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A mixed-methods study to identify, quantify and explore determinants of antimicrobial prescribing behaviours among clinicians in Qatar.

Talkhan, Hend


Hend Talkhan


Trudi McIntosh

Derek Stewart

Hisham Ziglam

Abdulrouf Palli Valappila

Moza Al-Hail

Mohammad Diab


The detection of antimicrobial resistance (AMR) and awareness of the magnitude of associated threats to global public health as well as the world economy have long been recognised, with many countries implementing antimicrobial stewardship (AMS) programmes. Although these programmes can be effective, AMS interventions often fail to consider the determinants (contextual influences) of antimicrobial prescribing behaviour, which vary within and across countries, practice settings and health professions. In addition, little attention has been paid to the use of theory to inform the design and choice of such interventions. The State of Qatar is an advanced country with exceptional economic and social progress. The 2030 vision statement by the Qatari government aims at a 'comprehensive world-class healthcare system', designed to meet the needs of the State's fast-growing population. In line with this, AMS programmes had been implemented across Qatar's public healthcare providers by 2015. However, there remains a significant increase in AMR coupled with inappropriate antimicrobial prescribing. The overarching aim of this programme of research was to identify, quantify and explore clinicians' behavioural determinants of antimicrobial prescribing in Qatar. It involved three phases, each based upon the findings of the earlier phase, informed by theory and guided by the United Kingdom (UK) Medical Research Council (MRC) framework for developing and evaluating complex interventions. The first phase (Phase 1) was a PROSPERO-registered systematic review on the use of theory in the development and evaluation of behaviour change interventions designed to improve clinicians' antimicrobial prescribing. Ten studies were identified; most were suboptimal in the use of theory and the application of the UK MRC framework. In addition to the lack of studies, none were carried out in the Middle East or targeted pharmacists, indicating a clear gap in the literature. In the second phase (Phase 2), a cross-sectional survey of clinicians in Qatar was conducted to identify the potential determinants of antimicrobial prescribing behaviour, using the Theoretical Domains Framework (TDF). Principal Component Analysis of 535 responses identified three components: 'Guidelines compliance', 'Influences on practice' and 'Self-efficacy'. Respondents generally scored highly for 'Guidelines compliance' and 'Self-efficacy', but less highly for the 'Influences on practice' component, with particular focus on the TDF domains: 'Environmental context and resources', and 'Social influences'. Comparison of component scores showed that doctors, the more qualified and those with greater experience were more likely to be positive in their responses (P < 0.05). In the final phase (Phase 3), online, semi-structured video interviews with 16 clinicians explored in depth the determinants of antimicrobial prescribing behaviour in Qatar, using the TDF. A number of themes, linked to ten TDF domains, were identified as determinants of antimicrobial prescribing and these determinants were interrelated. 'Goals', 'Intentions' and 'Beliefs of consequences' were key determinants that acted as facilitators; meanwhile 'Environmental context and resources', 'Social influences', 'Knowledge', 'Social/professional role and identity', and 'Memory, attention and decision processes' were the main barriers highlighted. This programme of research has generated original, robust and rigorous findings, which - it is hoped - will support the development of future BCIs focusing on the proposed evidence-based behaviour change techniques. These will have the potential to improve clinicians' antimicrobial prescribing and reduce the major health challenge of AMR.


TALKHAN, H. 2022. A mixed-methods study to identify, quantify and explore determinants of antimicrobial prescribing behaviours among clinicians in Qatar. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from:

Thesis Type Thesis
Deposit Date Jul 14, 2022
Publicly Available Date Jul 14, 2022
Keywords Antimicrobial prescribing; Prescriptions; Prescribing; Qatar
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