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Exploring determinants of antimicrobial prescribing behaviour using the theoretical domains framework.

Talkhan, Hend; Stewart, Derek; McIntosh, Trudi; Ziglam, Hisham; Abdulrouf, Palli Valappila; Al-Hail, Moza; Diab, Mohammad; Cunningham, Scott


Hend Talkhan

Derek Stewart

Trudi McIntosh

Hisham Ziglam

Palli Valappila Abdulrouf

Moza Al-Hail

Mohammad Diab


Few theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians' antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. Semi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. Data saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants’ beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. Antimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship.


TALKHAN, H., STEWART, D., MCINTOSH, T., ZIGLAM, H., ABDULROUF, P.V., AL-HAIL, M., DIAB, M. and CUNNINGHAM, S. [2024]. Exploring determinants of antimicrobial prescribing behaviour using the theoretical domains framework. Research in social and administrative pharmacy [online], Articles in Press. Available from:

Journal Article Type Article
Acceptance Date Dec 21, 2023
Online Publication Date Jan 3, 2024
Deposit Date Jan 23, 2024
Publicly Available Date Jan 23, 2024
Journal Research in social and administrative pharmacy
Print ISSN 1551-7411
Electronic ISSN 1934-8150
Publisher Elsevier
Peer Reviewed Peer Reviewed
Keywords Anti-bacterial agents; Anti-infective agents; Inappropriate prescribing; Theoretical domains
Public URL


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