title: General practitioners' views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial.
abstract: BACKGROUND
  Interventions to promote prudent antibiotic prescribing by general practitioners (GPs) have often only been developed for use in one country. We aimed to develop an intervention which would be appropriate to implement in multiple European countries in order to offer greater benefit to practice whilst using fewer resources. The INTRO (INternet TRaining for antibiOtic use) intervention needed to deliver training to GPs in the use of C-Reactive Protein (CRP) near patient tests to help diagnose acute cough and in communication skills to help explain prescribing decisions to patients. We explored GPs' views on the initial version of INTRO to test acceptability and potentially increase applicability for use in multiple countries before the start of a randomised trial.
  
  
  METHODS
  30 GPs from five countries (Belgium, England, the Netherlands, Poland and Spain), were interviewed using a "think aloud" approach. GPs were asked to work through the intervention and discuss their views on the content and format in relation to following the intervention in their own practice. GPs viewed the same intervention but versions were created in five languages. Data were coded using thematic analysis.
  
  
  RESULTS
  GPs in all five countries reported the view that the intervention addressed an important topic, was broadly acceptable and feasible to use, and would be a useful tool to help improve clinical practice. However, GPs in the different countries identified aspects of the intervention that did not reflect their national culture or healthcare system. These included perceived differences in communication style used in the consultation, consultation length and the stage of illness at which patient typically presented.
  
  
  CONCLUSIONS
  An online intervention to support evidence-based use of antibiotics is acceptable and feasible to implement amongst GPs in multiple countries. However, tailoring of the intervention to suit national contexts was necessary by adding local information and placing more emphasis on the fact that GPs could select the communication skills they wished to use in practice. Using think aloud methods to complement the development of interventions is a powerful method to identify regional contextual barriers to intervention implementation.
authors.affiliation: Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of microbiology, University of Antwerp, Antwerp, Belgium.
authors.forename: Sibyl
authors.initials: S
authors.lastname: Anthierens
authors.forename: Sarah
authors.initials: S
authors.lastname: Tonkin-Crine
authors.forename: Elaine
authors.initials: E
authors.lastname: Douglas
authors.forename: Patricia
authors.initials: P
authors.lastname: Fernandez-Vandellos
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Krawczyk
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Paul
authors.initials: P
authors.lastname: Little
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003194:Computer-Assisted Instruction / Q000379:methods*; D003371:Cough / Q000188:drug therapy*; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D020407:Internet; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents