title: Using theory to explore facilitators and barriers to delayed prescribing in Australia: a qualitative study using the Theoretical Domains Framework and the Behaviour Change Wheel.
abstract: Delayed antibiotic prescribing reduces antibiotic use for acute respiratory infections in trials in general practice, but the uptake in clinical practice is low. The aim of the study was to identify facilitators and barriers to general practitioners' (GPs') use of delayed prescribing and to gain pharmacists' and the public's views about delayed prescribing in Australia.
  
  
  
  This study used the Theoretical Domains Framework and the Behaviour Change Wheel to explore facilitators and barriers to delayed prescribing in Australia. Forty-three semi-structured, face-to-face interviews with general practitioners, pharmacists and patients were conducted. Responses were coded into domains of the Theoretical Domains Framework, and specific criteria from the Behaviour Change Wheel were used to identify which domains were relevant to increasing the use of delayed prescribing by GPs.
  
  
  
  The interviews revealed nine key domains that influence GPs' use of delayed prescribing: knowledge; cognitive and interpersonal skills; memory, attention and decision-making processes; optimism; beliefs about consequences; intentions; goals; emotion; and social influences: GPs knew about delayed prescribing; however, they did not use it consistently, preferring to bring patients back for review and only using it with patients in a highly selective way. Pharmacists would support GPs and the public in delayed prescribing but would fill the prescription if people insisted. The public said they would delay taking their antibiotics if asked by their GP and given the right information on managing symptoms and when to take antibiotics.
  
  
  
  Using a theory-driven approach, we identified nine key domains that influence GPs' willingness to provide a delayed prescription to patients with an acute respiratory infection presenting to general practice. These data can be used to develop a structured intervention to change this behaviour and thus reduce antibiotic use for acute respiratory infections in general practice.
authors.affiliation: Centre of Research Excellence in Minimising Antibiotics Resistance for Acute Respiratory Infections (Bond University, Gold Coast), University of the Sunshine Coast, Faculty of Science, Health, Education and Engineering, Sippy Downs, 4556, Australia. lsargent@usc.edu.au.
authors.forename: Lucy
authors.identifier: 0000-0002-6390-4854
authors.initials: L
authors.lastname: Sargent
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: McCullough
authors.affiliation: Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Del Mar
authors.affiliation: Chair in Population Health Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, 4556, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Lowe
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001288:Attention; D001315:Australia; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D004644:Emotions; D005260:Female; D058005:General Practitioners; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D000067656:Optimism; D010595:Pharmacists; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011582:Psychological Theory; D036301:Qualitative Research; D011793:Queensland; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013997:Time Factors; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute respiratory infections; Antibiotics; Delayed prescribing; General practitioners; Patients; Pharmacists; Theoretical Domains Framework