evidence from behavioural and psychological science and literature. National processes draw on national, subnational, and global data and evidence, as well as social science research methods, to obtain context-specific data and insights.
• Underpinned by health goals: The TAP process helps public health authorities with enabling, supporting, and motivating recommended health behaviours among different groups in order to reach national health goals.
• People-centred: End-user needs and perspectives are valuable and guide action. Public health authorities must be able to engage, listen to, and understand the communities and individuals they serve.
• Focused on equity: TAP is based on the belief that all people should be able to achieve their full health potential, regardless of their social position or other socially determined circumstance.
• Participatory: Stakeholders are engaged from project conception, promoting ownership and shared responsibility.

The manual has 2 parts. The first introduces readers to the behaviour-related drivers of AMR and provides an overview of the TAP model, defining the values and principles on which the TAP model is built and describing its theoretical foundation. The second part provides a detailed step-by-step walkthrough of the 5-stage TAP process, which is built on a set of core values and principles and supported by a peer-reviewed theoretical model. The approach has been developed as part of an overall vision of integrating people-centred research and social science methods into health programme planning and policy. The 5 stages include:

1. Engage: Undertake a capacity assessment to determine the feasibility, scope, and scale of a proposed TAP project, and establish a TAP working group to provide project oversight, engage stakeholders, and prepare a project plan.
2. Analyse: Conduct a situation analysis that explores a proposed AMR topic in depth by drawing on available literature, reports, input from stakeholder discussions, and other relevant data.
3. Prioritise: Carry out additional qualitative/quantitative research focused on understanding drivers and barriers to performing a specific behaviour(s) within a specific population(s).
4. Design: Use data gathered from the previous 2 stages to design and plan a behaviour change intervention.
5. Do it: Implement, monitor, and evaluate the intervention, which may also be adjusted and sometimes scaled-up.

In addition to the figures and tables in the TAP manual, 2 types of boxes appear throughout:

• Inspiration boxes, which provide inspiration on how to carry out a suggested activity or suggest what to consider in planning and implementing steps in the process; and
• Example boxes, which give concrete examples of how other TAP projects have approached a given step or activity.

Two separate publications, a TAP quick guide and toolbox, have also been developed to serve as a quick reference to information presented here and provide additional guidance. Corresponding exercises and tools in the quick guide and toolbox are referenced throughout the manual. See Related Summaries, below, for access.

The TAP model is being piloted in multiple countries worldwide and is a work in progress. As it is implemented in more countries and contexts, feedback on this manual and the process as a whole is welcome and can be sent to: euantimicrobials@who.int or eupress@who.int