TY - JOUR
T1 - Barriers and enablers to blood culture sampling in Indonesia, Thailand and Viet Nam
T2 - a Theoretical Domains Framework-based survey
AU - Suntornsut, Pornpan
AU - Asadinia, Koe Stella
AU - Limato, Ralalicia
AU - Tamara, Alice
AU - Rotty, Linda W.A.
AU - Bramanti, Rendra
AU - Nusantara, Dwi U.
AU - Nelwan, Erni J.
AU - Khusuwan, Suwimon
AU - Suphamongkholchaikul, Watthanapong
AU - Chamnan, Parinya
AU - Piyaphanee, Watcharapong
AU - Lan Vu, Huong Thi
AU - Nguyen, Yen Hai
AU - Nguyen, Khanh Hong
AU - Pham, Thach Ngoc
AU - Le, Quang Minh
AU - Vu, Vinh Hai
AU - Chau, Duc Minh
AU - Thi Hoang Vo, Dung Em
AU - Harriss, Elinor K.
AU - van Doorn, Hindrik Rogier
AU - Hamers, Raph Leonardus
AU - Lorencatto, Fabiana
AU - Atkins, Lou
AU - Limmathurotsakul, Direk
N1 - Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.
PY - 2024/2/19
Y1 - 2024/2/19
N2 - Objective Blood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. Design A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. Setting Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. Participants 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). Outcome measures Barriers and enablers to BC sampling. Results The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including ‘priority of BC (TDF-goals)’, ‘perception about their role to order or initiate an order for BC (TDF-social professional role and identity)’, ‘perception that BC is helpful (TDF-beliefs about consequences)’, ‘intention to follow guidelines (TDF-intention)’, ‘awareness of guidelines (TDF-knowledge)’, ‘norms of BC sampling (TDF-social influence)’, ‘consequences that discourage BC sampling (TDF-reinforcement)’, ‘perceived cost-effectiveness of BC (TDF-environmental context and resources)’ and ‘regulation on cost reimbursement (TDF-behavioural regulation)’. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified. Conclusions Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.
AB - Objective Blood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. Design A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. Setting Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. Participants 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). Outcome measures Barriers and enablers to BC sampling. Results The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including ‘priority of BC (TDF-goals)’, ‘perception about their role to order or initiate an order for BC (TDF-social professional role and identity)’, ‘perception that BC is helpful (TDF-beliefs about consequences)’, ‘intention to follow guidelines (TDF-intention)’, ‘awareness of guidelines (TDF-knowledge)’, ‘norms of BC sampling (TDF-social influence)’, ‘consequences that discourage BC sampling (TDF-reinforcement)’, ‘perceived cost-effectiveness of BC (TDF-environmental context and resources)’ and ‘regulation on cost reimbursement (TDF-behavioural regulation)’. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified. Conclusions Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.
UR - http://www.scopus.com/inward/record.url?scp=85185710383&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2023-075526
DO - 10.1136/bmjopen-2023-075526
M3 - Article
C2 - 38373855
AN - SCOPUS:85185710383
SN - 2044-6055
VL - 14
JO - BMJ open
JF - BMJ open
IS - 2
M1 - e075526
ER -