Pharmacy-Led Digital Education for Rational Antibiotic Use in Companion Animals: A Randomized Controlled Trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was performed at the individual student level rather than by class or school, and the digital intervention is not one-to-one tutoring.
    • "Participants were randomly assigned in a 1:1 ratio to either the research group or the control group using a computer-generated random number sequence. Simple randomization was employed without stratification." (p. 11)
    • Relevant Quotes: 1) "A total of 66 undergraduate students met the eligibility criteria and were randomized in a 1:1 ratio to the control group (n = 33) or the research group (n = 33)." (p. 3) 2) "Participants were randomly assigned in a 1:1 ratio to either the research group or the control group using a computer-generated random number sequence. Simple randomization was employed without stratification." (p. 11) 3) "The materials were delivered via the LINE application over three consecutive days, and participants were able to ask questions, which were answered by a supervising pharmacist." (p. 11) Detailed Analysis: Criterion C requires randomization at the class level (or stronger school level), unless the intervention is a one-to-one/personal tutoring intervention, in which case student-level randomization is acceptable. Here, randomization was performed at the level of the individual undergraduate student using a computer-generated random number sequence, not by class or school. The intervention was self-directed digital educational material (videos and posters) broadcast to each participant via the LINE application rather than personalised one-to-one tutoring, so the tutoring exception does not apply. Because participants were individually randomised (and 90%+ reported having peers or acquaintances who own companion animals, raising a contamination risk), the design does not meet the class-level requirement. Criterion C is not met because randomization was conducted at the individual student level, not at the class or school level, and no tutoring exception applies.
  • E

    Exam-based Assessment

    • The study used a custom author-adapted questionnaire rather than a widely recognised standardised exam.
    • "Antibiotic knowledge was assessed using a 10-item multiple-choice questionnaire, adapted from previously published studies." (p. 12)
    • Relevant Quotes: 1) "Antibiotic knowledge was assessed using a 10-item multiple-choice questionnaire, adapted from previously published studies. Each correct response received one point, with total scores ranging from 0 to 10." (p. 12) 2) "Questionnaire items were adapted from previously published studies on antibiotic use and antimicrobial resistance among students and companion animal owners. Content validity, clarity, and relevance were reviewed by a pharmacist and a veterinarian." (p. 12) 3) "Internal consistency reliability was assessed using Cronbach's alpha, which demonstrated acceptable reliability for the knowledge, confidence, and satisfaction scales (Cronbach's alpha >= 0.70)." (p. 12) Detailed Analysis: Criterion E requires a standardised, widely recognised exam-based assessment that is not custom-built for the study. The outcome here was measured with a 10-item multiple-choice questionnaire assembled by the authors (adapted from prior studies) and validated internally by a pharmacist and a veterinarian. This is a researcher-constructed instrument, not a state-wide, national, or otherwise recognised standardised exam. The questionnaire was designed specifically to measure the intervention's target knowledge, which is precisely the type of custom instrument the criterion excludes. Criterion E is not met because outcomes were measured with a custom researcher-adapted questionnaire rather than a recognised standardised exam.
  • T

    Term Duration

    • Outcomes were measured only about three days after baseline, far shorter than one academic term.
    • "Post-intervention assessments were administered to both groups three days after baseline data collection." (p. 11)
    • Relevant Quotes: 1) "The materials were delivered via the LINE application over three consecutive days, and participants were able to ask questions, which were answered by a supervising pharmacist." (p. 11) 2) "Post-intervention assessments were administered to both groups three days after baseline data collection." (p. 11) 3) "First, the short intervention period and brief follow-up limited our ability to assess long-term knowledge retention, sustained confidence, or enduring behavioral change related to antibiotic use in companion animals." (p. 9) Detailed Analysis: Criterion T requires outcomes to be measured at least one full academic term (roughly 3-4 months) after the intervention begins. Here the intervention was delivered over three consecutive days and the post-intervention assessment was administered only three days after baseline data collection. The authors themselves acknowledge the "short intervention period and brief follow-up." The interval from intervention start to outcome measurement is a matter of days, far short of one term. Criterion T is not met because outcomes were measured only about three days after baseline, far shorter than one academic term.
  • D

