Overuse of broad-spectrum antibiotics in secondary care is a key contributor to the emergence and spread of antimicrobial resistance (AMR); efforts are focused on minimizing antibiotic overuse as a crucial step toward containing the global threat of AMR. The concept of overtreatment has, however, been difficult to define. Efforts to address the overuse of medicine need to be informed by an understanding of how prescribers themselves understand the problem. We report findings from a qualitative interview study of 46 acute care hospital prescribers differing in seniority from three countries: United Kingdom, Sri Lanka and South Africa. Prescribers were asked about their understanding of inappropriate use of antibiotics. Prescriber definitions of inappropriate use included relatively clear-cut and unambiguous cases of antibiotics being used “incorrectly” (e.g., in the case of viral infections). In many cases, however, antibiotic prescribing decisions were seen as involving uncertainty, with prescribers having to make decisions about the threshold for appropriate use. Decisions about thresholds were commonly framed in moral terms. Some prescribers drew on arguments about their duty to protect public health through having a high threshold for prescribing, while others made strong arguments for prioritizing risk avoidance for the patients in front of them, even at a cost of increased resistance. Notions of whether prescribing was inappropriate were also contextually dependent: high levels of antibiotic prescribing could be seen as a rational response when prescribers were working in challenging contexts, and could be justified in relation to financial and social considerations. Inappropriate antibiotic use is framed by prescribers not just in clinical, but also in moral and contextual terms; this has implications for the design and implementation of antibiotic stewardship interventions aiming to reduce inappropriate use of antibiotics globally.

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

Although Agent Based Models (hereafter ABM) are now regularly reported in sociology journals, explaining the approach, describing models and reporting results leaves little opportunity to examine wider implications of ABM for sociological practice. This article uses an established ABM (the Schelling model) for this. The first part argues that ABM integrates qualitative and quantitative data distinctively, provides novel tools for understanding social causes and offers a significantly different perspective on theory building. The second part shows how the emerging ABM methodology is compatible with existing sociological practice while undermining several criticisms of ABM perceived to limit its sociological relevance.

GAM, combining games and agent-based models, shows potential for investigating complex social phenomena. Games offer engaging environments generating insights into social dynamics, perceptions, and behaviours, while agent-based models support the analysis of complexity. Games and agent-based models share the important ability both to input and output qualitative and quantitative data. Currently, there is no overview of GAM approaches. In a systematic literature review, we identified six research design types in empirical studies to date. The functional range of these design types is wide, with diverse application domains involving analogue, digital, and hybrid games. This makes GAM a highly versatile approach, appealing to researchers in both natural and social sciences, along with the gaming community itself. To consolidate the GAM field, we propose recording the design and implementation of studies that combine games and agent-based models by using a dedicated documentation scheme.