Evaluation of a Bayesian Belief Network tool for translating science and informing policy: the case of antibiotic misuse in Tanzania

was distributed to 385 clinical employees, including physicians, pharmacists, nurses, and lab specialists.Descriptive statistics and non-parametric tests (Mann-Whitney and Kruskal-Wallis) analyzed 5-point Likert scale (1 = Strongly Disagree, 2 = Partially Disagree, 3 = Neutral, 4 = Partially Agree, 5 = Strongly Agree) survey data, comparing median scores across ASP elements and employee groups, with significance at P < 0.05.Qualitative data from semi-structured interviews were thematically analyzed using NVIVO software.Results: Document reviews showed that ASPs at EHS hospitals are centrally managed, with all 12 hospitals meeting most core elements (Mode = 3).Variability in median scores highlighted challenges in formalizing programs across facilities.Survey results indicated partial dissemination of all core elements (median = 4).Leadership commitment (mean = 4.41, SD + 1.04) and pharmacy expertise (mean = 3.93, SD + 1.09) showed higher scores compared to other elements.Significant differences were observed between ASP members and non-members (p < 0.05), trained and untrained employees (p < 0.001), and across hospitals (p = 0.032).Qualitative analysis revealed strong strategic commitment and facility-driven ASP implementation supported by collaborative leadership, tailored education, and provider engagement.Key barriers included a lack of trust in ASP teams, physician resistance, absence of a competency framework, inadequate professional training, and limited access to rapid diagnostics.Discussion: Despite structural barriers and variability in adoption, EHS demonstrates strong leadership commitment, pharmacist engagement, and strategic implementation of ASP interventions.This first mixed-methods study in the UAE, utilizing data triangulation, benchmarks ASP practices against CDC standards.Findings align with practices in non-EHS government hospitals and high-income countries like Norway and Germany but contrast with some MENA region trends.Conclusion: EHS has established a robust foundation for sustainable ASPs, evidenced by adequate adoption and alignment with international frameworks.This study contributes to regional ASP benchmarking and highlights the need for further research to evaluate cost-effectiveness and clinical outcomes, including reductions in mortality and morbidity.