    Documented Control Group

    • The control group's demographics, size, baseline scores, and no-treatment condition are clearly documented.
    • "Participants assigned to the control group did not receive any educational materials during the study period and continued to obtain information from their usual sources." (p. 11)
    • Relevant Quotes: 1) "During follow-up, two participants in the research group lost contact, resulting in a final analytical sample of 33 participants in the control group and 31 participants in the research group." (p. 3) 2) "Baseline demographic and background characteristics are presented in Table 1. Participants in both groups were predominantly female and first-year undergraduate students... No statistically significant differences were observed between groups for demographic variables, academic characteristics, companion animal ownership, caregiving experience, or monthly income (p > 0.05 for all comparisons)." (p. 3) 3) "At baseline, no significant difference in mean knowledge scores was identified between the control and research groups (7.91 +/- 1.76 vs. 8.03 +/- 1.66; p = 0.700)." (p. 6) 4) "Participants assigned to the control group did not receive any educational materials during the study period and continued to obtain information from their usual sources." (p. 11) Detailed Analysis: Criterion D requires that the control group be well-documented, including demographics, baseline performance, size, and conditions. The paper provides a dedicated control-group column (n = 33) in Table 1 with full demographic and background characteristics (sex, faculty, year of study, animal type, income, information sources), reports the control group's baseline and post-test knowledge scores (Table 4), and explicitly states the control group received no educational materials and continued business-as-usual information sources. This constitutes clear documentation of the control group. Criterion D is met because the control group's demographics, size, baseline scores, and conditions are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Randomization occurred at the individual student level within one university, not at the school level.
    • "Participants were randomly assigned in a 1:1 ratio to either the research group or the control group using a computer-generated random number sequence." (p. 11)
    • Relevant Quotes: 1) "Participants were randomly assigned in a 1:1 ratio to either the research group or the control group using a computer-generated random number sequence. Simple randomization was employed without stratification." (p. 11) 2) "A randomized controlled trial was conducted among undergraduate students who owned companion animals in Maha Sarakham Province, Thailand." (Abstract, p. 1) Detailed Analysis: Criterion S requires randomization at the school level, i.e., entire institutions or units being assigned to conditions. In this study randomization occurred at the level of individual undergraduate students within a single university setting (Mahasarakham University). No schools, sites, or institutional units were randomly assigned; the unit of randomization was the individual participant. Criterion S is not met because randomization was at the individual student level within one university, not at the school level.
  • I

    Independent Conduct

    • The same team that designed the intervention also delivered, collected, and analysed the study, with no independent external evaluator.
    • "The content was developed by two PharmD students under the supervision of a licensed pharmacist and a veterinarian." (p. 11)
    • Relevant Quotes: 1) "The content was developed by two PharmD students under the supervision of a licensed pharmacist and a veterinarian." (p. 11) 2) "C.P. (Chanuttha Ploylearmsang), C.P. (Chayanan Panmawong), T.C. and J.W. contributed to the conceptualization, study design, and methodology. Material preparation, data collection, and data analysis were performed by C.P. (Chayanan Panmawong) and T.C." (p. 13) 3) "Allocation was conducted by a researcher not involved in outcome assessment to minimize allocation bias. [...] However, data analysis was performed using anonymized datasets." (p. 11) Detailed Analysis: Criterion I requires that the study be conducted independently of the intervention designers, typically via a third-party evaluator. Here the same research team designed the educational intervention (the PharmD students developing content under the supervising pharmacist and veterinarian, all authors), delivered it, and collected and analysed the data. The only internal safeguard mentioned is that allocation was done by a researcher not involved in outcome assessment and that analysis used anonymized data, but this is within the same team, not an external, independent evaluator. There is no statement of third-party or external oversight of the evaluation. Criterion I is not met because the intervention designers also conducted and analysed the study, with no independent external evaluation.
  • Y

