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The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review.

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


Objectives: This systematic review (SR) reviews the evidence on use of theory in developing and evaluating behaviour change interventions (BCIs) to improve clinicians antimicrobial prescribing (AP). Methods: The SR protocol was registered with PROSPERO. Eleven databases were searched from inception to October 2018 for peer-reviewed, English-language, primary literature in any healthcare setting and for any medical condition. This included research on changing behavioural intentions (e.g. in simulated scenarios) and research measuring actual AP. All study designs/methodologies were included. Excluded were: grey literature and/or those which did not state a theory. Two reviewers independently extracted and quality assessed the data. The Theory Coding Scheme (TCS) evaluated the extent of the use of theory. Results: Searches found 4227 potentially relevant papers after removal of duplicates. Screening of titles/ abstracts led to dual assessment of 38 full-text papers. Ten (five quantitative, three qualitative and two mixedmethods) met the inclusion criteria. Studies were conducted in the UK (n = 8), Canada (n = 1) and Sweden (n = 1), most in primary care settings (n = 9), targeting respiratory tract infections (n = 8), and medical doctors (n = 10). The most common theories used were Theory of Planned Behaviour (n = 7), Social Cognitive Theory (n = 5) and Operant Learning Theory (n = 5). The use of theory to inform the design and choice of intervention varied, with no optimal use as recommended in the TCS. Conclusions: This SR is the first to investigate theoretically based BCIs around AP. Few studies were identified; most were suboptimal in theory use. There is a need to consider how theory is used and reported and the systematic use of the TCS could help.


TALKHAN, H., STEWART, D., MCINTOSH, T., ZIGLAM, H., ABDULROUF, P.V., AL-HAIL, M., DIAB, M. and CUNNINGHAM, S. 2020. The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review. Journal of antimicrobial chemotherapy [online], 75(9), pages 2394-2410. Available from:

Journal Article Type Review
Acceptance Date Mar 27, 2020
Online Publication Date May 1, 2020
Publication Date Sep 30, 2020
Deposit Date Jul 16, 2020
Publicly Available Date May 2, 2021
Journal Journal of antimicrobial chemotherapy
Print ISSN 0305-7453
Electronic ISSN 1460-2091
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 75
Issue 9
Pages 2394-2410
Keywords Antimicrobial prescribing; Behaviour change; Medical interventions; Theoretical models; Praxis
Public URL


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