{
  "abstract": "Objectives 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.Design Qualitative process study nested in a randomised controlled trial, including observation and semi-structured interviews.Setting Primary healthcare in rural China.Participants 27 health practitioners from township health centres assigned to the intervention arm.Intervention 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.Primary and secondary outcome measures Not applicable.Analysis Data were analysed using thematic analysis.Results 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.Conclusions 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.Trial registration number ISRCTN30652037 (01/12/2020).",
  "authors": [
    {
      "affiliations": [
        "Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Tingting Zhang"
    },
    {
      "affiliations": [
        "School of Health Services Management, Ahui Medical University, Hefei, Anhui, China"
      ],
      "name": "Xingrong Shen"
    },
    {
      "affiliations": [
        "School of Health Services Management, Ahui Medical University, Hefei, Anhui, China"
      ],
      "name": "Jing Chai"
    },
    {
      "affiliations": [
        "School of Health Services Management, Ahui Medical University, Hefei, Anhui, China"
      ],
      "name": "Rong Liu"
    },
    {
      "affiliations": [
        "School of Health Services Management, Ahui Medical University, Hefei, Anhui, China"
      ],
      "name": "Debin Wang"
    },
    {
      "affiliations": [
        "School of Psychology, University of Southampton, Southampton, UK",
        "School of Psychological Science, University of Bristol, Bristol, UK"
      ],
      "name": "Lucy Yardley"
    },
    {
      "affiliations": [
        "Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Helen Lambert"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Christie Cabral"
    }
  ],
  "title": "Implementing multi-component intervention to reduce antibiotic prescribing in primary care of rural China: a qualitative process evaluation of the trial",
  "uid": "888c81d9-91f9-5dac-b011-960e96fd8fea"
}