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Table 1 Overview of emerging categories, sub-categories, sub-themes and overarching theme

From: ‘Struggling to be a defender of health’ –a qualitative study on the pharmacists’ perceptions of their role in antibiotic consumption and antibiotic resistance in Romania

Manifest meaning Latent meaning
Categories (in bold) and sub-categories (plain text) Sub-themes Overarching theme
Health system barriers that the patients face in accessing care Maintaining equilibrium between ethics, law and economy Undervalued medicines’ professionals struggling with agency related and structural barriers to meet their deontological duties
Access to medical professionals implies various extra costs
Financial barriers to take antibiotics correctly
Social situations that affect vulnerable populations
Prevention is not a focus of the system and is expensive
The patient’s health comes first
Facing negative incentives that determine a pharmacist to push the limits of law
Distrust in state institutions Antibiotic resistance problem rooted in a low social capital environment
A flawed law that is often bent or broken
Ministry of Public Health –a challenged institution
A strained relationship between the state and the pharmacists
Unreliable statistics
Pharmacists –theoretical roles that are not translated into practice
Suffering from an image deficit at all levels including among themselves
The pharmacist perceived as a salesperson
The pharmacist assistant – sometimes used to the detriment of the medical act
Pharmacists university education is questionable
Pharmacists continuous education rarely targeting antibiotics and mostly focusing on the commercial aspects of the profession
High rates of antibiotic consumption and antibiotic resistance (ABR) a collective fault for a neglected but serious issue
ABR a low-visibility problem
High antibiotic consumption a shared blame
Working in silos
Limited or degraded institutional collaboration with the doctors
Distrust in the doctors resources to carry out a good quality medical act
Education is needed Wanting to fulfil their educational role
Patients have a low level of health literacy
Patients having incorrect conduct in pharmacies when it comes to antibiotics
Questionable sources of getting medical information
Education of the patient- a sustainable solution
Pharmacists have the potential to educate
Pharmacy an accessible and welcoming environment
Pharmacists used to fostering their diplomatic abilities
Pharmacist a voice in the community