A Behavioral Analysis of Factors That Influence Antibiotic Prescribing in Hospitals: A Metasynthesis of Reviews

Antibiotic resistance is a global public health threat driven, in part, by antibiotic overprescription. Behavior change theories are increasingly used to try to modify prescriber behavior. A metasynthesis of 8 reviews was conducted to identify factors influencing antibiotic prescribing for adults in hospital settings and to analyze these factors using 4 behavior change frameworks. Forty-three factors were identified across 7 thematic categories and then mapped to the theoretical domains framework and capability-opportunity-motivation model of behavior. The behavior change wheel and behavior change techniques taxonomy were then used to identify appropriate interventions and their components. The domain "environmental context and resources" was coded the most often, followed by "social influences" and "beliefs about consequences," revealing that prominent sources of antibiotic prescribing behavior are "physical opportunity" and "social opportunity." Based on these results, suggested interventions include environmental prompts/cues, education on consequences of antibiotic overuse, social comparison and support, and incentives.