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Fitzpatrick MA, Solanki P, Wirth M, Weaver FM, Suda KJ, Burns SP, Safdar N, Collins E, Evans CT. Knowledge, perceptions, and beliefs about urinary tract infections in persons with neurogenic bladder and impacts on interventions to promote person-centered care. Spinal Cord 2024; 62:221-227. [PMID: 38454065 PMCID: PMC11175994 DOI: 10.1038/s41393-024-00972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
STUDY DESIGN Qualitative study. OBJECTIVES To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management. SETTING Three Veterans Affairs (VA) medical centers. METHODS Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory. RESULTS Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient-provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups. CONCLUSIONS Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.
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Affiliation(s)
- Margaret A Fitzpatrick
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
- Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephen P Burns
- Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, WA, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton VA Hospital, Madison, WI, USA
| | - Eileen Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Romaszko-Wojtowicz A, Tokarczyk-Malesa K, Doboszyńska A, Glińska-Lewczuk K. Impact of COVID-19 on antibiotic usage in primary care: a retrospective analysis. Sci Rep 2024; 14:4798. [PMID: 38413799 PMCID: PMC10899221 DOI: 10.1038/s41598-024-55540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
The COVID-19 pandemic has contributed to many changes in the medical practice, including a wider access to tele-consultations. It not only influenced the type of treatment but also shed light on mistakes often made by doctors, such as the abuse of antibiotics. This study aimed to evaluate the antibiotic treatment, and the impact of the COVID-19 pandemic on antibiotic prescribing during a GP's visit. The retrospective medical history analysis involved data from a first-contact medical center (Pantamed, Olsztyn, Poland), from 1 January 2018 to 31 May 2023. Quantities of prescribed antibiotics were assessed and converted into the so-called active list for a given working day of adult patients (> 18 years of age). Statistical analysis based on collective data was performed. During the COVID-19 pandemic, a decline in the number of medical consultations has been observed, both remotely via tele-medicine and in personal appointments, compared to the data from before the pandemic: n = 95,251 versus n = 79,619. Also, during the COVID-19 pandemic, there was a decrease in the total amount of prescribed antibiotics relative to the data before the pandemic (2.44 vs. 4.54; p > 0.001). The decrease in the quantities of prescribed antibiotics did not depend on the way doctor consultations were provided. The COVID-19 pandemic has contributed to changing the family doctors' management of respiratory infections. The ability to identify the etiological agent-the SARS-COV2 virus-contributed to the reduction of the antibiotics use.
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Affiliation(s)
- Anna Romaszko-Wojtowicz
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Jagiellońska 78, 10-357, Olsztyn, Poland.
| | - K Tokarczyk-Malesa
- Department of Family Medicine and Infectious Diseases, Collegium Medicum, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Anna Doboszyńska
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Jagiellońska 78, 10-357, Olsztyn, Poland
| | - K Glińska-Lewczuk
- Department of Water Resources, Climatology and Environmental Management, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Kasse GE, Humphries J, Cosh SM, Islam MS. Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review. BMC PRIMARY CARE 2024; 25:8. [PMID: 38166736 PMCID: PMC10759428 DOI: 10.1186/s12875-023-02223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Antibiotic resistance is growing globally. The practice of health professionals when prescribing antibiotics in primary health care settings significantly impacts antibiotic resistance. Antibiotic prescription is a complex process influenced by various internal and external factors. This systematic review aims to summarize the available evidence regarding factors contributing to the variation in antibiotic prescribing among physicians in primary healthcare settings. METHODS This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies. RESULTS Of the 1816 identified studies, 49 studies spanning 2000-2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues' prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability. CONCLUSION Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
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Affiliation(s)
- Gashaw Enbiyale Kasse
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia.
- Department of Clinical Medicine, College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, 196, Ethiopia.
| | - Judy Humphries
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne M Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
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Musoke D, Lubega GB, Gbadesire MS, Boateng S, Twesigye B, Gheer J, Nakachwa B, Brown MO, Brandish C, Winter J, Ng BY, Russell-Hobbs K, Gibson L. Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study. J Pharm Policy Pract 2023; 16:147. [PMID: 37978569 PMCID: PMC10655315 DOI: 10.1186/s40545-023-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Private pharmacies are the first point of contact for the public regarding acquisition of medicines and other pharmaceuticals in many low- and middle-income countries including Uganda. Most antimicrobial stewardship (AMS) programmes in Uganda have targeted pharmacies in public health facilities, with little known about private pharmacies. This study explored knowledge and practices related to AMS in private pharmacies in Wakiso district, central Uganda. METHODS This was a qualitative study that involved 31 in-depth interviews to explore AMS among retail private pharmacy staff including pharmacists, pharmacy technicians/dispensers, and nurses. Participants were asked about antimicrobial resistance (AMR) and AMS practices at their pharmacy. The audio-recorded interviews were transcribed verbatim and imported to NVivo 2020 (QSR International) for thematic analysis. RESULTS Five major themes emerged from the study: commonly sold antimicrobials; knowledge on AMR and AMS; potential contributors to AMR; practices related to AMS; and challenges to AMS. The commonly sold antimicrobials in the pharmacies with or without prescriptions were oral azithromycin, Ampiclox® (ampicillin and cloxacillin), amoxicillin, ciprofloxacin, Septrin® (co-trimoxazole), metronidazole, Flucamox® (amoxicillin and flucloxacillin), Augmentin® (amoxicillin and clavulanic acid), cephalexin, doxycycline, and chloramphenicol. Participants had heard about AMR but not AMS, although only a few correctly defined AMR. Lack of knowledge among health workers and local communities; the overuse, misuse, and abuse of antimicrobials such as non-adherence to dosage; self-medication; and purchase of drugs without prescription were identified as potential accelerators to the emergence of AMR. Current practices related to AMS in private pharmacies were limited to meetings, antimicrobial dispensing, providing client advice, record keeping, and monitoring of drugs. Cost of healthcare, client satisfaction and retention, outdated guidelines, and the business orientation of pharmacies were the main challenges related to AMS. CONCLUSION There was poor knowledge of AMR and AMS, and limited AMS practices in private pharmacies. Private pharmacies have the potential to contribute to Uganda's fight against AMR if motivated and equipped with adequate knowledge to enhance their practices related to AMS.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Mimi Salome Gbadesire
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
| | - Stephanie Boateng
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
| | - Belinda Twesigye
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Jagdeep Gheer
- Medicines Optimisation Team, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board Trust Offices, Amersham Hospital, Amersham, HP7 0JD, UK
| | - Betty Nakachwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Michael Obeng Brown
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
| | - Claire Brandish
- Pharmacy Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Jody Winter
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Bee Yean Ng
- Department of Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Kate Russell-Hobbs
- Pharmacy Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Linda Gibson
- Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
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Krockow EM, Cheng KO, Maltby J, McElroy E. Existing terminology related to antimicrobial resistance fails to evoke risk perceptions and be remembered. COMMUNICATIONS MEDICINE 2023; 3:149. [PMID: 37880476 PMCID: PMC10600229 DOI: 10.1038/s43856-023-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global healthcare threat promoted by all use of antibiotics. Hence, reducing overuse of antibiotics is essential. The necessary behaviour change relies on effective public health communication, but previous information campaigns-while showing some successes-have fallen short in generating a lasting increase of public awareness. A potential reason for this is AMR-related terminology, which has been criticised as inconsistent, abstract and difficult to pronounce. We report the first empirical test of word memorability and risk association for the most frequent AMR-related health terms. METHODS Across two surveys sampling 237 US and 924 UK participants, we test people's memory for and the risk they associate with six AMR-related terms and thirty-four additional health risk terms (e.g., cancer). Participants also rate the terms on different linguistic dimensions including concreteness, familiarity, processing fluency and pronounceability. RESULTS Our findings suggest that existing AMR-related health terms-particularly "AMR" and "Antimicrobial resistance"-are unsuitable for public health communication, because they score consistently low on both memorability and risk association. Out of the AMR terms, "Antibiotic resistance" and-to a lesser extent-"Drug-resistant infections" perform best. Regression analyses suggest that linguistic attributes (e.g., familiarity, processing fluency, pronounceability) are predictors of the terms' risk association. CONCLUSIONS Our findings highlight an urgent need to rename AMR with a memorable term that effectively signals the existential threat of AMR and thereby motivates a change in antibiotic use. The success of the revised term is likely to depend, at least partially, on its linguistic attributes.
