Abimbola Ayorinde ^1* Iman Ghosh ¹ Junaid Shaikh ¹ Victoria Adetunji ¹ Anna Brown ¹ Mary Jordan ¹ Ellie Gilham ² Daniel Todkill ¹ Diane Ashiru-Oredope ²

• ¹ Warwick Medical School, Faculty of Science, Engineering and Medicine, University of Warwick, Coventry, West Midlands, United Kingdom
• ² UK Health Security Agency (UKHSA), London, United Kingdom

Antimicrobial resistance (AMR) is a major public health threat. With the growing emphasis on patient-centred care/ shared decision making, it is important for healthcare professionals' (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to be adequately equipped to facilitate appropriate antimicrobial use. We systematically identified existing interventions which aim to improve HCPs interaction with patients and examined barriers and facilitators of appropriate the use of such interventions and appropriate antimicrobial use among both HCPs and patientsantimicrobial use while using these interventions. We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and internet (via Google search engine). We included primary studies, published in English from 2010 to 2023 (PROSPERO CRD42023395642). The protocol was preregistered with PROSPERO (CRD42023395642). We performed quality assessment using mixed methods appraisal tool. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation -Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Of 9,172 citations retrieved from database searches, From 4,979 citations remained after removal of duplicates. , wWe included 59 studies spanning over 13 countries. Interventions often involved multiple components beyond HCPs' interaction with patients. From 24 studies reporting barriers and facilitators, we identified issues relating to capability (such as, knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions and forgetfulness); opportunity (such as, time constraint and intervention accessibility) and motivation (such as, patient's desire for antibiotics and fear of litigation). These findings should be considered by intervention designers/adopters and policy makers to improve utilisation and effectiveness.