Background

Blood culture (BC) is the core sample for antimicrobial resistance (AMR) surveillance and diagnostic stewardship. BC is also a crucial diagnostic test that influences treatment decisions and impacts patient management and clinical outputs. International guidelines on sepsis management stress the importance of taking a blood culture before or when not possible immediately after administration of antibiotics.

BC sampling rates are lower than recommended in high-income countries (HICs) and low- and middle-income countries (LMICs). Several barriers have been identified that impeded the adoption of BC sampling recommendations.

Some of them include insufficient awareness among clinicians, a lack of practical recommendations for clinicians about when to take a blood sample, limited knowledge of the BC guideline, lack of time in clinical practice to perform BC sampling, BC bottles not being readily available, and cost consideration for the patients.

The Theoretical Domain Framework (TDF) has been developed by synthesizing a wide range of theories. It enables researchers to investigate a broader range of individual, socio-cultural and environmental behavioural influences than they would with a single theory alone. The TDF has been widely used to explore barriers and enablers to healthcare professional behaviours, including antimicrobial stewardship, management of sepsis, and infection prevention control.

A systematic review was performed to identify known barriers and enablers to the adoption of BC sampling recommendations. The identified TDF 14 domains are knowledge, skills, professional roles and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, goals, memory, attention and decision processes, environmental context and resources, social influences, emotion, and behavioural regulation.

Aims

This study aims to identify and explore known and unknown barriers and facilitators to adopting BC sampling recommendations in Indonesia, Thailand and Viet Nam. The outcome measures are:

1. Presence, proportion and level of reported barriers to the adoption of blood culture sampling recommendations
2. Presence, proportion and level of reported facilitators to the adoption of blood culture sampling recommendations

Study Design

A quantitative survey study using electronic semi-anonymous questionnaires will be performed in Indonesia, Thailand and Viet Nam. This is a research project being conducted under the collaboration between OUCRU Indonesia and Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Thailand, OUCRU Viet Nam, Centre for Behavior Change, University College London, United Kingdom.

A questionnaire structured around the domains of the TDF was developed in English. Items represent statements related to each domain that respondents will rate their agreement to on five-point Likert-Type scales (representing the level of barriers and enablers they perceive). In the questionnaire, a case scenario for which BC ordering is recommended by present international guidelines (e.g., WHO diagnostic stewardship) will be presented.

The questionnaire was translated from English to Thai, Vietnamese and Bahasa Indonesia.