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Affiliation(s)
- Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK.
| | - Kate O Cheng
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Maltby
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Eoin McElroy
- School of Psychology, Ulster University, Coleraine, UK
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Bhatt V, Ponnampalavanar SSLS, Chong CW, Tang LY, Krishnasamy K, Goh SSL, Teh CSJ. Socio-Demographic Factors and Public Knowledge of Antibiotic Resistance. Healthcare (Basel) 2023; 11:2284. [PMID: 37628482 PMCID: PMC10454014 DOI: 10.3390/healthcare11162284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Antibiotic resistance is a serious health issue, and raising public awareness of it is crucial to combating it. This study aimed to assess the socio-demographic factors associated with knowledge of antibiotics and antibiotic resistance in Malaysia. (2) Methods: A cross-sectional study was carried out between April 2022 and March 2023. Malaysian adults aged ≥18 years old and able to understand English or Malay were recruited. During data collection, the WHO questionnaire "Antibiotic Resistance, Multi-Country Public Awareness Survey" was used. Data were collected across 14 states in Malaysia. (3) Results: A total of 517 participants completed the questionnaire. Most participants were females (67.9%), aged 30-49 (46%), and from central Malaysia (69.8%). Most participants (98.5%) reported taking antibiotics. A misconception presented was that sore throats, fevers, colds, and flu can be treated with antibiotics. A total of 58.8% of participants had high knowledge of antibiotic usage (scores 12-15), while 64% had high knowledge of antibiotic resistance (scores 9-14). Findings indicate that increasing age, income, and education were associated with higher knowledge. (4) Conclusions: This study highlights the knowledge deficiency of antibiotic resistance among Malaysians. Educational programs should engage a younger and lower socio-economic population to increase awareness.
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Affiliation(s)
- Vedika Bhatt
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | | | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia;
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | | | - Sheron Sir Loon Goh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
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David JC, Piednoir E, Nadarajah K, Delouvée S. Attitudes, Knowledge, Risk Perception of Antimicrobial Resistance and Antibiotic Use Behaviors: A Cross-Sectional Survey in a Young Adult Population. Subst Use Misuse 2023; 58:698-703. [PMID: 36803507 DOI: 10.1080/10826084.2023.2181035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background: The emergence and spread of bacterial resistance to antibiotics is a major threat to global public health. There is strong evidence that the general public plays a role in the emergence and spread of antimicrobial resistance. Objective: In this study, the impact of attitudes, knowledge, and risk perception of antimicrobial resistance on students' antibiotic use behaviors was investigated. Methods: A cross-sectional survey was conducted using a questionnaire with a sample of 279 young adults. Descriptive analysis and hierarchical regression analyses were used to analyze the data. Results: The results indicated that positive attitudes, a minimal level of knowledge about antimicrobial resistance, and awareness of the seriousness of this phenomenon have a positive influence on the appropriate use of antibiotics. Conclusions: Overall, the results of this study highlight the need for awareness campaigns that provide the public with accurate information about the risks associated with antibiotic resistance and appropriate antibiotic use.
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Affiliation(s)
- Jean-Charles David
- Laboratoire de Psychologie: Cognition, Comportement, Communication, Rennes, France
| | - Emmanuel Piednoir
- Centre de Prévention des Infections Associées aux Soins, Centre Hospitalier Universitaire, Rennes, France.,Centre hospitalier Avranches-Granville (groupe hospitalier Mont Saint-Michel), Granville, France
| | - Kévin Nadarajah
- Laboratoire de Psychologie: Cognition, Comportement, Communication, Rennes, France
| | - Sylvain Delouvée
- Laboratoire de Psychologie: Cognition, Comportement, Communication, Rennes, France
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Montoya-Urrego D, Velasco-Castaño JJ, Quintero Velez JC, Jiménez Quiceno JN. Knowledge, Attitudes, and Practices (KAP) About Antibiotic Use in Hemodialysis Patients with Chronic Kidney Disease and Their Household Contacts, Medellín-Colombia. Infect Drug Resist 2023; 16:1725-1736. [PMID: 36999128 PMCID: PMC10046125 DOI: 10.2147/idr.s392680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/16/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose The lack of knowledge and the excessive and inappropriate use of antibiotics are some of the causes of bacterial resistance. Hemodialysis patients have a high consumption of antibiotics and are constantly cared by their household contacts. This population circulates between hospital and community and are a model to study knowledge regarding bacterial resistance and antibiotic use in these settings. This study describes the knowledge, attitudes and practices (KAP) about antibiotic use and bacterial resistance in hemodialysis patients and their household contacts in Medellín-Colombia. Patients and Methods A cross-sectional descriptive study was conducted on hemodialysis patients from a renal unit associated with a hospital in Medellín-Colombia, and their household contacts between May 2019 and March 2020. A KAP instrument was applied to participants during home visits. The KAP regarding antibiotic use were characterized, and a content analysis of open questions was made. Results A total of 35 hemodialysis patients and 95 of their household contacts were included. Of participants, 83.1% (108/130) did not correctly identify the situations in which antibiotics should be used. Likewise, a gap in knowledge about antibacterial resistance was evidenced thanks to the emerging categories in content analysis. Regarding attitudes, 36.9% (48/130) of the participants discontinued antibiotic treatment when they felt better. Additionally, 43.8% (57/130) agree to keep antibiotics in their home. Finally, it was found that it is usual for pharmacists and family members to recommend or sell antibiotics without prescription; likewise, pharmacies were the most popular place to acquire these medications. Conclusion This study identified gaps in KAP regarding the use of antibiotics and bacterial resistance in hemodialysis patients and their household contacts. This allows focusing education strategies in this regard, in order to increase awareness about the correct use of antibiotics and the consequences of bacterial resistance and to improve prevention actions in this vulnerable population.
