“The mechanisms which lead to antimicrobial resistance are biological. However the conditions promoting or mitigating against these biological mechanisms are profoundly social.” Prof Dame Sally MacIntyre

Anyone in the health system who has set out to address antimicrobial stewardship (AMS) will acknowledge the complexity of its different dimensions and the urgent need for more widespread and more sustainable solutions. At the same time, they often lament the difficulty of motivating action, changing behaviours and replicating or sustaining the results of their efforts.

I recall the excitement of diving eagerly into a multicentre AMS intervention that measured the impact of an AMS intervention bundle on antibiotic utilisation using the WHO’s Defined Daily Dose (DDD) methodology. And yes, I remember how thrilled we were to achieve “statistically significant” results.

Looking back, however, I am struck by the fact that we missed the opportunity to explore and understand how and why it works, the context-specific differences, cultural influences and other social dimensions including the interprofessional relationship challenges and wins. With little to no exposure to qualitative research methods nor the input of social scientists and anthropologists we were, like many health professionals and researchers in this field, falling into the trap of “one-size fits all” and did not know what we did not know.

It is therefore such a privilege to have the opportunity to bring together a series of articles by top AMS researchers with the aim of expanding and strengthening qualitative research in this field. Importantly by initiating this series and creating the right review structures JAC-Antimicrobial Resistance (JAC-AMR) also recognized the need for more publishing space for multidisciplinary qualitative research. In this series, the invited authors with diverse backgrounds and considerable expertise address and review intricate and varying qualitative research methods, behaviour change determinants, interventions and qualitative perspectives, with the aim of strengthening commitment and expanding qualitative initiatives to further the impact of AMS globally.

Dr Dena van den Bergh is an honorary lecturer in Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. She also works independently in her own business in the field of health systems improvement. Her research interests include design and implementation of large scale change in healthcare including antimicrobial stewardship and infection prevention strategies across different healthcare settings, quality and systems improvement and change leadership in health systems improvement.

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You can read the first articles in this ongoing series, here:

• A commitment and call to strengthen and expand qualitative research efforts to improve the impact of antimicrobial stewardship
• Navigating sociocultural disparities in relation to infection and antibiotic resistance—the need for an intersectional approach
• Understanding antibiotic use: practices, structures and networks