Embase, PubMed, PsycInfo, Social
Science Citations Index and Google Scholar. The search
strategy that was adopted included the following search
terms: (antibiotic* OR antibacterial* OR infection*) AND/
OR (attitude of health personnel) AND (nursing home* OR
long term care facilit*) AND (interview* OR ‘qualitative
research’). There were no date or language restrictions
imposed. We searched the reference lists of relevant arti-
cles to screen for any relevant studies.
2.2 Study Inclusion Criteria
The studies were included in the review if they met the
following criteria: (1) used qualitative data collection and
analysis methods; (2) were focussed on LTCF antibiotic
use; (3) included health care professionals (doctors, nurses
or pharmacists, or a combination of these groups) or LTCF
administrators in the sample; and (4) used qualitative
methods to evaluate an AMS intervention. In the case of
studies where qualitative and quantitative methods were
employed, only the qualitative data were collected. The
abstracts were evaluated by the primary author according
to the inclusion criteria, and the full-text articles were
obtained and evaluated where appropriate. Where there
was uncertainty about whether to include a study in the
review, another author was consulted.
2.3 Quality Appraisal
The quality of the papers was assessed using the Critical
Appraisal Skills Programme (CASP) assessment tool for
qualitative research, as outlined in Electronic Supplemen-
tary Material (ESM) Online Resource 1 [11]. Each author
individually assessed the quality of each study, and a de-
cision on the exclusion and inclusion of studies was made
collectively and with consensus between all authors.
2.4 Analysis
Thematic synthesis was used to analyse the results of the
studies included in this review. This method identifies the
prominent or recurring themes in the literature and collates
these findings under thematic headings [9, 12]. The initial
stages conducted by two authors were line-by-line coding
of the text and development of descriptive sub-themes as
free codes without a hierarchy. The final stage was gen-
eration of main themes based on discussion between all
authors. In order to present the synthesis of the findings, a
conceptual model was developed by the primary author and
reviewed by all authors. This qualitative synthesis is re-
ported in accordance with the Enhancing Transparency in
Reporting the Synthesis of Qualitative Research
(ENTREQ) guidelines (see ESM Online Resource 2) [13].
3 Results
3.1 Study Selection Process
A total of 1308 papers were retrieved and reviewed ac-
cording to the title. An abstract review of 139 studies was
conducted, and 34 studies were selected for full-text review
(Fig. 1).
