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Antimicrobial resistance (AMR) and its threats have long been recognised. Many countries have developed antimicrobial stewardship programmes with strategies to optimise antimicrobial prescribing, minimise AMR and improve outcomes. 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. Research Design and Methodology: The systematic review protocol was developed and registered with the International Prospective Register of Systematic Reviews (CRD42018098586). MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, PsycINFO, ScienceDirect, The Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effectiveness, Joanna Briggs Institute Library and Google Scholar were searched for peer-reviewed, English-language studies investigating theoretically based behaviour change interventions designed to improve clinicians’ antimicrobial prescribing in any healthcare setting. Additional studies were obtained from the bibliographies of retrieved papers. Two review authors independently extracted data and assessed study quality. Clinical and methodological heterogeneity limited data synthesis. Results: The searches resulted in 4227 potentially relevant papers after duplicates removal. Screening of titles/abstracts led to retrieval and dual assessment of 38 full-text papers. Of those, a total of 14 studies (4 qualitative, 5 quantitative and 5 mixed-methods) met the inclusion criteria and were included in the systematic review. Most of studies included were from the UK (n = 8) and most were published in 2008 and in 2017 (n = 6); none was published before 2008. The majority of studies were carried out in primary care settings (n = 10) targeting upper respiratory tract infections (n = 7). Theoretical approaches used to inform the design and choice of intervention varied across included studies. The most common included: Theory of Planned Behaviour, Social Cognitive Theory and Operant Learning Theory. Conclusion/Discussion: This systematic review is the first to investigate theoretically based behaviour change interventions for antimicrobial prescribing. Only a small number of primary research studies involving theory in intervention development and evaluation were identified. There is a need for further research in this area. Restricting the review to papers published in English may have been a limitation.

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Theoretical approaches in the development and evaluation of behaviour change interventions that improve clinicians’ antimicrobial prescribing: a systematic review