{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:03:58Z","timestamp":1789625038380,"version":"build-2803163510"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate antimicrobial stewardship participation and its associated factors among intensive care unit (ICU) nurses based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among ICU nurses from 11 hospitals across China in March 2026. Data on demographic and occupational characteristics were collected using a general information questionnaire. Antimicrobial stewardship participation and its influencing factors were assessed using the ICU Nurses\u2019 Participation in Antimicrobial Stewardship Behavior and Influencing Factors (ASP-BF) Scale, and nursing professional self-efficacy was measured using the Nursing Professional Self-Efficacy (NPSE) Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 497 ICU nurses were included. The mean scores were 48.80\u202f\u00b1\u202f9.86 for capability (possible range: 13\u201365), 38.42\u202f\u00b1\u202f10.60 for opportunity (possible range: 11\u201355), 82.55\u202f\u00b1\u202f16.86 for motivation (possible range: 23\u2013115), 59.94\u202f\u00b1\u202f13.57 for behavior (possible range: 16\u201380), and 29.60\u202f\u00b1\u202f4.45 for NPSE (possible range: 7\u201335). Structural equation modeling (SEM) showed that capability (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.41), opportunity (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.84), and NPSE (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.77) were positively associated with motivation, and motivation was positively associated with behavior (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.75; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICU nurses had generally favorable levels of capability, opportunity, motivation, behavior, and NPSE in relation to antimicrobial stewardship participation. Motivation was directly associated with participation behavior, while capability, opportunity, and NPSE were associated with behavior through motivation. In addition, antimicrobial stewardship training was associated with better participation behavior. Future interventions should focus on strengthening institutional support, improving multidisciplinary collaboration and workflow conditions, and providing structured training to enhance nurses\u2019 participation in antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1922847","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:34:11Z","timestamp":1789623251000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Participation in antimicrobial stewardship among intensive care unit nurses: a cross-sectional study based on the COM-B model"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiao","family":"Dang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijingzi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Nursing Affairs, First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"You","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/s0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050","volume":"404","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"900","DOI":"10.3390\/antibiotics13090900","article-title":"Antibiotic use and antimicrobial resistance: a global public health crisis","volume":"13","author":"Estany-Gestal","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/s13054-025-05653-8","article-title":"Optimal antibiotic use in the intensive care unit","volume":"29","author":"Micek","year":"2025","journal-title":"Crit Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jointm.2022.10.001","article-title":"Antimicrobial stewardship in the intensive care unit","volume":"3","author":"Ture","year":"2023","journal-title":"J Intensive Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13756-019-0471-0","article-title":"Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review","volume":"8","author":"Nathwani","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e2253806","DOI":"10.1001\/jamanetworkopen.2022.53806","article-title":"Association between antimicrobial stewardship programs and antibiotic use globally: a systematic review and Meta-analysis","volume":"6","author":"Zay Ya","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/j.ajic.2022.09.001","article-title":"Duration of antibiotics through care transitions: a quality improvement initiative","volume":"51","author":"Soto","year":"2023","journal-title":"Am J Infect Control"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13756-024-01369-6","article-title":"Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review","volume":"13","author":"Harun","year":"2024","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"637","DOI":"10.3947\/ic.2022.0171","article-title":"Core elements for implementing antimicrobial stewardship programs in Korean general hospitals","volume":"54","author":"Cheong","year":"2022","journal-title":"Infect Chemother"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3011","DOI":"10.1111\/jocn.16204","article-title":"Nurses' perceptions of their role in antimicrobial stewardship within the hospital environment. An integrative literature review","volume":"31","author":"Davey","year":"2022","journal-title":"J Clin Nurs"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/jacamr\/dlad123","article-title":"A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use","volume":"5","author":"Bos","year":"2023","journal-title":"JAC Antimicrob Resist"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1017\/ice.2018.362","article-title":"Integrating bedside nurses into antibiotic stewardship: a practical approach","volume":"40","author":"Monsees","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2023\/9059920","article-title":"Knowledge, attitudes, and practices of bedside nurses regarding antimicrobial stewardship in China: an explanatory sequential mixed methods study","volume":"2023","author":"Zhao","year":"2023","journal-title":"J Nurs Manag"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.idh.2021.04.003","article-title":"Perceived roles and barriers to nurses' engagement in antimicrobial stewardship: a Thai qualitative case study","volume":"26","author":"van Gulik","year":"2021","journal-title":"Infect Dis Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"51","DOI":"10.7196\/SAJCC.2020.v36i1.410","article-title":"Perceived barriers to the development of the antimicrobial stewardship role of the nurse in intensive care: views of healthcare professionals","volume":"36","author":"Rout","year":"2020","journal-title":"S Afr J Crit Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.ijnss.2023.12.002","article-title":"Nurses' engagement in antimicrobial stewardship and its influencing factors: a cross-sectional study","volume":"11","author":"Nie","year":"2024","journal-title":"Int J Nurs Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.jhin.2022.07.010","article-title":"Influences on nurses\u2019 engagement in antimicrobial stewardship behaviours: a multi-country survey using the theoretical domains framework","volume":"129","author":"Chater","year":"2022","journal-title":"J Hosp Infect"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"105992","DOI":"10.1016\/j.nedt.2023.105992","article-title":"Structural