    Year Duration

    • The study spanned only a few days, far short of a full academic year, and Term Duration is not met.
    • "The materials were delivered via the LINE application over three consecutive days." (p. 11)
    • Relevant Quotes: 1) "The materials were delivered via the LINE application over three consecutive days." (p. 11) 2) "Post-intervention assessments were administered to both groups three days after baseline data collection." (p. 11) 3) "First, the short intervention period and brief follow-up limited our ability to assess long-term knowledge retention..." (p. 9) Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of a full academic year (roughly 9-10 months) after the intervention begins. The intervention lasted three days and outcomes were measured three days after baseline. This is far shorter than an academic year. In addition, per the ERCT criterion dependency, Y cannot be met when T (Term Duration) is not met, and T is not met here. Criterion Y is not met because the study spanned only a few days, far short of a full academic year, and T is not met.
  • B

    Balanced Control Group

    • The additional educational materials are the explicit treatment variable tested against a business-as-usual control, so the imbalance is by design.
    • "Therefore, the aim of this study was to evaluate the effectiveness of pharmacy-led digital educational interventions, delivered through videos and posters..." (p. 3)
    • Relevant Quotes: 1) "Participants allocated to the research group received pharmacy-led digital educational materials, including short videos and visually engaging posters focusing on rational antibiotic use in companion animals. The materials were delivered via the LINE application over three consecutive days, and participants were able to ask questions, which were answered by a supervising pharmacist." (p. 11) 2) "Participants assigned to the control group did not receive any educational materials during the study period and continued to obtain information from their usual sources." (p. 11) 3) "Therefore, the aim of this study was to evaluate the effectiveness of pharmacy-led digital educational interventions, delivered through videos and posters, on antibiotic knowledge and confidence regarding rational antibiotic use in companion animals..." (p. 3) Detailed Analysis: Criterion B asks whether extra time/budget/resources given to the intervention group are matched in the control group, unless those additional resources are themselves the explicit treatment variable being tested. Here the intervention group received the digital educational materials (videos, posters, and pharmacist Q&A over three days) while the control group received no educational materials and continued business-as-usual information sources. The additional resource is the educational content itself, which is explicitly the treatment variable: the study's stated aim is to "evaluate the effectiveness of pharmacy-led digital educational interventions." Under the ERCT decision logic, when the additional resource is the primary treatment variable being tested against a business-as-usual baseline, the control group may remain unmatched by design. The extra educational input is integral to the intervention being tested, not a separable confounding add-on. Criterion B is met because the additional educational materials are the explicit treatment variable being tested against a business-as-usual control.

• Level 3 Criteria

  • R

    Reproduced

    • This novel single-site study has not been independently replicated by another research team.
    • "Broader scalability should be evaluated through larger, multi-site studies with longer follow-up and behavioral outcome assessments." (p. 13)
    • Relevant Quotes: 1) "This randomized controlled trial demonstrates that pharmacy-led digital education delivered through videos and posters significantly improved both antibiotic knowledge and confidence regarding rational antibiotic use in companion animals among undergraduate students." (p. 7) 2) "Broader scalability should be evaluated through larger, multi-site studies with longer follow-up and behavioral outcome assessments." (p. 13) Detailed Analysis: Criterion R requires that this specific study be independently replicated by a different research team in a different context, published in a peer-reviewed journal. The paper presents itself as a novel, single-site trial and explicitly calls for future multi-site studies, indicating no replication has yet occurred. Related RCTs on antibiotic education exist in the literature (e.g., the authors cite Wright et al., 2024, "Influencing Attitudes towards Antimicrobial Use and Resistance in Companion Animals" and Wilding et al., 2021, on an animated film), but these are different interventions and populations, not independent reproductions of this specific pharmacy-led companion animal study. An external verification search was attempted; the session's web-search quota was exhausted, but given this is a June 2026 single-site study, no independent replication of this specific study was identified. Criterion R is not met because there is no independent replication of this specific study.
  • A

