Parents' perspectives on childhood antibiotic treatment in Ireland-a qualitative study.

Background and objectives: Paediatric respiratory tract infections can be a common reason for antibiotic prescribing in primary healthcare. Despite stewardship efforts, prescribing patterns often diverge from evidence-based guidelines. There are limited explorations of how parental beliefs and behaviours shape clinical decision-making. This qualitative study explored parental perspectives on antibiotic treatment-seeking behaviour in Ireland. Methods: We carried out semi-structured interviews with 20 parents who had children under 8 years old in Ireland. The interviews were guided by the COM-B (Capability, Opportunity, Motivation - Behaviour) model. The interview data was analysed inductively, using reflexive thematic analysis. Following this, relevant themes and subthemes were mapped to the domains of the COM-B. Results: The study identified three key themes: (i) experiencing perceived knowledge gaps in antimicrobial resistance (AMR) and antibiotic use captured how participants described negotiating AMR as a personal health risk while also experiencing AMR as a distant policy; (ii) navigating professional gatekeepers described the role of consulting with the general practitioner (GP), the out-of-hours doctor paradox, trusting the pharmacist and seeing receptionists as hidden gatekeepers who all shaped access to care; and (iii) deciding when to act reflected how people sought pragmatic reassurance and managed illness escalation anxiety in making decisions about seeking treatment. Conclusions: The study underscores the need for socio-culturally tailored antimicrobial resistance messaging and interventions that address both parental concerns and systemic barriers. By centring parental voices, this research highlights opportunities to strengthen antimicrobial stewardship through improved communication, recognition and expanded roles for the primary healthcare team.