Abstract
Inappropriate prescribing of antibiotics accelerates antibiotic resistance when managing common bacterial infections in primary care settings. Rapid diagnostic tests (RDT) to assess the need for antibiotic treatments are available and used as standard practice within Scandinavia – one of the lowest global prescribers of antibiotics. However, their uptake has been limited in the UK and little is known about why. This doctoral study investigated the most influential drivers (enablers/barriers) of RDT implementation, using a four-phase, mixed-methods, and meta-analytic approach.A systematic review was conducted and thematically synthesised. It identified gaps within the current international literature. This included a lack of focus on Scottish primary care settings and patients, as well as a limited use of theory. These gaps were addressed in the subsequent phases of the empirical work reported in this study.
The Theoretical Domains Framework (TDF) was selected as the meta-framework underpinning the data collection and/or analysis of the phases of this mixed-methods study. Phase one involved a meta-synthesis of four studies using the TDF. The results of this analysis as well as thematically and behaviourally (using the TDF) analysed focus groups were used to inform phase two which involved the development of a survey underpinned by the TDF. The survey was disseminated online (n=194) and analysed using descriptive and (regression and multivariate) inferential statistics to identify the most influential barriers and facilitators of RDT behaviours. This was followed-up by six telephone interviews which were thematically and behaviourally analysed, using the TDF. A data triangulation was then performed across the results of the three phases. This identified three key TDF domains: knowledge; beliefs about consequences and environmental context and resources.
The results from the triangulation were utilised to systematically select evidence-based intervention elements to address the identified barriers and facilitators. These took the form of intervention functions, policy categories and behaviour change techniques. These strategies should be used to inform the future implementation of RDT in Scottish primary care settings. Future research should explore the feasibility of the identified intervention elements with the involvement of patients and other stakeholders. These results should be shared with rapid test developers and primary care policy makers or NHS board members who may be involved in rapid test development or introduction in Scottish primary care settings, to support rapid diagnostic test implementation.
| Date of Award | 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Kareena McAloney-Kocaman (Supervisor), Paul Flowers (Supervisor) & Simon Hunter (Supervisor) |