Strama's 10-point program in practice

Objectives and Target Audience

Objective(s)

1. Support healthcare providers in implementing practical antibiotic stewardship actions in clinical settings.
2. Translate Sweden’s national 10-point AMR strategy into everyday practice at hospitals and clinics.

Target audience

Nurses

General practitioners

Medical doctors

Medical students

Campaign Scope

National

Communication Strategy

Communication Channels Used

Printed materials

websites/blogs

Campaign Material(s)

Tools & checklists

Brochure

PowerPoints

Key messages

Potentially:
1. Antibiotic stewardship is everyone’s responsibility.
2. Simple actions like reviewing prescriptions daily, optimizing duration, and documenting indication can have major impacts.
3. Follow-up, evaluation, and feedback loops are essential to success.

Campaign Focus

Human health

Campaign Setting

GP practice

Design and Content

Use of Scientific Evidence

Yes

Visual and Symbolic Elements

Use of colors

Icongraphy

Symbols

Pedagogical Approach

Educational model applied

Transmissive

Participatory

Content Complexity Level

Specialized

Diversity and Inclusion

Content accessibility

Diversity and Inclusion

Involvement of Vulnerable Groups

Cultural Sensitivity and Contextualization

Yes

Dissemination and Sustainability

Replicability

Yes

Content usage license

Free

Campaign Status

Active

Impact Evaluation

Evaluation methods used

Prescription surveillance

Provider feedback

Community participation in evaluation

Yes

Quantitative impact indicators

Download

Adherence rates

Reduction in total antibiotic prescribing

Number of antibiotics prescribed per 1000 patients

Qualitative impact indicators

Attitude changes

Feedback

Increase awareness

Measured results

Known from STRAMA publications:
1. Used as part of broader national success: Sweden met its “250 prescriptions per 1000 inhabitants” goal.
2. Several hospitals reported lower prescribing and improved documentation after adoption.

Lessons and Observations

Identified gaps

No scientific evidence or references, unclear if evidence-based

Credibility assumed due to source, no references

Accessible formats for hearing impaired users not provided

Accessible formats for visually impaired users not provided

No adaptation for different age groups

Frequently Asked Questions (FAQs) section not included

Campaign timeline information incomplete or missing

Interactive features not included

Feedback or audience involvement not visible

Reporting on results or impact not found

Outreach activities not documented

1. No interactive e-learning version or digital checklist app.
2. No data reporting if fully adapted for primary care or outpatient settings.
3. Limited visibility of patient perspectives or cross-cultural adaptation.

Lessons learned

Multilingual materials may reach more diverse communities.

Tailoring content to specific groups (e.g., parents, seniors, teens) may enhance impact.

Partnering with schools, municipalities, and local groups may enhance credibility and distribution.

1. Practical tools based on evidence and teamwork can drive cultural change.
2. Stewardship implementation works best when broken into daily, actionable steps.
3. Visual and checkable formats aid clinical adoption.

Identified biases

Digital Access Bias

Digital Literacy Bias

Disability Accessibility Bias

Educational Bias

Evaluation Absence Bias

Involvement Bias

Scientific Basis Bias

Vulnerable Groups Bias

1. Content is based on the Swedish system; transferability elsewhere may be limited.
2. Assumes baseline access to infection specialists and stewardship teams.

Identified Weaknesses

Limited feedback loop

Limited accessibility

Limited reach / Single channel

1. Lacks dynamic tools like apps or decision aids.
2. No embedded evaluation system.
3. Dependent on clinicians’ willingness to use and explain the content.
4. Limited centralized tracking of implementation across hospitals.

Identified Strengths

Dedicated website or online portal

Easy to locate materials

1. Trusted national authority: STRAMA, originally a nongovernmental initiative, has earned high credibility among Swedish physicians and now functions as an advisory board to the Public Health Agency of Sweden (PHAS).
2. It is participatory: Requires team collaboration, daily integration in clinical routines.
3. Clear, concise checklist format.
4. Grounded in real-world clinical practice.
5. Flexible for local adaptation and interdisciplinary teamwork.

Documents