# Implementing multi-component intervention to reduce antibiotic prescribing in primary care of rural China: a qualitative process evaluation of the trial

## TL;DR

A multi-component intervention to reduce antibiotic use in rural Chinese primary care was evaluated, showing mixed success with tools like patient leaflets being well-received.

## Contribution

The study provides insights into implementing and adapting multi-component interventions to reduce antibiotic overuse in rural primary care settings in China.

## Key findings

- Health practitioners found patient leaflets and public commitment letters useful for reducing antibiotic prescriptions.
- The decision support system faced usability barriers during consultations.
- Peer support groups were poorly understood and difficult to implement due to lack of clinical teams.

## Abstract

The overuse of antibiotics for respiratory tract infections in primary healthcare in rural China is a particular challenge and is highly related to antibiotic resistance. Our research team designed a multi-component intervention focusing predominantly on health practitioners to reduce antibiotic prescriptions in rural communities of China. The effects of the intervention were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of the implementation of the intervention and related influencing factors.

Qualitative process study nested in a randomised controlled trial, including observation and semi-structured interviews.

Primary healthcare in rural China.

27 health practitioners from township health centres assigned to the intervention arm.

A complex intervention to reduce antibiotic prescriptions in rural communities of China, which includes the following components: training for health practitioners, a public letter of commitment, patient leaflets, a decision support system and a peer support group.

Not applicable.

Data were analysed using thematic analysis.

The overall multi-component intervention was described as useful in reducing antibiotic prescribing, with a particularly high acceptance and use of patient leaflets and the public letter of commitment among health practitioners. There were mixed views on the decision support system and peer support group. Practitioners reported usability-related barriers to using the decision support system during consultations. Practitioners did not understand the role or benefits of the peer support group and found it difficult to initiate group discussions, due to the lack of any existing clinical team at the primary care level.

The multi-component intervention appears to be acceptable and useful in primary healthcare in rural China. Successful implementation requires a comprehensive understanding of the contextual characteristics of the setting. Interventions to reduce antibiotic prescribing in China in the future could consider wider stakeholders including patients, retail pharmacies and health authorities.

ISRCTN30652037 (01/12/2020).