Many countries have developed antimicrobial stewardship programmes with strategies to optimise antimicrobial prescribing. There remains a need for behaviour change interventions at clinician level to promote appropriate prescribing. Theories should be used for developing and evaluating interventions to change human behaviour.

Aim / Objectives:The aim of this review was to critically appraise, synthesise and present the available evidence for theoretical approaches in the development and evaluation of behaviour change interventions designed to improve clinicians' antimicrobial prescribing.

Design & Methodology:

The systematic review protocol was developed and registered with the International Prospective Register of Systematic Reviews (CRD42018098586).

Two review authors independently extracted data and assessed study quality. Clinical and methodological heterogeneity limited data synthesis.


The searches resulted in 4227 relevant articles after duplicates removal. Screening of titles/abstracts led to retrieval and dual assessment of 38 full-text articles. Of those, a total of 10 studies met the inclusion criteria.

The majority of studies were carried out in primary care settings (n = 9) targeting upper respiratory tract infections (n = 8). Use of theory varied considerably across studies included. Theory of Planned Behaviour, Social Cognitive Theory and Operant Learning Theory were the most common theories used to inform the design and choice of interventions.

Conclusion / Discussion

It is feasible to develop and evaluate theoretically based interventions to improve professional practice. The findings of this systematic review will inform understanding of the theoretical basis of behaviour change interventions which contribute to contain AMR rates and prevent the world entering a “post-antibiotic era”.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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