IFPHOR0038 Factors Affecting Antimicrobial Stewardship in a Peri-Urban Community Setting in Wakiso District, Uganda: A Qualitative Study

Abstract Background Factors that influence antimicrobial stewardship practices are context-specific, necessitating a deeper understanding of community behaviours. This is particularly important in countries that have weak health systems, and the burden of healthcare is largely carried by individuals and their families. Objective To explore factors affecting antimicrobial stewardship in a peri-urban community setting. Study setting The study was conducted in Nakawuka Ward, a peri‑urban community in Wakiso District, Uganda, where access to human and veterinary healthcare is constrained by limited government facilities, and reliance on private and informal providers within a pluralistic health system. Methods Informed by social constructivism and the socioecological model, 18 in-depth interviews and 8 key informant interviews were conducted among community members and local leaders / health service providers, respectively. Reflective thematic analysis was used to identify patterns and meanings affecting community antimicrobial stewardship. Results Behaviours around antimicrobial stewardship practices were driven by locally constructed knowledge of illness and culture, household-level self-research, relational dynamics with health providers and family, trade-offs between health and daily survival, strategies to minimise financial expenditures or loss, and productivity pressures shaping antimicrobial choices. The findings show that antimicrobial use and practices are embedded within broader interlinked socio-cultural, economic, and relational factors. Conclusion The findings highlight that the use of antimicrobials in community settings is influenced by complex behavioural and contextual dynamics. Effective stewardship efforts should integrate community realities, lived experiences, and socioeconomic burdens into their design to sustain behaviour change.