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Affiliation(s)
- Daniela Montoya-Urrego
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Juan José Velasco-Castaño
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Juan C Quintero Velez
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Ciencias Veterinarias Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - J Natalia Jiménez Quiceno
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
- Correspondence: J Natalia Jiménez Quiceno, Universidad de Antioquia, Escuela de Microbiología, Calle 67 No. 53-108, Medellín, Antioquia, 050010, Colombia, Tel +57 604 219 54 97; +574-219-5481, Email
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Guo H, Hildon ZJL, Chow A. "Antibiotics are for everyone, our past and our future generations, right? If antibiotics are dead, we will be in big trouble": Building on community values for public engagement on appropriate use of antibiotics in Singapore. Front Public Health 2022; 10:1001282. [PMID: 36249259 PMCID: PMC9561345 DOI: 10.3389/fpubh.2022.1001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Shared decision-making (SDM) and trust building through continuity of care are known to play a pivotal role in improving appropriate antibiotic prescribing and use. Problem However, less is known about how to effectively leverage these factors when present-or overcome them when not-to address community needs and improve patient liaison. Methods We addressed this question using a convergent parallel mixed-methods design. Focus group discussions (N = 13; August 2018-September 2020), were analyzed alongside a nationally-representative cross-sectional survey (N = 2004; November 2020-January 2021), in Singapore. Descriptive quantitative analyses and multivariable logistic regression were undertaken to examine antibiotic knowledge and factors associated with preference for SDM. Qualitative applied thematic analysis was integrated with these data to further explain the findings. Findings Poor knowledge and misbeliefs on appropriate antibiotic use and antimicrobial resistance (AMR) were identified. For example, only 9% of the surveyed population understood that AMR occurs when the bacteria, not the human body, become resistant to antibiotics. Qualitative data corroborated the survey findings and suggested a shared value was placed on public education to avoid the fallout from resistant bacterial strains on current and future generations. This study also identified the opportunity to harness community trust in primary care doctors, who were described as highly valued educators for antibiotic use and AMR. Those who had trust in doctors were 75% more likely to prefer SDM (aOR 1.75, 95% CI 1.10-2.77, P = 0.017), especially adults aged ≥50 years who were receiving continued care with a regular doctor (aOR 1.83, 95% CI 1.18-2.86, P = 0.007). Continuity of care was observed to value-add SDM by building trusting relationships, though it was often absent in younger populations. Conclusion This study highlights the long-term value-add of building on cultural capital pertaining to appropriate antibiotic use and AMR, by leveraging on the role of trust in doctors, desire for SDM and anchoring these in continuity of care when possible. Recommendations Using focused messaging and exploring alternative channels of communications such as annual check-ins or tele-consultations with a regular doctor, and emphasizing continuity of care across all age groups would help bridge the identified gaps.
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Affiliation(s)
- Huiling Guo
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
- National Centre for Infectious Diseases, Ministry of Health, Singapore, Singapore
| | - Angela Chow
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health and National University Health System, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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10
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Visschers VHM, Feck V, Herrmann A. Knowledge, Social Influences, Perceived Risks and Benefits, and Cultural Values Explain the Public's Decisions Related to Prudent Antibiotic Use. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:1488-1503. [PMID: 34784422 PMCID: PMC9544676 DOI: 10.1111/risa.13851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
People should use antibiotics (AB) prudently to mitigate antibiotic resistance (ABR). Previous studies-and, subsequently, interventions-on ABR have focused mainly on improving public awareness and knowledge. We investigated a comprehensive theory-based explanatory model to understand the public's decision making regarding prudent AB use, based on, among others, the theory of planned behavior. In a cross-sectional online survey, the psychological determinants of people's decisions about prudent AB use were examined in a sample of 1,228 Swiss adults. The questionnaire assessed respondents' demand for AB, willingness to adopt measures that prevent the need for AB, perceived risks of ABR, perceived benefits of AB, attitudes and social influences regarding AB, knowledge of AB and ABR, and cultural values. Mokken scale analysis revealed three types of knowledge: knowledge of the functioning of AB, of ABR, and of preventive measures. Structural equation modeling indicated that respondents' demand for AB was mostly predicted by social influences, perceived benefits of AB, and knowledge of AB functioning. Willingness to prevent AB use was mainly related to conservative values, perceived risks of ABR, negative attitudes toward AB, and knowledge of preventive measures. Our study suggests that the provision of information about AB and preventive measures is a first step toward changing people's decisions related to prudent AB use. Future interventions that additionally utilize cultural values to convey important messages and target additional factors, such as social influences, the risks of ABR, and the benefits of cautious AB use, can be more successful in promoting prudent AB use.
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Affiliation(s)
- Vivianne H. M. Visschers
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Vanessa Feck
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Anne Herrmann
- School of Applied PsychologyUniversity of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
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Sobeck J, Smith-Darden J, Gartner D, Kaljee L, Pieper B, Kilgore P, Zervos M. Antibiotic Knowledge, Beliefs, and Behaviors: Testing Competing Hypotheses Using an Urban Community Sample. HEALTH COMMUNICATION 2022; 37:862-871. [PMID: 33499691 DOI: 10.1080/10410236.2021.1875557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Antibiotic use and misuse continue to be a worldwide concern with the increasing rate of antimicrobial resistance, lack of new antibiotics in the pipeline, and rising health care costs. Despite studies that attempt to distinguish between factors associated with antibiotic use and misuse (e.g., knowledge and beliefs and provider-patient communication), few studies have tested comparative hypotheses related to antibiotic use behavior. This study 1) compares two theoretical models (health belief and patient-centered communication) to learn which best represents the pathways associated with antibiotic use; and 2) describes urban consumers' knowledge, beliefs, and behaviors regarding antibiotic use. Interviewers completed 505 intercept surveys across six clinic- and community-based sites in Southeast Michigan. Structural equation modeling was utilized to compare two competing theoretical models predicting antibiotic behavior. Findings support the assertion that a patient-provider communication model fits the data better than the null model. Descriptive statistical analysis explicated participant knowledge was mixed. While many participants knew correct general facts about antibiotics, 35% of the sample put forth that they believed that antibiotics cure colds and flu and over half (57%) endorsed the belief that antibiotics are good for treating infections caused by viruses. The implications for theory and practice are discussed including the need for clinicians to target communication strategies for the populations that they serve.
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Affiliation(s)
| | | | - Danielle Gartner
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health System
| | | | - Paul Kilgore
- Department of Pharmacy Practice, Eugene Applebaum Collage of Pharmacy and Health Sciences Wayne State University
| | - Marcos Zervos
- Division of Infectious Diseases, Henry Ford Health System
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David JC, Piednoir E, Delouvée S. Knowledge and Perceptions of Antibiotic Resistance in the French Population. Infect Dis Now 2022; 52:306-310. [PMID: 35331974 DOI: 10.1016/j.idnow.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/10/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To draw up an inventory of health behaviors and knowledge of the French population regarding antibiotic resistance. RESULTS Overall, 44% of participants properly defined antibiotic resistance. Antibiotic abuse was identified as the main cause of antibiotic resistance, and 66% believed that an antibiotic-resistant infection can be fatal. However, 32% did not strictly comply with the dosage and duration of an antibiotic treatment. Analysis of social representations of antibiotic resistance revealed erroneous beliefs about this phenomenon. CONCLUSION Our results highlight the need to continue to inform the French public of antibiotic resistance. Associated beliefs could be obstacles to the proper use of antibiotics.