    All-subject Exams

    • Only a single custom knowledge domain was assessed, and criterion E is not met, so all-subject exams fails.
    • "The primary outcome of this study was antibiotic knowledge score, while secondary outcomes included confidence in antibiotic use and satisfaction with digital educational materials." (p. 12)
    • Relevant Quotes: 1) "The primary outcome of this study was antibiotic knowledge score, while secondary outcomes included confidence in antibiotic use and satisfaction with digital educational materials." (p. 12) 2) "Antibiotic knowledge was assessed using a 10-item multiple-choice questionnaire, adapted from previously published studies." (p. 12) Detailed Analysis: Criterion A requires that impact be measured across all main subjects using standardised exam-based assessments, and it explicitly depends on criterion E. The study measured only a single, narrow domain (antibiotic knowledge and confidence), not the main academic subjects of the students' curriculum, and it used a custom questionnaire rather than a standardised exam. Since criterion E is not met, criterion A cannot be met, and in any case only one specialised topic was assessed. Criterion A is not met because only a single custom knowledge domain was assessed and criterion E is not met.
  • G

    Graduation Tracking

    • Outcomes were measured days after baseline with no tracking to graduation, and criterion Y is not met.
    • "First, the short intervention period and brief follow-up limited our ability to assess long-term knowledge retention..." (p. 9)
    • Relevant Quotes: 1) "Post-intervention assessments were administered to both groups three days after baseline data collection." (p. 11) 2) "First, the short intervention period and brief follow-up limited our ability to assess long-term knowledge retention, sustained confidence, or enduring behavioral change related to antibiotic use in companion animals." (p. 9) 3) "Future studies should incorporate longer follow-up periods and repeated assessments to evaluate the durability of knowledge gains, confidence, and antibiotic use behaviors over time." (p. 10) Detailed Analysis: Criterion G requires follow-up tracking of participants through to graduation from their educational stage, and it depends on criterion Y. The study measured outcomes only three days after baseline, explicitly acknowledges a "brief follow-up," and calls for longer follow-up in future work. There is no tracking to graduation, and Y is not met, so G cannot be met. A search for subsequent graduation-tracking follow-up papers by the same authors was attempted; the session's web-search quota was exhausted, but no such follow-up publication was identified for this June 2026 study. Criterion G is not met because there was no follow-up to graduation and criterion Y is not met.
  • P

    Pre-Registered

    • The trial was registered retrospectively in June 2026, long after data collection ended, so it was not pre-registered.
    • "The trial was retrospectively registered with the Thai Clinical Trials Registry (TCTR20260601013) on 1 June 2026." (p. 10)
    • Relevant Quotes: 1) "The study was conducted between November 2024 and January 2025 in Maha Sarakham Province, Thailand. The trial was retrospectively registered with the Thai Clinical Trials Registry (TCTR20260601013) on 1 June 2026 (https://www.thaiclinicaltrials.org/show/TCTR20260601013)." (p. 10) Detailed Analysis: Criterion P requires that the full study protocol be pre-registered before data collection begins. The paper explicitly states the trial was "retrospectively registered" on 1 June 2026, whereas the study was conducted between November 2024 and January 2025. Registration therefore occurred roughly 16 months after data collection ended, not before it began. The registry ID (TCTR20260601013) encodes the registration date 2026-06-01, consistent with the stated retrospective registration. This is the opposite of pre-registration. Criterion P is not met because the trial was retrospectively registered in June 2026, long after data collection (Nov 2024-Jan 2025) was completed.