Table 3 Summary of major identified factors with potential intervention

Diagnostic uncertainty

Lack of confidence about diagnosis

Providing education on dealing with uncertainty in medical practice Promoting rapid diagnostics e.g. Applying point-of-care testing [31, 64, 68]

Physician‒patient relationship

The communication between patients and physicians during consultation

Improving communication skills and public knowledge of antibiotics through antibiotics awareness campaigns, and implementing shared decision-making [38, 44]

Guidelines

Attitudes towards practice guidelines and beliefs on applicability of guidelines

Improving applicability of guidelines and letting prescribers participate in hospital guideline formation to improve, support and adherence [8, 25, 42, 45, 61]

Clinical experience and education of physicians

Prior individual cases, types of clinical experience, years and education

Facilitating training for junior and young professionals, on antibiotic prescription and stewardship [44, 58]

Source of updating knowledge/source of information

Up-to-date knowledge and reliable sources of information

Facilitating accessibility of online databases, continuing medical education and guidelines from health organizations [26, 35, 57]

Colleagues' pressure and prescribing habits, and professional routines

Colleagues and senior physicians in the decision process for prescribing antibiotics

Educating senior physicians about their position as role models and teaching them how to explain why they are using antibiotics. improving young physicians' ability to reflect on their superiors' antibiotic prescriptions [6, 37]

Financial factors

Finance incentives, access to and investments in healthcare

Continuous monitoring of the payment system of health care providers [38, 40, 47]

Patients’ previous experiences of receiving antibiotics and cultural perceptions of illness and health

The history of antibiotic use and beliefs about health, cause of diseases and labelling of illness

Patient education, communication skill training and implementing shared decision-making [56]

Attitude, perception and knowledge of physicians regarding antibiotic resistance

The physician responsible for growing antibiotic resistance and awareness of it

Promoting feedback to physicians on their own prescription characteristics and distributing posters/leaflets to increase awareness about antibiotic resistance [30, 48]

Practice volume and time pressure

Number of patients who physicians manage within specific time

Optimize appointment scheduling, providing telemedicine service and optimization of workflow [32]

Demographic and social determinants of patient health

Poverty, low education level, living place, comorbid conditions, access to health care

Implement income support programs like health insurance, promoting health literacy and education programs [55, 94,95,96,97]

Over-the-counter prescription of antibiotics and pressures from pharmaceutical industries

Purchased without a prescription from pharmacies and pressure from pharmaceutical companies

Transparency practice, public awareness campaigns, and strengthening regulation [33, 50]