Table 2

Ranking of Theoretical Domains Framework (TDF) domains

TDF domain
(in ranking order)
Frequency *
(max n=13 studies)
Elaboration †
(number of influences)
Bidirectionality ‡Types of influences on antibiotic prescribing
1. Beliefs about consequences1333Yes
  • Evidence and education

  • Clinical experience

  • Clinical assessment

  • Knowledge and perceptions of patient

  • Perceptions of patient expectations and satisfaction

  • Time and workload

  • Awareness and perception of responsibility for AMR

  • Costs associated with prescribing

  • Legal issues

  • Attitudes to and use of AMS strategies

2. Social influences1213Yes
  • Knowledge and perceptions of patient

  • Perceptions of patient expectations and satisfaction

  • Communication skills and strategies

  • Monitoring, auditing, feedback and accountability

  • Perceptions of own and others’ prescribing

3. Skills118Yes
  • Communication skills and strategies

  • Perceptions of patient expectations and satisfaction

4. Environmental context and resources1012Yes
  • Time and workload

  • Perceptions of own and others’ prescribing

  • Attitudes to and use of AMS strategies

5. Intentions §107Yes
  • Evidence and education

  • Perceptions of patient expectations and satisfaction

  • Communication skills and strategies

  • Attitudes to and use of AMS strategies

6. Emotions ¶103Yes
  • Clinical experience (eg, concern related to it)

  • Legal issues (eg, concern with it)

7. Social / professional role and identity810Yes
  • Perception of professional role and ethos

  • Communication skills and strategies

  • Monitoring, auditing, feedback and accountability **

8. Knowledge76Yes
  • Evidence and education

  • Awareness and perception of responsibility for AMR

  • Monitoring, auditing, feedback and accountability**

9. Beliefs about capabilities54Yes
  • Clinical experience and confidence

10. Memory, attention, decision processes12Yes
  • Awareness and perceptions of responsibility for AMR (responding to immediate pressures over long-term consequences or vice versa) ††

11. Reinforcement21No
  • Attitudes to and use of AMS strategies (use of financial incentives)

  • *Number of studies in which the TDF domain was identified.

  • †Number of influences identified in studies in each TDF domain.

  • ‡Bidirectionality was when the influence could be either a barrier or a facilitator to appropriate prescribing (eg, the influence ‘knowledge of evidence or guidelines’ could be a barrier (ie, a lack of knowledge of evidence or guidelines) or a facilitator (ie, having knowledge of evidence and guidelines).

  • §TDF domain ‘intentions’ was double-coded with TDF domains ‘skills’ and ‘beliefs about consequences’.

  • ¶TDF domain ‘emotions’ was double-coded with TDF domain 'beliefs about consequences'.

  • **Some influences included in the theme ‘Monitoring, auditing, feedback and accountability’ were also double-coded with TDF domain ‘social influences’.

  • ††Some influences included in the theme ‘Awareness & perceptions of responsibility for AMR’ were also double-coded with TDF domain 'beliefs about consequences'.

  • AMR, antimicrobial resistance ; AMS, antimicrobial stewardship.