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Affiliation(s)
- J-C David
- LP3C (Laboratoire de psychologie: cognition, comportement, communication), Université de Rennes, 2, place du Recteur Henri-Le-Moal, 35000 Rennes, France
| | - E Piednoir
- Centre de prévention des infections associées aux soins, centre hospitalier universitaire, 35000 Rennes, France
| | - S Delouvée
- LP3C (Laboratoire de psychologie: cognition, comportement, communication), Université de Rennes, 2, place du Recteur Henri-Le-Moal, 35000 Rennes, France.
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Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey. Patient Prefer Adherence 2021; 15:2405-2416. [PMID: 34754181 PMCID: PMC8572111 DOI: 10.2147/ppa.s328890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia's general public's knowledge and expectations on antibiotic use. PURPOSE To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public. MATERIALS AND METHODS A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data. RESULTS Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001). CONCLUSION Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.
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Affiliation(s)
- Lai San Kong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Farida Islahudin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Leelavathi Muthupalaniappen
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
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Hayes CV, Mahon B, Sides E, Allison R, Lecky DM, McNulty CAM. Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet. Antibiotics (Basel) 2021; 10:1113. [PMID: 34572695 PMCID: PMC8464808 DOI: 10.3390/antibiotics10091113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals' (HCPs) and patients' needs on provision of self-care and safety-netting advice for common infections. Twenty-seven patients and seven HCPs participated in semi-structured focus groups (FGs) and interviews. An information leaflet was iteratively developed and reviewed by participants in interviews and FGs, and an additional 5 HCPs, and 25 patients (identifying from minority ethnic groups) via online questionnaires. Qualitative data were analysed thematically, double-coded, and mapped to the TDF. Participants required information on symptom duration, safety netting, self-care, and antibiotics. Patients felt confident to self-care and were averse to consulting with HCPs unnecessarily but struggled to assess symptom severity. Patients reported seeking help for children or elderly dependents earlier. HCPs' concerns included patients' attitudes and a lack of available monitoring of advice given to patients. Participants believed community pharmacy should be the first place that patients seek advice on common infections. The patient information leaflet on common infections should be used in primary care and community pharmacy to support patients to self-manage symptoms and determine when further help is required.
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Affiliation(s)
- Catherine V. Hayes
- Primary Care and Interventions Unit, Public Health England, Gloucester GL1 1DQ, UK; (B.M.); (E.S.); (R.A.); (D.M.L.); (C.A.M.M.)
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Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study. Antibiotics (Basel) 2021; 10:antibiotics10091107. [PMID: 34572689 PMCID: PMC8472776 DOI: 10.3390/antibiotics10091107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 01/08/2023] Open
Abstract
Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.
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Mokoena TTW, Schellack N, Brink AJ. Driving antibiotic stewardship awareness through the minibus-taxi community across the Tshwane District, South Africa-a baseline evaluation. JAC Antimicrob Resist 2021; 3:dlab106. [PMID: 34377980 PMCID: PMC8346700 DOI: 10.1093/jacamr/dlab106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The minibus-taxi community plays an integral role within society, and for years this community has been neglected. Of late, studies on minibus-taxi operators' health and their perceptions of HIV have emerged. Antibiotic resistance is a global problem and to help curb its spread studies have looked into the knowledge, attitude and perceptions amongst students and healthcare professionals, and yet little to nothing is known about the minibus-taxi community. OBJECTIVES To assess the knowledge and understanding of the minibus-taxi community on antibiotics and antibiotic resistance, and document indigenous antibiotic terminology used across the Tshwane District in Gauteng, South Africa. METHODS A semi-structured questionnaire was adopted from WHO, translated into commonly spoken languages and administered to 83 minibus-taxi community members: 27 minibus-taxi operators and 56 commuters. A convenience sampling method was utilized in selecting the minibus-taxi ranks and routes. The questionnaire was later adapted to the minibus-taxi community's busy lifestyle and a section added to document antibiotic terms. RESULTS Seventy-one percent (n = 59) of the participants knew the importance of taking antibiotics as directed, while 64% (n = 53) believed it's correct to share antibiotics. Seventy-five percent (n = 62) thought antibiotic resistance occurred in the human body. One misconception noted was that the minibus-taxi community thought antibiotics treated cold/flu and fever. Over 80% of the community were unfamiliar with antibiotic terminology. CONCLUSIONS Several misconceptions were documented amongst the minibus-taxi community and, whilst highlighting the linguistic barriers for the term antibiotic resistance, we identified several enablers for public awareness and empowerment. Further studies are required to define appropriate indigenous terms for future educational antibiotic campaigns.
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Affiliation(s)
- Tumelo T W Mokoena
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Adrian J Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town and National Laboratory Sciences, Cape Town, South Africa
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Hayes CV, Eley CV, Wood F, Demirjian A, McNulty CAM. Knowledge and attitudes of adolescents towards the human microbiome and antibiotic resistance: a qualitative study. JAC Antimicrob Resist 2021; 3:dlab039. [PMID: 35399743 DOI: 10.1093/jacamr/dlab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 01/13/2023] Open
Abstract
Background Antibiotic and dietary behaviour affect the human microbiome and influence antibiotic resistance development. Adolescents are a key demographic for influencing knowledge and behaviour change. Objectives To explore adolescents' knowledge and attitudes towards the microbiome and antibiotic resistance, and the capability, motivation and opportunity for educators to integrate microbiome teaching in schools. Methods Qualitative study informed by the Theoretical Domains Framework (TDF) and COM-B model. Six educational establishments were purposively selected by rural/city and socioeconomic status, within Gloucestershire, South West England in 2019. Forty 14-18-year olds participated in focus groups, and eight science or health educators participated in interviews. Data were analysed thematically, double-coded and mapped to the TDF/COM-B. Results Adolescents were aware of 'good microbes' in the body but lacked deeper knowledge. Adolescents' knowledge of, and intentions to use, antibiotics appropriately differed by their levels of scientific study. Adolescents lacked knowledge on the consequences of diet on the microbiome, and therefore lacked capability and motivation to change behaviour. Educators felt capable and motivated to teach microbiome topics but lacked opportunity though absence of topics in the national curriculum and lack of time to teach additional topics. Conclusions A disparity in knowledge of adolescents needs to be addressed through increasing antibiotic and microbiome topics in the national curriculum. Public antibiotic campaigns could include communication about the microbiome to increase awareness. Educational resources could motivate adolescents and improve their knowledge, skills and opportunity to improve diet and antibiotic use; so, supporting the UK antimicrobial resistance (AMR) national action plan.
