Perspectives of health care professionals and policymakers on antimicrobial stewardship and implementation challenges in low- and middle-income country hospital settings: a qualitative systematic review protocol

Objective: The objective of this review is to synthesize qualitative evidence on the perceptions of health care professionals and policymakers regarding barriers and facilitators to implementing antimicrobial stewardship (AMS) programs in hospital settings, particularly in low- and middle-income countries. Introduction: AMS programs are widely recognized as critical interventions to combat antimicrobial resistance and optimize the use of antibiotics. While quantitative studies have demonstrated the effectiveness of AMS programs in reducing inappropriate antibiotic use, less is known about the experiences, perceptions, and contextual factors that influence their implementation and sustainability. Eligibility criteria: This review will include qualitative studies exploring the experiences, perceptions, attitudes, and contextual factors influencing implementation of AMS programs among health care professionals and policymakers. Studies conducted in any health care setting and involving any population relevant to AMS programs will be considered. Methods: The key information sources to be searched for this review include PubMed, CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, Embase (Elsevier), and Web of Science. The search will include studies published in any language from 2015 onwards. Study selection will be conducted independently by 2 reviewers, with any disagreements resolved through discussion or consultation with a third reviewer. All included studies will be critically appraised for methodological quality, and only those meeting a predefined threshold will proceed to synthesis. Data relevant to the review objectives will be extracted, followed by an aggregative data synthesis approach. Confidence in the findings will be assessed using a structured grading process based on credibility and dependability. Review registration: PROSPERO CRD420251044164