Irrational use of antibiotics in Iran from the perspective of complex adaptive systems: redefining the challenge

Abstract Background Irrational use of antibiotics is proving to be a major concern the health systems globally. This results in resistance and increases care costs. In Iran, despite many years research, appreciable efforts, policymaking avoid irrational antibiotics, yet indicators show suboptimal pointing an urgent need for adopting alternative approaches further understand problem offer new solutions. Applying Complex Adaptive Systems (CAS) theory, explore research their challenges has become popular. Therefore, this study aimed better complexity Iran propose potential Method utilized CAS observatory tool qualitatively collect analyse data. Twenty interviews two Focus Group discussions were conducted. The data was enriched with policy document reviews fully system. MAXQDA software used organize analyze Result We could identify several diverse heterogeneous, highly interdependent agents operating at different levels system Iran. network structure its adaptive emergent behavior, information flow, governing rules, feedback values system, way they interact identified. findings described as behavior that formed by interplay factors over time. According study, insufficient ineffective interaction flow regarding between are among key causes Results showed effective rules minimize missing or can easily disobeyed. gaps weaknesses which redesigning modification recognized well. Conclusion suggests re-engineering implementing system-level changes including establishing strong, timely, interactions identified stakeholders, facilitate provision on-time feedback, create win-win participatory manner stakeholders distributed control