Effectiveness of nudge-based visual storytelling in antibiotic adherence in uncomplicated urinary tract infection in Pakistan: protocol for a randomized controlled trial
Abstract
Antibiotic resistance (ABR) is a global health threat, significantly driven by its misuse. The World Health Organization stresses the need for better antibiotic use to combat ABR through behavioral change interventions. Visual storytelling, which merges narrative with visuals, can enhance health behaviors by boosting cognitive and emotional engagement. In Pakistan, more than half of the population lack access to mobile phone, limiting digital health solutions. To address this gap, we developed a culturally tailored Visual Storytelling for Antibiotic Adherence (VISTA) intervention – a theory-driven sticker-based tool – to improve antibiotic adherence among urinary tract infection (UTI) patients in low-connectivity settings. In this parallel, two-arm superiority randomized controlled trial, participants with physician-confirmed uncomplicated UTI who have filled an oral antibiotic prescription will be recruited from six tertiary care hospitals in Khyber Pakhtunkhwa, Pakistan. The participants will be randomized in a 1:1 manner to receive either the VISTA intervention or standard care. The VISTA intervention was developed based on nudge theory, guided by the Taxonomy of Choice Architecture framework, and complemented by the MINDSPACE (messenger, incentives, norms, defaults, salience, priming, affect, commitments, and ego) framework. It was developed and validated through a Delphi method, assessing expert feedback, and refined based on a patient understanding study. The…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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