Barriers and Facilitators of appropriate Antibiotic Dispensing Practices Among Community Settings in Ghana and the implications: A qualitative study

Abstract

Abstract Antimicrobial resistance (AMR) remains a critical global health concern, particularly in low- and middle-income countries (LMICs), where inappropriate antibiotic use is widespread. In Ghana, antibiotics are frequently dispensed without prescriptions by community pharmacies (CPs) and over-the-counter medicine sellers (OTCMS), despite regulatory restrictions. This study aimed to explore the behavioural and contextual factors influencing antibiotic dispensing practices among CP and OTCMS personnel using behavioural science frameworks. A qualitative study was conducted using semi-structured interviews with 12 participants across four Ghanaian regions, including eight from CPs (five pharmacists, two pharmacy technicians, and one medical counter assistant) and four from OTCMS outlets. Participants were purposively selected to reflect variation in practice type, setting, and antibiotic dispensing behaviour. Data were thematically analysed and mapped onto the Capability, Opportunity, Motivation-Behavior (COM-B) model and the Theoretical Domains Framework (TDF). Three major themes were identified: perceived readiness and capability to dispense appropriately, the impact of systemic and contextual factors, and motivation to adhere to professional guidelines. Key barriers included limited AMR knowledge among OTCMS staff, weak regulatory enforcement, patient pressure, and commercial incentives. Facilitators included professional identity, peer support, awareness of AMR consequences, and openness to training. These findings highlight the importance of multifaceted, context-specific interventions that address individual behaviour, regulatory structures, and health system enablers. Theory-informed strategies based on the Behaviour Change Wheel (BCW) may enhance antimicrobial stewardship in Ghanaian community settings and similar LMIC contexts.