{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:49:27Z","timestamp":1791514167910,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Am Coll Clin Pharm"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Developing antimicrobial stewardship (AMS) competencies is an essential priority in pharmacy education. However, stewardship training in many curricula remains largely knowledge\u2010based, with limited implementation of theory\u2010informed learning strategies and longitudinal competency evaluation. The objective of this study is to evaluate the effectiveness of a theory\u2010informed, multicomponent Digital Antimicrobial Stewardship Education Intervention (DASEI) in improving AMS\u2010related knowledge, clinical reasoning, perceptions, and attitudes among undergraduate pharmacy students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cluster stepped\u2010wedge quasi\u2010experimental design with repeated measurements was conducted among undergraduate pharmacy students across eight clusters. The intervention combined webinar\u2010based learning, case\u2010based polling, vignette simulations, and reinforcement microlearning grounded in the Capability, Opportunity, Motivation\u2010Behavior (COM\u2010B) framework. Outcomes were assessed at baseline (T0), postintervention (T1), and follow\u2010up (T2\u2013T4) using validated instruments and were analyzed using linear mixed\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 268 participants (mean age 20.8\u2009\u00b1\u20091.6\u2009years; 72.4% female) were included. Mean antibiotic knowledge scores increased from 16.08\u2009\u00b1\u20093.20 at baseline to 20.96\u2009\u00b1\u20092.70 at follow\u2010up, while vignette\u2010based decision\u2010making scores improved from 3.46\u2009\u00b1\u20091.10 to 5.01\u2009\u00b1\u20090.70. Perception and attitude scores increased from 3.82\u2009\u00b1\u20090.54 to 4.04\u2009\u00b1\u20090.43 and from 3.70\u2009\u00b1\u20090.52 to 4.10\u2009\u00b1\u20090.42, respectively. Mixed\u2010effects analysis demonstrated significant intervention effects across outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), with sustained improvements over time and variation across academic levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The theory\u2010informed DASEI model improved AMS competencies among pharmacy students. Integrating structured digital stewardship training into pharmacy curricula may strengthen experiential learning, clinical reasoning development, and readiness for stewardship practice, particularly, in resource\u2010constrained educational settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jac5.70298","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:05:33Z","timestamp":1790132733000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of a Theory\u2010Informed Antimicrobial Stewardship Educational\u00a0Intervention in Pharmacy Students: A Stepped\u2010Wedge Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1248-042X","authenticated-orcid":false,"given":"Ikhwan Yuda","family":"Kusuma","sequence":"first","affiliation":[{"name":"Pharmacy Study Program, Faculty of Health Universitas Harapan Bangsa  Purwokerto Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0357-5313","authenticated-orcid":false,"given":"Rian","family":"Nurahman","sequence":"additional","affiliation":[{"name":"Pharmacy Study Program, Faculty of Health Universitas Harapan Bangsa  Purwokerto Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4813-6749","authenticated-orcid":false,"given":"Nelly","family":"Maryanti","sequence":"additional","affiliation":[{"name":"Pharmacy Study Program, Faculty of Health Universitas Harapan Bangsa  Purwokerto Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7064-4203","authenticated-orcid":false,"given":"Muhammad Jayyid","family":"Zidan","sequence":"additional","affiliation":[{"name":"Pharmacy Study Program, Faculty of Health Universitas Harapan Bangsa  Purwokerto Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02724-0"},{"key":"e_1_2_12_3_1","unstructured":"WHO \u201cAntimicrobial Resistance \u201d2023 accessed March 20 2026 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/antimicrobial\u2010resistance."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010021\u201011885\u20104"},{"key":"e_1_2_12_5_1","unstructured":"T.Rizvi \u201cExploring the Role of Community Pharmacists in Antimicrobial Stewardship \u201d(PhD thesis University of Tasmania 2021)."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S435190"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11050691"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.46542\/pe.2021.211.432442"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky166"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010023\u201004423\u2010w"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010019\u20101623\u2010x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofx117"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-014-0535-6"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2006.05.007"},{"key":"e_1_2_12_15_1","volume-title":"Kirkpatrick's Four Levels of Training Evaluation","author":"Kirkpatrick J. 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