A Multicenter Survey Study on Antibiotic Stewardship Awareness and Prescribing Behavior Among Intern Doctors in Turkey: A Knowledge–Attitude–Practice (KAP) Gap Analysis Model

Abstract

Antibiotic resistance (AMR) has emerged as one of the most critical global health threats, driven largely by inappropriate prescribing practices and insufficient antimicrobial stewardship awareness among healthcare professionals. Intern doctors, as frontline prescribers in training, play a pivotal role in shaping rational antibiotic use behaviors. This multicenter survey study investigates the Knowledge–Attitude–Practice (KAP) profile of intern doctors in Turkey regarding antibiotic stewardship and prescribing behavior, with an emphasis on identifying structural gaps between awareness and clinical practice.
A cross-sectional, multicenter KAP framework was conceptualized based on validated constructs from prior studies examining physician and trainee knowledge and prescribing behavior (Ahmed et al., 2020; Atif et al., 2021; Zaidi et al., 2020). The study integrates comparative global evidence highlighting persistent gaps in antibiotic rationality despite moderate-to-high knowledge levels (Sobierajski et al., 2021; Nabidda et al., 2023). The findings are interpreted through the lens of antimicrobial resistance burden studies and stewardship program effectiveness literature (Huemer et al., 2020; Tang et al., 2023).
Results indicate a recurring disconnect between theoretical knowledge and clinical decision-making, consistent with prior observations in medical student and intern populations across multiple regions (Baddal et al., 2022; Yuste et al., 2022). Attitudinal factors, clinical pressure, and institutional prescribing norms were identified as major determinants of antibiotic overuse, aligning with findings from hospital-based Turkish and international studies (Sencan et al., 2022; Ayhan et al., 2024).
The study highlights the urgent need for structured antibiotic stewardship integration in intern training curricula and institutional prescribing governance systems. Strengthening KAP alignment is essential to mitigate inappropriate antibiotic use and reduce AMR progression.