Enablers and barriers to antimicrobial stewardship for upper respiratory tract infections in Kosovo's primary care: a qualitative study protocol.

Abstract

Upper respiratory tract infections (URTIs) are one of the most common reasons for primary care visits, yet often do not require treatment with antibiotics. Antibiotic use is associated with side effects and the development of antibiotic resistance. Antimicrobial stewardship (AMS) programmes are essential to mitigate this issue. Many countries, including Kosovo, an upper-middle-income country, have not yet implemented AMS programmes. The implementation of AMS in Kosovo is shaped by economic, social, technological and legal factors. However, it is the structural weaknesses within the health system that pose the most significant barriers. This study will examine the barriers and enablers for AMS programmes for URTIs in the primary care setting. We plan to employ a qualitative case study approach, comprising interviews and focus groups conducted at six primary care sites within Kosovo, as well as central health institutions. We will include diverse stakeholders involved or affected by AMS implementation, such as healthcare workers, patients and their representatives, and policymakers from the Ministry of Health. The Consolidated Framework for Implementation Research will guide the design of the study, data collection and analysis. We will use framework analysis to examine key themes within the domains of intervention characteristics, outer setting, inner setting, characteristics of individuals involved, the implementation process and other insights. Ethical approval was obtained from the Kosovo Doctors Chamber (Reference No 122/2024), and we will adhere to good practice in terms of informed consent and data protection. Findings will be disseminated primarily through peer-reviewed publications.