Translation of policy into practice: a qualitative exploratory study of digitally supported antimicrobial stewardship programs in Nepalese hospitals

Background Antimicrobial resistance (AMR) represents an escalating public health crisis worldwide, with low- and middle-income countries bearing a disproportionate burden. Nepal has developed its National Action Plan on AMR (2024–2028), yet translating policy into functional hospital-based antimicrobial stewardship programs (ASPs), particularly those supported by digital health tools, remains a formidable challenge. This study explored the facilitators and barriers to implementing digitally supported ASPs in Nepalese hospitals from the perspectives of diverse health system stakeholders. Methods A qualitative exploratory study was conducted using an interpretivist approach. Semi-structured in-depth interviews were conducted with 38 purposively selected participants. Data were analyzed using Braun and Clarke’s six-phase thematic analysis. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Four overarching themes emerged: (1) perceptions and awareness of AMR, characterized by recognition of AMR as an urgent crisis driven by inappropriate prescribing, unregulated community antibiotic access, and One Health determinants; (2) current antimicrobial use practices and systemic challenges, including the dominance of empirical prescribing, variable guideline adherence, and ASP structures constrained by inadequate manpower and authority; (3) feasibility and acceptability of digital health tools for ASP, revealing broad support for digital integration alongside concerns about system fragmentation, variable institutional digital maturity, and the insistence that digital tools should support rather than replace clinical judgment; and (4) barriers, facilitators, and recommendations for sustainable ASP implementation, highlighting workforce shortages, leadership commitment, policy alignment, interoperability standards, and the need for sustained investment in both human resources and digital infrastructure. Conclusion While awareness of AMR and initial ASP structures exists across Nepalese hospitals, effective and sustainable implementation requires coordinated action spanning clinical, laboratory, digital, and policy domains. Digital health tools offer considerable promise for strengthening stewardship activities, but their successful integration depends on resolving foundational issues of interoperability, workforce capacity, standardization, and sustained leadership commitment. These findings provide concrete, pillar-specific entry points for operationalizing Nepal’s revised National Action Plan on AMR (2024–2028).