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Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B
  1. Molly Courtenay1,
  2. Samantha Rowbotham2,
  3. Rosemary Lim3,
  4. Sarah Peters4,
  5. Kathryn Yates5,
  6. Angel Chater6
  1. 1 Healthcare Sciences, Cardiff University, Cardiff, UK
  2. 2 Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
  3. 3 School of Pharmacy, Reading University, Reading, UK
  4. 4 Health Sciences, University of Manchester, Manchester, UK
  5. 5 Londonwide LMC, Londonwode LMCs and Londonwide Enterprise Ltd, London, UK, UK
  6. 6 Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
  1. Correspondence to Professor Molly Courtenay; courtenaym{at}


Objectives Respiratory tract infections are frequently managed by nurse and pharmacist prescribers, and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing among these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to: (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections and (2) identify the behaviour change techniques (BCTs) that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour.

Design Qualitative design comprising semistructured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour.

Setting Primary care.

Participants Twenty one prescribers (4 pharmacists and 17 nurses).

Results A range of factors across 12 domains of the TDF were found to influence prescriber behaviour, and 40 BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting and information about health consequences) were identified as supporting prescribers in managing these expectations.

Conclusion With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups.

  • quality in health care
  • infection control
  • qualitative research

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  • Contributors MC made a substantial contribution to the conception and design of the work; the acquisition and interpretation of data; and drafting of the work. SR and AC made a substantial contribution to the design of the work, the acquisition, analysis and interpretation of data and drafting of the work. RL, SP and KY made a substantial contribution to the acquisition and interpretation of data and critically revised drafts of the work. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was funded by an industrial grant.

  • Disclaimer All authors had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval Ethical approval was provided by the School of Healthcare Sciences Research Governance and Ethics Committee, Cardiff University (4475REC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available; that is, the dataset supporting the conclusions of this article is included within the article.

  • Patient consent for publication Not required.

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