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Table 1 Initial decisions and rationale to ensure ownership, research quality and feasibility (before conducting the pilot evaluation)

From: Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe

Decision Rationale with respect to: local ownership/feasibility/research quality
Data collection and transcriptions should be completed by national project facilitators Local ownership Local participants carry out and transcribe the conducted interviews to create local ownership and specific insight into how future interventions could be targeted.
General practitioners (GP) and community pharmacists who prescribe or sell antibiotics should be interviewed Research quality Interviews with GPs were supplemented with interviews with community pharmacists due to their role in dispensing/informing patients about antibiotics in general and the documented practice of providing antibiotics without a prescription in community pharmacies in some countries in Southeast Europe (Hoxha et al.).
Patients interviewed should be adults who have suffered from an infection within the previous 3 months that they treated with antibiotics (with or without a prescription) Research quality Adults were chosen to ensure a minimum comparability of data (antibiotic use by children is believed to contain other aspects, especially regarding attitudes – Wun et al.). A 3 month limit was selected to reduce memory bias. Both patients with and without prescriptions should be included, as the high antibiotic consumption could be caused by both groups (Mitsi et al.).
Infections should consist of only upper respiratory tract infections Research quality The area of infection was specified to ensure comparability of data. Furthermore, upper respiratory tract infections are common diseases, hence constituting an ideal case to study the typical reasons behind high antibiotic consumption with regard to knowledge, attitudes and behaviour.
Specific antibiotics to be investigated were: amoxicillin-clavulanic acid, azithromycin, ciprofloxacin and ceftriaxone Research quality Specific antibiotics were selected to ensure the comparability of data. The four antibiotics selected have all been shown to be used irrationally in the region of Southeastern Europe (Versporten et al.), with a risk to public health, as most are broad spectrum. A few deviations to this could be tolerated if the ABs were not used in a specific country.
Three interviews should be conducted within the four groups of interviewees: patients with a prescription, patients without a prescription, GPs and community pharmacists; hence, 12 interviews total per country. The patient interviews should contain a detailed description of the last time the interviewee was prescribed/bought an antibiotic. Interviews with health care professionals should address detailed descriptions of 3 specific episodes during the last week in which they handled antibiotics. All specific incidents should further be explored in relation to the way the relevant parties usually prescribe/purchase or prescribe/sell antibiotics Feasibility and research quality The number of interviews was designed to maintain a decent workload balance for the participants, yet it was expected that it would be possible through data triangulation of the 12 interviews to detect condensed patterns of antibiotic knowledge, attitudes and behaviour. Antibiotic knowledge, behaviour and attitudes can best be derived through detailed narratives, which are more easily obtained when they address specific recent incidents. To ensure that this recent incident represented typical behaviour, its resemblance to former similar situations was also explored. As the number of AB episodes described in the interviews that would be used in the data analysis was therefore at least 24 (6 from patients and 18 from health care professionals), it was estimated that data saturation could then be achieved regarding aspects of AB use.
Data analysis should be conducted in collaboration between the Section for Social and Clinical Pharmacy and local facilitators Research quality Combining the analytical competencies of the researchers from Copenhagen with detailed knowledge of the local culture of local facilitators was assessed as being the most ideal way of achieving high quality results.