Antimicrobial stewardship programme implementation in Ho Chi Minh City, Vietnam: a qualitative study to understand...

Implementing antimicrobial stewardship programmes (ASPs) is essential for optimising antimicrobial use and reducing resistance. However, integrating these programmes into Vietnamese healthcare settings remains challenging. This study aimed to explore the behavioral determinants influencing the ASP implementation among healthcare professionals (HCPs) in hospitals in Ho Chi Minh City (HCMC), Vietnam.

A qualitative study was conducted from April to June 2024 using semi-structured interviews with physicians and clinical pharmacists with at least one year of ASP implementation experience. The interview guide and data analysis were informed by the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework-14 (TDF-14) to identify key mediators affecting ASP practices, which were then mapped onto the COM-B model within the BCW to inform the subsequent intervention development process.

A total of 41 interviews were completed across 12 hospitals. ASP implementation was found to be a multifaceted behaviour influenced by a wide range of interrelated factors. Facilitators included strong professional commitment, accessible clinical guidelines, and collaborative work culture. However, implementation was frequently constrained by non-localised or conflicting guidelines, excessive workloads, insufficient training, and clinical pharmacists' limited decision-making authority. Identified factors were subsequently mapped to the 14 domains of the TDF-14, with nine domains prioritised for future intervention: "Knowledge", "Skills", "Social/professional role and identity", "Beliefs about capabilities", "Beliefs about consequences", "Memory, attention and decision processes", "Environmental context and resources", "Social influences", and "Behavioural regulation". These nine domains were mapped to the corresponding components of the COM-B model within the BCW, to guide future intervention development.

This study offers theory-informed insights into the behavioral factors affecting the ASP implementation among HCPs, offering a foundation for developing context-specific interventions to improve ASP practices. Future work will focus on mapping key BCW components to behaviour change techniques to design targeted interventions aimed at enhancing ASP effectiveness across Vietnamese hospitals.