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Affiliation(s)
- Catherine V Hayes
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | - Charlotte V Eley
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK
| | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, UK
| | - Alicia Demirjian
- Primary Care and Interventions Unit, Public Health England, Gloucester, UK.,Evelina London Children's Hospital, London, UK.,King's College London, London, UK
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Ancillotti M. An Effort Worth Making: A Qualitative Study of How Swedes Respond to Antibiotic Resistance. Public Health Ethics 2021; 14:1-11. [PMID: 34234840 PMCID: PMC8254642 DOI: 10.1093/phe/phaa033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Due to the alarming rise of antibiotic resistance, medically unwarranted use of antibiotics has assumed new moral significance. In this paper, a thematic content analysis of focus group discussions was conducted to explore lay people's views on the moral challenges posed by antibiotic resistance. The most important finding is that lay people are morally sensitive to the problems entailed by antibiotic resistance. Participants saw the decreasing availability of effective antibiotics as a problem of justice. This involves individual as well as collective moral responsibility. Yet, holding agents responsible for their use of antibiotics involves varying degrees of demandingness. In our discussion, these findings are related to the contemporary ethical debate on antibiotic resistance and two proposals for the preservation of antibiotic effectiveness are compared to and evaluated against participants' views.
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Vazquez-Cancela O, Souto-Lopez L, Vazquez-Lago JM, Lopez A, Figueiras A. Factors determining antibiotic use in the general population: A qualitative study in Spain. PLoS One 2021; 16:e0246506. [PMID: 33539449 PMCID: PMC7861377 DOI: 10.1371/journal.pone.0246506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Antibiotic resistance is an important Public Health problem and many studies link it to antibiotic misuse. The population plays a key role in such misuse. Objective The aim of this study was thus to explore the factors that might influence antibiotic use and resistance in the general population. Methods Qualitative research using the focus group (FG) method. Groups were formed by reference to the following criteria: age (over and under 65 years); place of origin; and educational/professional qualifications. FG sessions were recorded, transcribed and then separately analysed by two researchers working independently. Written informed consent was obtained from all participants. Results Eleven FGs were formed with a total of 75 participants. The principal factors identified as possible determinants of antibiotic misuse were: (i) lack of knowledge about antibiotics; (ii) doctor-patient relationship problems; (iii) problems of adherence; and, (iv) use without medical prescription. Antibiotic resistance is a phenomenon unknown to the population and is perceived as an individual problem, with the term “resistance” being confused with “tolerance”. None of the groups reported that information about resistance had been disseminated by the health care sector. Conclusions The public is unaware of the important role it plays in the advance of antimicrobial resistance. There is evidence of diverse factors, many of them modifiable, which might account for antibiotic misuse. Better understanding these factors could be useful in drawing up specific strategies aimed at improving antibiotic use.
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Affiliation(s)
- Olalla Vazquez-Cancela
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
- University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
| | - Laura Souto-Lopez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
| | - Juan M. Vazquez-Lago
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
- University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- * E-mail:
| | - Ana Lopez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña (Corunna), Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
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Sagmeister KJ, Schinagl CW, Kapelari S, Vrabl P. Students' Experiences of Working With a Socio-Scientific Issues-Based Curriculum Unit Using Role-Playing to Negotiate Antibiotic Resistance. Front Microbiol 2021; 11:577501. [PMID: 33552005 PMCID: PMC7855855 DOI: 10.3389/fmicb.2020.577501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022] Open
Abstract
The emergence and widespread of antibiotic-resistant pathogenic microorganisms are of great individual and societal relevance. Due to the complex and multilayered nature of the topic, antibiotic resistance (ABR) is the object of concern for several scientific fields, such as microbiology or medicine, and encompasses a broad range of political, economic, and social aspects. Thus, the issue related to antibiotic-resistant bacterial diseases offers an excellent platform for designing and implementing the teaching and learning of socio-scientific issues (SSI). We created a SSI-based curriculum unit for use in secondary science classrooms by developing a collaborative partnership between education researchers and microbiologists. This classroom environment allows students to explore and negotiate ABR as a societal and scientific phenomenon. For this purpose, we leveraged role-playing within the SSI-based unit as a productive context for engaging students in learning opportunities that provide multiple perspectives on ABR and the complex interplay of its accelerators. This case-based paper describes Austrian school students' experiences from their participation in a SSI-embedded role-playing classroom environment and subsequent activities that included a mini congress with a poster presentation and a panel discussion. An open-ended questionnaire-based assessment tool was used to examine the situational characteristics of the students' work. To assess students' contributions, we applied a qualitative content analysis design and identified cognitive and affective outcomes. The students' learning experiences demonstrate that they considered the content - the social complexities of antibiotic-resistant bacteria and associated diseases - exciting and very topical. The students perceived that learning about ABR is relevant for their future and involves both individual and societal responsibility for action. Although the curriculum unit and its assignments were described as labor-intensive, it became apparent that the role-playing setting has the potential to inform students about multiple stakeholder positions concerning ABR. Concerning the promotion of science practices, almost all students claimed that they learned to organize, analyze, evaluate, and present relevant information. Moreover, the students affirmed that they learned to argue from the perspective of their assigned roles. However, the students did not clarify whether they learned more through this SSI-based classroom instruction than through conventional science teaching approaches.
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Affiliation(s)
| | | | - Suzanne Kapelari
- Department of Subject-Specific Education, University of Innsbruck, Innsbruck, Austria
| | - Pamela Vrabl
- Department of Microbiology, University of Innsbruck, Innsbruck, Austria
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Macdonald KE, Stacey HJ, Harkin G, Hall LML, Young MJ, Jones JD. Patient perceptions of phage therapy for diabetic foot infection. PLoS One 2020; 15:e0243947. [PMID: 33315926 PMCID: PMC7735629 DOI: 10.1371/journal.pone.0243947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
Infections of diabetic foot ulcers are common, generally recalcitrant and often complicated by antibiotic resistance. Alternative antimicrobial strategies are needed. Phage therapy is a promising alternative that is being rediscovered. Despite phage therapy's 100-year history, there have been no investigations into patient thoughts and concerns. This study aimed to explore patient awareness of and concern about antibiotic resistance and gain insight into the perceptions of phage therapy among a patient group that could potentially benefit from phage therapy. Patients with an active or resolved (healed or amputated) diabetic foot ulcer were eligible to participate. A survey was distributed digitally to eligible patients across Scotland via the NHS Research Scotland Diabetes Network and hard copies were available in diabetic foot clinics at the Royal Infirmary of Edinburgh and Queen Elizabeth University Hospital, Glasgow. A focus group of five survey respondents was held in Glasgow. Fifty-five survey responses were obtained. There was a high level of awareness (76.4%; N = 55) and concern (83.3%; N = 54) about antibiotic resistance. While largely aware of viruses, most patients had not heard of phage or phage therapy. Patients were no more concerned about phage than antibiotic therapy, with most suggesting more information could alleviate any concerns. Patient acceptability of phage therapy was high, a finding confirmed by the focus group. Patients are concerned about antibiotic resistance and supportive of 'new' antimicrobials. We have demonstrated that patients are supportive, enthusiastic and accepting of phage therapy. Although 'Western' phage therapy remains in its infancy, an understanding of patient ideas, concerns and expectations will be important in eventually shaping and successfully reintroducing phage therapy.
