Table 5.
Strengths and barriers of the pivotal factors of PAR learned during the BAbAR project to improve antibiotic prescribing behaviour during OOH primary care
| Pivotal factors | ||
|---|---|---|
| 1. Participation | Strengths | In 2 out of 3 GPCs, the project was bottom-up initiated by local GPs |
| Participants were engaged early in the process | ||
| Participation of stakeholders was voluntary | ||
| Barriers | In 1 of the 3 GPCs, the study was initiated by the study team, so there were limited local key persons | |
| Only committed GPs participated in the exploratory, co-creation and evaluation phase | ||
| Level of participation, ownership of the project and motivation for change differed between the different GPCs | ||
| 2. Key persons | Strengths | Great involvement and commitment of a number of key persons |
| Were considered as co-researchers, and involved in every stage of the research | ||
| Provided understanding of the context | ||
| Barriers | Limited number of key persons | |
| Requires a great commitment | ||
| 3. Action researcher–participant relationship | Strengths | Insider-outsider role of the main researcher increases credibility |
| Positive relationship between researcher and key persons | ||
| Barriers | Varying levels of commitment between the different GPCs and/or GPs | |
| 4. Real-world focus | Strengths | The exploratory phase of this project analysed in depth the context |
| Use of quality indicators to describe and identify the current state | ||
| Material adapted for target population (e.g. leaflet in multiple languages) | ||
| Materials containing solutions for difficulties experienced by GPs during the consultation (e.g. safety-netting, explaining duration of infection, leaflet to provide instead of a prescription…) | ||
| Cross-pollination of ideas and solutions over the different GPCs | ||
| Barriers | Time-consuming due to mixed-methods approach | |
| The sudden onset of COVID-19 stopped the project | ||
| Practical problems (e.g. availability of materials, busy shifts) | ||
| 5. Resources | Strengths | Budget raised by both the GPC and the academic partner |
| Barriers | Limited budget | |
| Time-consuming project | ||
| 6.Research methods | Strengths | Mixed-methods approach to gain a rich description |
| Exploring the problem could be considered as an intervention already by exposing the problem | ||
| Barriers | Data processing takes time | |
| 7. Project process and management | ||
| Responsiveness and flexibility | Strengths | Rapid and flexible feedback and adjustments |
| Barriers | Limited PDSA cycles | |
| Feedback mechanisms | Strengths | Access and automatic extraction of data from the EHR |
| Use of standardized quality indicators | ||
| Barriers | Manually processing the data to provide tailored feedback | |
| Possible errors in the data due to registration faults | ||
| Evaluation | Strengths | During and after implementation phase |
| Mixed methods | ||
| Barriers | Difficult evaluation of outcomes because of large group of different GPs (limited contact with the intervention) and shorter study period than foreseen | |
| 8. Knowledge | Strengths | Contribution to knowledge at GP level, but moreover contribution to knowledge at the level of using PAR in this context |