Unraveling behavioral and sociocultural factors that shape antimicrobial use among patients and general public, Addis Ababa, Ethiopia, a qualitative study

Antimicrobial resistance (AMR) is a critical global health threat, particularly in low- and middle-income countries (LMICs). In Ethiopia, high infectious disease burdens, unregulated antimicrobial access, and low awareness exacerbate inappropriate use, accelerating AMR. While microbiological aspects of AMR are studied, behavioral and sociocultural factors influencing antimicrobial use remain underexplored. This study investigates these factors in Addis Ababa to inform strategies for mitigating AMR and improving public health outcomes. This qualitative study, conducted from April to May 2025 in Addis Ababa, Ethiopia, involved 25 in-depth interviews with patients and the general public across five public health facilities and three community pharmacies. Participants were selected using purposive and convenience sampling techniques. Semi-structured interviews, explored behavioral and sociocultural determinants of antimicrobial use. A codebook was refined iteratively by two coders to ensure consistency. Data were audio-recorded, transcribed, and analyzed using Dedoose software through thematic analysis. Ethical approval was obtained, and confidentiality was maintained throughout. The identified themes were linked with Theoretical domains framework domains to enhance the depth of understanding. Five key themes emerged: limited knowledge and misconceptions about antimicrobials, with many viewing them as universal cures; prevalent self-medication and non-prescription use, driven by accessibility and trust in pharmacists; varied healthcare-seeking behaviors, influenced by trust and logistical barriers; sociocultural influences, including peer advice and traditional beliefs combining antibiotics with remedies; and structural and economic barriers, such as limited healthcare access and high costs, promoting misuse. These factors, rooted in knowledge gaps, cultural norms, and systemic weaknesses, contribute significantly to inappropriate antimicrobial use and AMR. The study highlights how misconceptions, self-medication, sociocultural norms, and structural barriers drive inappropriate antimicrobial use in Addis Ababa, exacerbating AMR. Multifaceted interventions are needed, including community education to address knowledge gaps, stricter prescription regulations, improved healthcare access through expanded insurance and clinics, and engagement with cultural leaders to align practices with evidence-based use. These strategies can mitigate AMR while ensuring equitable access to effective treatments, addressing both behavioral and systemic challenges.