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Affiliation(s)
- Katherine E. Macdonald
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Helen J. Stacey
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian Harkin
- Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Lesley M. L. Hall
- Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Matthew J. Young
- Diabetic Foot Clinic, Outpatient Department 2, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Joshua D. Jones
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Mowbray F, Sivyer K, Santillo M, Jones N, Peto TEA, Walker AS, Llewelyn MJ, Yardley L. Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review and revise’ experience. Pilot Feasibility Stud 2020; 6:43. [PMID: 32280483 PMCID: PMC7126355 DOI: 10.1186/s40814-020-00590-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/24/2020] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review and revise’ which is a key strategy to minimise antibiotic overuse in hospitals.
Methods
In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study.
Results
Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions.
Conclusions
This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review and revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received.
Trial registration
Current Controlled Trials ISRCTN12674243 (10 April 2017),
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Spicer JO, Roberts RM, Hicks LA. Perceptions of the Benefits and Risks of Antibiotics Among Adult Patients and Parents With High Antibiotic Utilization. Open Forum Infect Dis 2020; 7:ofaa544. [PMID: 33335939 PMCID: PMC7731524 DOI: 10.1093/ofid/ofaa544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/02/2020] [Indexed: 01/21/2023] Open
Abstract
Background Inappropriate antibiotic use is common. Understanding how patients view antibiotic risks and/or benefits could inform development of patient education materials and clinician communication strategies. We explored current knowledge, attitudes, and behaviors related to antibiotics among populations with high antibiotic use. Methods We conducted 12 focus groups with adult patients and parents across the United States by telephone in March 2017. Purposive sampling was used to identify participants with high antibiotic use. We transcribed the discussions verbatim and performed thematic analysis. Results We identified 4 major themes. First, participants expressed uncertainty regarding which clinical syndromes required antibiotics, and emotion often influenced their desire for antibiotics. Second, they had a limited understanding of antibiotic risks. Antibiotic resistance was viewed as the primary risk but was seen as a “distant, future” issue, whereas immediate adverse events, such as side effects, were minimized; however, patients expressed concern when told about the risk of serious adverse events. Third, they prioritized antibiotic benefits over risks in their decision-making, both due to an inaccurate estimation of antibiotic risks and/or benefits and a tendency to prioritize instant gratification. Fourth, most participants were willing to defer to their clinicians’ decisions about antibiotics, especially if their clinician provided symptomatic treatment and anticipatory guidance. Conclusions Patients have a limited understanding of antibiotic risks, potentially explaining why they are willing to try antibiotics even if it is unclear antibiotics will help. Educating patients on the potential antibiotic risks versus benefits, rather than just antibiotic resistance, may have a bigger impact on their decision-making.
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Affiliation(s)
- Jennifer O Spicer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca M Roberts
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ancillotti M, Eriksson S, Andersson DI, Godskesen T, Nihlén Fahlquist J, Veldwijk J. Preferences regarding antibiotic treatment and the role of antibiotic resistance: A discrete choice experiment. Int J Antimicrob Agents 2020; 56:106198. [PMID: 33080314 DOI: 10.1016/j.ijantimicag.2020.106198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/29/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify preferences of the Swedish public regarding antibiotic treatment characteristics and the relative weight of antibiotic resistance in their treatment choices. METHODS A questionnaire including a discrete choice experiment questionnaire was answered by 378 Swedish participants. Preferences of the general public regarding five treatment characteristics (attributes) were measured: contribution to antibiotic resistance, cost, side effects, failure rate and treatment duration. Latent class analysis models were used to determine attribute-level estimates and heterogeneity in preferences. Relative importance of the attributes and willingness to pay for antibiotics with a lower contribution to antibiotic resistance were calculated from the estimates. RESULTS All attributes influenced participants' preferences for antibiotic treatment. For the majority of participants, contribution to antibiotic resistance was the most important attribute. Younger respondents found contribution to antibiotic resistance more important in their choice of antibiotic treatments. Choices of respondents with lower numeracy, higher health literacy and higher financial vulnerability were influenced more by the cost of the antibiotic treatment. Older respondents with lower financial vulnerability and health literacy, and higher numeracy found side effects to be most important. CONCLUSIONS All attributes can be considered as potential drivers of antibiotic use by lay people. Findings also suggest that the behaviour of lay people may be influenced by concerns over the rise of antibiotic resistance. Therefore, stressing individual responsibility for antibiotic resistance in clinical and societal communication has the potential to affect personal decision making.
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Affiliation(s)
- M Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - S Eriksson
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - D I Andersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - T Godskesen
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - J Nihlén Fahlquist
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - J Veldwijk
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Essilini A, Kivits J, Caron F, Boivin JM, Thilly N, Pulcini C. 'I don't know if we can really, really change that': a qualitative exploration of public perception towards antibiotic resistance in France. JAC Antimicrob Resist 2020; 2:dlaa073. [PMID: 34223028 PMCID: PMC8209967 DOI: 10.1093/jacamr/dlaa073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background Since the 2000s, French authorities have put in place various national plans to make the general public aware of antibiotic stewardship. Twenty years later, France is still one of the countries with the highest use of antibiotics in Europe. Objectives Our study explored the general public’s perceptions of antibiotic resistance, their behaviour around antibiotic use and their expectations regarding awareness campaigns. Methods A qualitative study was performed from March 2018 to March 2019 in a French region using focus groups. Two types of public were targeted: parents of young children and retired people. The interview guide contained open-ended questions organized around three main themes: perceptions of antibiotic resistance; experience and use of antibiotics; and health information and campaigns. Results Nine focus groups were created, including 17 parents and 19 retirees. Participants did not link antibiotic overuse and antibiotic resistance. Antibiotic resistance was not perceived as a personal responsibility but as a suffered phenomenon on which the participants could not act. The blame was particularly put on the presence of antibiotics in the environment. Although participants expressed trust in their GPs, antibiotics remained perceived as the only solution for them to be cured quickly. Conclusions The study highlighted that the GPs were the preferred information source regarding the use of antibiotics. Actions targeting the public and health professionals will have little impact if, at the same time, efforts on work environment representation are not undertaken.