equation modeling for associated factors with patient safety behaviors among nursing interns: a cross-sectional study based on the capability opportunity motivation-behavior model","volume":"132","author":"Huang","year":"2024","journal-title":"Nurse Educ Today"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"4591","DOI":"10.1007\/s00520-022-06812-1","article-title":"Barriers and facilitators to physical activity participation in patients with head and neck cancer: a scoping review","volume":"30","author":"Ning","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12877-023-03756-x","article-title":"Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model","volume":"23","author":"Gong","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1748-5908-9-33","article-title":"Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework","volume":"9","author":"Huijg","year":"2014","journal-title":"Implement Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1268336","DOI":"10.3389\/fpubh.2024.1268336","article-title":"Depression, professional self-efficacy, and job performance as predictors of life satisfaction: the mediating role of work engagement in nurses","volume":"12","author":"Morales-Garc\u00eda","year":"2024","journal-title":"Front Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3390\/healthcare11152156","article-title":"An observational cross-sectional study on the correlation between professional competencies and self-efficacy in Albanian registered nurses","volume":"11","author":"Duka","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"8869949","DOI":"10.1155\/2024\/8869949","article-title":"Communication self-efficacy and job satisfaction among nurses during the COVID-19 pandemic","volume":"2024","author":"Ghahremani","year":"2024","journal-title":"J Nurs Manag"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1007\/s11096-018-0675-z","article-title":"Role of pharmacists in antimicrobial stewardship programmes","volume":"40","author":"Garau","year":"2018","journal-title":"Int J Clin Pharm"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"252","DOI":"10.3390\/antibiotics8040252","article-title":"Antimicrobial stewardship programs in community health systems perceived by physicians and pharmacists: a qualitative study with gap analysis","volume":"8","author":"Park","year":"2019","journal-title":"Antibiotics (Basel)"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1017\/ash.2024.63","article-title":"Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses","volume":"4","author":"Perez","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"216","DOI":"10.3390\/nursrep15060216","article-title":"Nurses' engagement in antimicrobial stewardship Programmes: a mapping review of influencing factors based on Irvine's theory","volume":"15","author":"Filipe","year":"2025","journal-title":"Nurs Rep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2774","DOI":"10.1093\/jac\/dkz245","article-title":"Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: prospective observational study","volume":"74","author":"Yoon","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"754","DOI":"10.3390\/healthcare11050754","article-title":"Nursing profession self-efficacy scale-version 2: a stepwise validation with three cross-sectional data collections","volume":"11","author":"Magon","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"121","DOI":"10.4103\/0253-7176.116232","article-title":"How to calculate sample size for different study designs in medical research?","volume":"35","author":"Charan","year":"2013","journal-title":"Indian J Psychol Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"957630","DOI":"10.3389\/fpubh.2022.957630","article-title":"Knowledge, attitude, and practice assessment toward COVID-19 among communities in East Nusa Tenggara, Indonesia: a cross-sectional study","volume":"10","author":"Lee","year":"2022","journal-title":"Front Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e042321","DOI":"10.1136\/bmjopen-2020-042321","article-title":"Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study","volume":"10","author":"Kirby","year":"2020","journal-title":"BMJ Open"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"103772","DOI":"10.1016\/j.ijnurstu.2020.103772","article-title":"The nurses' role in antimicrobial stewardship: a scoping review","volume":"113","author":"van Huizen","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.ajic.2017.12.016","article-title":"Exploring the nurses' role in antibiotic stewardship: a multisite qualitative study of nurses and infection preventionists","volume":"46","author":"Carter","year":"2018","journal-title":"Am J Infect Control"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1016\/j.aucc.2022.09.005","article-title":"Nursing experiences in antimicrobial optimisation in the intensive care unit: a convergent analysis of a national survey","volume":"36","author":"Padigos","year":"2023","journal-title":"Aust Crit Care"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1748-5908-7-37","article-title":"Validation of the theoretical domains framework for use in behaviour change and implementation research","volume":"7","author":"Cane","year":"2012","journal-title":"Implement Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1186\/s12913-023-09559-5","article-title":"A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care","volume":"23","author":"Turner","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.2147\/jmdh.S376664","article-title":"Nurses' perceptions, involvement, confidence and perceived barriers towards antimicrobial stewardship program in Pakistan: findings from a multi-center, cross-sectional study","volume":"15","author":"Mustafa","year":"2022","journal-title":"J Multidiscip Healthc"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.ajic.2019.12.002","article-title":"Nurses as antimicrobial stewards: recognition, confidence, and organizational factors across nine hospitals","volume":"48","author":"Monsees","year":"2020","journal-title":"Am J Infect Control"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/j.ajic.2018.05.020","article-title":"A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship","volume":"46","author":"Fisher","year":"2018","journal-title":"Am J Infect Control"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.ajic.2022.05.001","article-title":"Effect of educational intervention on nurses' perception and practice of antimicrobial stewardship programs","volume":"51","author":"Hendy","year":"2023","journal-title":"Am J Infect Control"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.ajic.2017.01.002","article-title":"An online course improves nurses' awareness of their role as antimicrobial stewards in nursing homes","volume":"45","author":"Wilson","year":"2017","journal-title":"Am J Infect Control"},{"key":"ref45","year":"2026"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922847\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:34:12Z","timestamp":1789623252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922847\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2026.1922847"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1922847","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"1922847"}}