When Antibiotics Are Refused: A Qualitative Study of Patient-Provider Communication, Trust, and Reported or Anticipated Responses in Jordan.

Background/Objectives: Patient-centered antimicrobial stewardship depends not only on restricting non-prescription antibiotic access, but also on how people interpret professional advice when an antibiotic request is declined. This study explored how adults in Jordan interpreted antibiotic refusal and distinguished personally reported experiences from anticipated vignette responses and perceptions of other people's behavior. Methods: Semi-structured interviews were conducted between November 2025 and March 2026 with 32 adults purposively recruited for variation in age, gender, region, education, caregiving status, healthcare access, and antibiotic-use experience. Thirteen participants reported a previous refusal encounter-seven involving a pharmacist and six involving a physician-whereas 19 discussed refusal primarily through vignettes. Data were analyzed using an experiential, contextualist form of reflexive thematic analysis. Results: Three themes were developed: (1) antibiotics as active and responsible care under uncertainty; (2) refusal as a negotiation of credibility and care; and (3) continued antibiotic seeking after refusal as a set of reported, anticipated, or socially attributed possibilities. Antibiotics could symbolize strength, rapid recovery, and responsible caregiving. Refusal was more readily interpreted as care when participants described or anticipated acknowledgement, a reasoned explanation, symptom-relief options, and safety-netting. Responses after refusal included acceptance and monitoring, uncertainty or clinical reassessment, and continued antibiotic seeking, but these were not equivalent forms of evidence. Conclusions: Antibiotic refusal is a trust-sensitive and context-dependent patient-provider interaction rather than a uniform behavioral pathway. The findings identify communication and access conditions that merit prospective evaluation; they do not establish that communication causes acceptance or that vignette intentions predict behavior.