Open Access Research article

General practitioners’ views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial

Sibyl Anthierens1, Sarah Tonkin-Crine2*, Elaine Douglas3, Patricia Fernandez-Vandellos4, Jaroslaw Krawczyk5, Carl Llor6, Jochen WL Cals7, Nick A Francis8, Lucy Yardley9, Samuel Coenen1, Theo Verheij10, Herman Goossens11, Paul Little2 and the GRACE INTRO study team

Author affiliations

1 Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of microbiology, University of Antwerp, Antwerp, Belgium

2 Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK

3 Department of Epidemiology & Public Health, University College London, London, UK

4 Applied Research in Respiratory Diseases, Hospital Clinic of Barcelona, Barcelona, Spain

5 Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland

6 Primary Care Centre Jaume I, University Rovira i Virgili, Tarragona, Spain

7 Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands

8 Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK

9 Faculty of Human and Social Sciences, University of Southampton, Southampton, UK

10 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands

11 Laboratory of Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium

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Citation and License

BMC Family Practice 2012, 13:101  doi:10.1186/1471-2296-13-101

Published: 11 October 2012



Interventions to promote prudent antibiotic prescribing by general practitioners (GPs) have often only been developed for use in one country. We aimed to develop an intervention which would be appropriate to implement in multiple European countries in order to offer greater benefit to practice whilst using fewer resources. The INTRO (INternet TRaining for antibiOtic use) intervention needed to deliver training to GPs in the use of C-Reactive Protein (CRP) near patient tests to help diagnose acute cough and in communication skills to help explain prescribing decisions to patients. We explored GPs’ views on the initial version of INTRO to test acceptability and potentially increase applicability for use in multiple countries before the start of a randomised trial.


30 GPs from five countries (Belgium, England, the Netherlands, Poland and Spain), were interviewed using a “think aloud” approach. GPs were asked to work through the intervention and discuss their views on the content and format in relation to following the intervention in their own practice. GPs viewed the same intervention but versions were created in five languages. Data were coded using thematic analysis.


GPs in all five countries reported the view that the intervention addressed an important topic, was broadly acceptable and feasible to use, and would be a useful tool to help improve clinical practice. However, GPs in the different countries identified aspects of the intervention that did not reflect their national culture or healthcare system. These included perceived differences in communication style used in the consultation, consultation length and the stage of illness at which patient typically presented.


An online intervention to support evidence-based use of antibiotics is acceptable and feasible to implement amongst GPs in multiple countries. However, tailoring of the intervention to suit national contexts was necessary by adding local information and placing more emphasis on the fact that GPs could select the communication skills they wished to use in practice. Using think aloud methods to complement the development of interventions is a powerful method to identify regional contextual barriers to intervention implementation.

Primary health care; Behaviour change intervention; Implementation; Attitude of health personnel; Qualitative research