A Framework for Assessing Antimicrobial Stewardship in Companion Animal Practice

Thesis Abstract

The escalating global concern over antimicrobial resistance (AMR) underscores the critical need for effective antimicrobial stewardship (AMS) practices within veterinary medicine, particularly in companion animal practice where antimicrobial usage is prevalent and often empirically determined. Despite increasing recognition of the role veterinarians play in AMS, a comprehensive, context-specific framework to assess and enhance stewardship activities in this sector remains underdeveloped. This study aims to develop and empirically validate a robust framework for assessing antimicrobial stewardship in companion animal practice, thereby contributing a practical tool for veterinary practitioners, policymakers, and researchers seeking to optimize antimicrobial use and combat AMR. The primary objectives are to (1) systematically review existing models, guidelines, and evaluation tools pertaining to AMS in veterinary and human medicine; (2) identify key components, drivers, and barriers influencing antimicrobial use in companion animal clinics; (3) construct a theoretical framework based on the Behavioral Change Theory and the Theory of Planned Behavior to underpin AMS assessment; and (4) empirically test the framework's validity and reliability through a cross-sectional study involving veterinary clinics. Utilizing a mixed-methods research design, the study integrates qualitative thematic analysis with quantitative validation. The qualitative phase involved semi-structured interviews with 30 veterinary practitioners selected via purposive sampling across urban and rural clinics to explore practices, perceptions, and contextual factors influencing antimicrobial prescribing behaviors. Data obtained were subjected to thematic analysis using NVivo software to identify recurrent themes informing framework components. The quantitative phase encompassed a structured questionnaire developed from qualitative insights, distributed to a representative sample of 250 licensed veterinarians, selected through stratified random sampling across the country. The instrument assessed variables including prescribing behavior, awareness of guidelines, perceived barriers, and organizational factors. Data analysis employed exploratory and confirmatory factor analysis (EFA and CFA) via SPSS and AMOS to validate the construct structure, followed by multiple regression analyses to examine predictors of stewardship practices. Expected findings include a delineation of key institutional, behavioral, and knowledge-related factors influencing antimicrobial prescribing in companion animal practice, and the identification of core elements such as clinician knowledge, client communication, organizational policies, and external regulatory influences. The framework is anticipated to demonstrate satisfactory validity and reliability indices, with a Cronbach’s alpha exceeding 0.80, and model fit indices indicating good construct fit (CFI > 0.90, RMSEA < 0.08). The results are expected to underscore the importance of targeted behavioral interventions and organizational support to optimize antimicrobial use, aligned with the principles of the Behavioral Change Theory and the Theory of Planned Behavior. This research substantially advances current understanding by providing a theoretically grounded, empirically validated framework tailored for veterinary practitioners in companion animal practice. It offers a practical assessment model that can be customized to different contexts, thereby facilitating regular evaluation and continuous improvement of AMS strategies. The contribution to knowledge includes an integration of behavioral theories with empirical data to elucidate determinants of antimicrobial prescribing, and the development of a comprehensive evaluation tool for practice-based AMS assessment. The study concludes that systematic application of the framework can significantly improve stewardship practices, reduce inappropriate antimicrobial use, and ultimately mitigate AMR risks associated with companion animal care. Recommendations include the integration of the framework into veterinary accreditation and training programs, development of continuing education modules focused on antimicrobial stewardship, and policy advocacy for enforceable guidelines. Finally, suggestions for further research include longitudinal studies to assess the framework’s impact over time and adaptation to different geographical and practice settings.