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Affiliation(s)
- Anaïs Essilini
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France
| | - Joëlle Kivits
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France
| | - Frédéric Caron
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France
| | - Jean-Marc Boivin
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France.,Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, équipe MICS, F-54000 Nancy, France.,Université de Lorraine, CHRU-Nancy, Département des Maladies Infectieuses, Nancy, France
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26
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Cambaco O, Alonso Menendez Y, Kinsman J, Sigaúque B, Wertheim H, Do N, Gyapong M, John-Langba J, Sevene E, Munguambe K. Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance? BMC Public Health 2020; 20:1183. [PMID: 32727445 PMCID: PMC7389384 DOI: 10.1186/s12889-020-09243-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antibiotic misuse and other types of unnecessary use of antibiotics can contribute to accelerate the process of antibiotic resistance, which is considered a global concern, mostly affecting low-and middle-income countries (LMICs). In Mozambique there is limited evidence on community knowledge and practices regarding antibiotics and antibiotic resistance. As part of the ABACUS project, this paper describes knowledge and practices of antibiotic use among the general population in the semi-rural district of Manhiça to inform evidence-based communication intervention strategies for safer antibiotic use. METHODS The study was conducted in Manhiça, a semi-rural district of Southern Mozambique. Sixteen in-depth interviews and four focus group discussions (FGDs) were conducted with community members to explore lay knowledge and practices regarding antibiotics and awareness of antibiotic resistance. The qualitative data was analysed using a combination of content and thematic analysis. The SRQR guidelines for reporting qualitative studies was performed. RESULTS Although participants did not hold any consistent knowledge of antibiotics, their visual recognition of amoxicillin (distinct red yellow capsule) was acceptable, but less so for different types and brands of antibiotics. The majority of participants were aware of the term 'antibiotic', yet the definition they gave was rarely backed by biomedical knowledge. Participants associated antibiotics with certain colours, shapes and health conditions. Participants reported common habits that may contribute to resistance: not buying the full course, self-medication, sharing medicines and interruption of treatment. Most had never heard of the term 'antibiotic resistance' but were familiar with the phenomenon. They often understood the term 'resistance' as treatment failure and likened 'resistance' to non-compliance, ineffective medication, disease resistance or to an inability of the physical body to respond to it. CONCLUSION There is a broad understanding of the importance of medication compliance but not specifically of antibiotic resistance. In addition, there is a recognized gap between knowledge of responsible drug compliance and actual behaviour. Future qualitative research is required to further explore what determines this behaviour. The existing ability to visually identify amoxicillin by its distinct red and yellow appearance is informative for future awareness and behavioural change campaigns that may incorporate visual aids of antibiotics.
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Affiliation(s)
- Olga Cambaco
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | | | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Heiman Wertheim
- Department of Medical Microbiology and Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Nga Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Kintampo, Ghana
| | | | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
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Davis MDM, Lohm DB, Whittaker A, Flowers P. 'Willy nilly' doctors, bad patients, and resistant bodies in general public explanations of antimicrobial resistance. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1394-1408. [PMID: 32449529 DOI: 10.1111/1467-9566.13111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Increased public engagement is a feature of policy and communications focussed on the reduction of antimicrobial resistance. Explaining antimicrobial resistance for general publics has proven difficult and they continue to endorse apparently mistaken knowledge, including the conflation of antimicrobial resistance with the notion of the resistant body. We interviewed members of the general public in Melbourne, Australia, to explore explanatory models for antimicrobial resistance and shed light on the persistence of the resistant body assumption and related concepts. In the face of AMR's complexity and the portended antibiotic apocalypse, publics rely on a heavily inscribed understanding of the body defending itself against microbes. Publics also read antibiotic misuse and overuse messages as the responsibility of other patients and medical practitioners, and not themselves. Significantly, the scientific world view that has created expert knowledge about AMR hails publics in ways that discredits them and limits their capacity to take action. Increased engagement with publics will be required to ensure that collaborative and sustainable AMR approaches are fashioned for the future.
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Affiliation(s)
- Mark D M Davis
- School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | - Davina B Lohm
- School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | - Andrea Whittaker
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Ghouri F, Hollywood A, Ryan K. 'There is no choice apart from antibiotics…': Qualitative analysis of views on urinary infections in pregnancy and antimicrobial resistance. Health Expect 2020; 23:644-650. [PMID: 32113189 PMCID: PMC7321732 DOI: 10.1111/hex.13044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/13/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a health risk as it can lead to life-threatening infections. There has been a rise in resistant urinary tract infections (UTIs) which is the most common infection in pregnancy. This can be challenging in pregnancy due to the additional need to safeguard foetal development. The study's aim was to explore views about AMR in women who experienced UTIs in pregnancy. DESIGN Fifteen semi-structured interviews were conducted in the UK and analysed using thematic analysis. RESULTS Results highlighted two themes: conceptualization of AMR and pregnancy as a deviation from the norm, with an overarching theme of 'self-efficacy'. Results show that participants were concerned about AMR but uncertain about the effect on society compared to individual's taking antibiotics and about completing antibiotic courses. Participants reported an unsparing use of antibiotics was justified in pregnancy, and behaviours like drinking adequate water were ineffective at preventing UTIs. In summary, women had low self-efficacy regards tackling AMR and managing their health. CONCLUSION Misconceptions about how AMR affects society vs the individual translated into viewing it as a future problem to be tackled by the health-care sector. Consequently, AMR requires reconceptualization as a current problem requiring collective action. This research also indicates women endorse a biomedical model of UTIs in pregnancy which attributes resolving illness to interventions such as medicines, implying an automatic reliance on antibiotics. Subsequently, there is a need for self-efficacy by focusing on a behavioural model which emphasizes behaviours for infection prevention, thus reducing the need for antibiotics.
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Affiliation(s)
- Flavia Ghouri
- School of Pharmacy, University of Reading, Reading, UK
| | | | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
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Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey. Geriatrics (Basel) 2019; 4:E61. [PMID: 31731508 PMCID: PMC6960576 DOI: 10.3390/geriatrics4040061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023] Open
Abstract
Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.
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Affiliation(s)
- Lai San Kong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
| | - Farida Islahudin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
| | - Leelavathi Muthupalaniappen
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.S.K.); (F.I.)
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30
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The drugs don't work: evaluation of educational theatre to gauge and influence public opinion on antimicrobial resistance. J Hosp Infect 2019; 104:193-197. [PMID: 31628957 DOI: 10.1016/j.jhin.2019.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
Abstract
Increased public awareness of antimicrobial resistance (AMR) is a key component of effective antimicrobial stewardship strategies. Educational theatre combined with an expert panel was used to engage the public about AMR through delivery of a play entitled 'The drugs don't work'. Audience knowledge and understanding of AMR were measured by pre- and post-play questionnaires. Performance of the play and discussion with the expert panel significantly improved audience knowledge and understanding of AMR, including antibiotic misuse and prescribing. Educational theatre provides a positive learning experience and is an innovative method of public engagement to disseminate important public health messages.
