Effectiveness of a Theory‐Informed Antimicrobial Stewardship Educational Intervention in Pharmacy Students: A Stepped‐Wedge Study

BACKGROUND: Developing antimicrobial stewardship (AMS) competencies is an essential priority in pharmacy education. However, stewardship training in many curricula remains largely knowledge-based, with limited implementation of theory-informed learning strategies and longitudinal competency evaluation. The objective of this study is to evaluate the effectiveness of a theory-informed, multicomponent Digital Antimicrobial Stewardship Education Intervention (DASEI) in improving AMS-related knowledge, clinical reasoning, perceptions, and attitudes among undergraduate pharmacy students. METHODS: A cluster stepped-wedge quasi-experimental design with repeated measurements was conducted among undergraduate pharmacy students across eight clusters. The intervention combined webinar-based learning, case-based polling, vignette simulations, and reinforcement microlearning grounded in the Capability, Opportunity, Motivation-Behavior (COM-B) framework. Outcomes were assessed at baseline (T0), postintervention (T1), and follow-up (T2-T4) using validated instruments and were analyzed using linear mixed-effects models. RESULTS: A total of 268 participants (mean age 20.8 ± 1.6 years; 72.4% female) were included. Mean antibiotic knowledge scores increased from 16.08 ± 3.20 at baseline to 20.96 ± 2.70 at follow-up, while vignette-based decision-making scores improved from 3.46 ± 1.10 to 5.01 ± 0.70. Perception and attitude scores increased from 3.82 ± 0.54 to 4.04 ± 0.43 and from 3.70 ± 0.52 to 4.10 ± 0.42, respectively. Mixed-effects analysis demonstrated significant intervention effects across outcomes (p < 0.05), with sustained improvements over time and variation across academic levels. CONCLUSION: The theory-informed 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-constrained educational settings.