@article{Charani:2019:10.1371/journal.pone.0209847,
author = {Charani, E and Smith, I and Skodvin, B and Perozziello, A and Lucet, JC and Lescure, FX and Brigand, G and Poda, A and Ahmad, R and Singh, S and Holmes, AH},
doi = {10.1371/journal.pone.0209847},
journal = {PLoS ONE},
title = {Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries – a qualitative study},
url = {http://dx.doi.org/10.1371/journal.pone.0209847},
volume = {14},
year = {2019}
}

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TY  - JOUR
AB  - BackgroundMost of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.Materials and methodsHealthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.Results54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, on
AU  - Charani,E
AU  - Smith,I
AU  - Skodvin,B
AU  - Perozziello,A
AU  - Lucet,JC
AU  - Lescure,FX
AU  - Brigand,G
AU  - Poda,A
AU  - Ahmad,R
AU  - Singh,S
AU  - Holmes,AH
DO  - 10.1371/journal.pone.0209847
PY  - 2019///
SN  - 1932-6203
TI  - Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries – a qualitative study
T2  - PLoS ONE
UR  - http://dx.doi.org/10.1371/journal.pone.0209847
UR  - http://hdl.handle.net/10044/1/66800
VL  - 14
ER  - 

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