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Developing and evaluating interventions to reduce inappropriate prescribing by general practitioners of antibiotics for upper respiratory tract infections: A randomised controlled trial to compare paper-based and web-based modelling experiments

Shaun Treweek1*, Ian W Ricketts2, Jillian Francis3, Martin Eccles4, Debbie Bonetti5, Nigel B Pitts5, Graeme MacLennan3, Frank Sullivan1, Claire Jones2, Mark Weal6 and Karen Barnett1

Author Affiliations

1 Quality, Safety and Informatics Research Group, University of Dundee, Kirsty Semple Way, Dundee, UK

2 School of Computing, University of Dundee, Queen Mother Building, Dundee, UK

3 Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresthill, Aberdeen, UK

4 Institute of Health and Society, University of Newcastle, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK

5 Clinical and Population Science and Education, University of Dundee, Kirsty Semple Way, Dundee, UK

6 School of Electronics and Computer Science, University of Southampton, Southampton, UK

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Implementation Science 2011, 6:16  doi:10.1186/1748-5908-6-16

Published: 3 March 2011



Much implementation research is focused on full-scale trials with little evidence of preceding modelling work. The Medical Research Council Framework for developing and evaluating complex interventions has argued for more and better theoretical and exploratory work prior to a trial as a means of improving intervention development. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting general practitioners (GPs) with a clinical scenario about making a treatment decision.


The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing for upper respiratory tract infections in primary care. The study will also include a trial of email versus postal invitations to participate.


More effective behaviour change interventions are needed and this study will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the National Health Service where behaviour needs to be modified, including interventions aimed directly at the public.

Trial registration

ClinicalTrials (NCT): NCT01206738