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31
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Irawati L, Alrasheedy AA, Hassali MA, Saleem F. Low-income community knowledge, attitudes and perceptions regarding antibiotics and antibiotic resistance in Jelutong District, Penang, Malaysia: a qualitative study. BMC Public Health 2019; 19:1292. [PMID: 31615486 PMCID: PMC6794866 DOI: 10.1186/s12889-019-7718-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/30/2019] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Understanding community perspectives on antibiotics and antibiotic resistance (ABR) is a key component in designing educational interventions to combat ABR at the community level in Malaysia. Therefore, this study aimed to explore community residents' knowledge, attitudes and perceptions regarding antibiotics and ABR in Jelutong District, Penang, Malaysia. Moreover, it intended to identify areas of focus to be addressed when designing an educational intervention to increase residents' knowledge and change their attitudes and perceptions. METHODS A qualitative approach was adopted to gain a deeper understanding of community residents' knowledge, attitudes and perceptions regarding antibiotics and ABR. A purposive sampling was employed. Twenty-two residents (aged ≥18 years) were interviewed with the aid of a semi-structured interview guide. All interviews were audio recorded, transcribed verbatim and thematically analysed. RESULTS The majority of the participants asserted that antibiotics could be effective against viral infections. Moreover, many participants were unaware that antibiotics have adverse effects. Some acquired antibiotics from a community pharmacy without a prescription, took antibiotics given to them by their family or friends, or took leftover antibiotics prescribed for a previous illness. A few indicated that they would request antibiotics from their physician when they had viral infections. More than half of the participants discontinued taking antibiotics when their symptoms improved. The majority stated that ABR occurs when the body becomes used to antibiotics. Most participants were unaware of the causes, consequences and prevention of ABR. In fact, they were not concerned about it. As a result, only a few perceived themselves as having responsibility for preventing this problem. CONCLUSIONS The community residents had misconceptions about antibiotics and ABR, negative attitudes towards antibiotics and negative perceptions of ABR. The areas of focus that need to be addressed when designing an educational intervention to increase the general public knowledge and change their attitudes and perceptions are the appropriate use of antibiotics and their adverse effects; the importance of adhering to antibiotic therapy; and the definition, causes, consequences and prevention of ABR.
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Affiliation(s)
- Lyna Irawati
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Alian A. Alrasheedy
- Unaizah College of Pharmacy, Qassim University, Buraydah, Qassim Saudi Arabia
| | | | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Redfern J, Bowater L, Crossley M, Verran J. Spreading the message of antimicrobial resistance: a detailed account of a successful public engagement event. FEMS Microbiol Lett 2019; 365:5050914. [PMID: 29992290 DOI: 10.1093/femsle/fny175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/07/2018] [Indexed: 11/13/2022] Open
Abstract
The increase in Antimicrobial resistance (AMR) microorganisms has been exacerbated by exposure to antimicrobial drugs (e.g. antibiotics). A solution to AMR may require academic researchers to not only contribute to the drug discovery pipeline through laboratory research, but also to engage and inform non-specialist audiences using a variety of interventions in order to change behaviour towards our use of antibiotics. In this paper, the authors describe a hands-on public engagement event focusing on AMR. 'A Spoonful of Soil', was created by drawing on the past experiences of the delivering team (also described), with planning focusing on clear concise messages, selection of an appropriate audience and ensuring the event would be of significant interest to the audience. The event had a significant footfall of over 300 visitors. Key messages which aimed to raise awareness of AMR and educate visitors on the actions and behaviours that can help address the global issue of AMR were delivered by appropriate experts successfully, however success in reaching audience cannot be concluded from the feedback and evaluation gathered.
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Affiliation(s)
- J Redfern
- Manchester Metropolitan University, School of Healthcare Science, Chester Street, Manchester, M1 5GD, UK
| | - L Bowater
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - M Crossley
- Manchester Metropolitan University, School of Computing, Mathematics and Digital Technology, Chester Street, Manchester, M1 5GD, UK
| | - J Verran
- Manchester Metropolitan University, School of Healthcare Science, Chester Street, Manchester, M1 5GD, UK
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Whittaker A, Lohm D, Lemoh C, Cheng AC, Davis M. Investigating Understandings of Antibiotics and Antimicrobial Resistance in Diverse Ethnic Communities in Australia: Findings from a Qualitative Study. Antibiotics (Basel) 2019; 8:antibiotics8030135. [PMID: 31480708 PMCID: PMC6783953 DOI: 10.3390/antibiotics8030135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/18/2022] Open
Abstract
This paper explores the understandings of antibiotics and antimicrobial resistance (AMR) among ethnically diverse informants in Melbourne, Australia. A total of 31 face-to-face semi-structured qualitative interviews were conducted with a sample of ethnic in-patients who were admitted with an acquired antimicrobial infection in a public hospital (n = 7); five hospital interpreters; and ethnic members of the general community (n = 19) as part of a broader study of lay understandings of AMR. Thematic analysis revealed there was poor understanding of AMR, even among informants being treated for AMR infections. Causes of the increasing incidence of AMR were attributed to: weather fluctuations and climate change; a lack of environmental cleanliness; and the arrival of new migrant groups. Asian informants emphasized the need for humoral balance. Antibiotics were viewed as ‘strong’ medicines that could potentially disrupt this balance and weaken the body. Travel back to countries of origin sometimes involved the use of medical services and informants noted that some community members imported antibiotics from overseas. Most used the internet and social media to source health information. There is a lack of information in their own languages. More attention needs to be given to migrant communities who are vulnerable to the development, transmission and infection with resistant bacteria to inform future interventions.
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Affiliation(s)
- Andrea Whittaker
- School of Social Sciences, Monash University, Melbourne 3800, Australia.
| | - Davina Lohm
- School of Social Sciences, Monash University, Melbourne 3800, Australia
| | - Chris Lemoh
- School of Clinical Sciences, Monash University, Melbourne 3800, Australia
- Monash Infectious Diseases, Melbourne 3168, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne 3181, Australia
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne 3800, Australia
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34
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Lesho EP, Laguio-Vila M. The Slow-Motion Catastrophe of Antimicrobial Resistance and Practical Interventions for All Prescribers. Mayo Clin Proc 2019; 94:1040-1047. [PMID: 30922694 DOI: 10.1016/j.mayocp.2018.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 01/29/2023]
Abstract
All medical and surgical specialties depend on the pool of effective antibiotics that continues to evaporate because of the increasing prevalence of drug-resistant bacteria. Antimicrobial-resistant infections kill 700,000 patients every year. By 2050, they are projected to cause 10 million deaths per year at a cumulative global cost of $100 trillion. Professional societies and international health agencies, including the United Nations, have declared escalating antimicrobial resistance as one of the gravest and most urgent threats to global public health and issued calls for action. The propensity of bacteria to mobilize and share genetic resistance determinants across species and genera, record levels of conflict-driven human population displacement, and the dearth of new antibiotics and rapid diagnostic tests, along with climate change and the epidemic of opioid addiction, exacerbate the antimicrobial resistance crisis. The predominant cause of antibiotic resistance is exposure to antibiotics through appropriate and inappropriate use. Mindfulness, nudging by peers, and adjuncts and alternatives to antibiotics, such as phage therapies, microbiome-based therapies, and novel medical informatics applications, could help reduce antibiotic use. This article describes the antimicrobial resistance crisis and highlights points in the continuum of care in which clinicians can readily implement practical, no-cost changes to minimize antibiotic exposure.
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Affiliation(s)
- Emil P Lesho
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY.
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35
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Ellis J, Vassilev I, Kennedy A, Moore M, Rogers A. Help seeking for antibiotics; is the influence of a personal social network relevant? BMC FAMILY PRACTICE 2019; 20:63. [PMID: 31088394 PMCID: PMC6518744 DOI: 10.1186/s12875-019-0955-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Health policy focuses on reducing antibiotic prescribing that in order to succeed requires the public to hold similar attitudes towards judicious use. Social network influences on health behaviour and attitudes are well established and yet these influences are not sufficiently acknowledged in the UK's antibiotic stewardship programmes. Therefore, the aim of this study was to evaluate individuals' attitudes and behaviours towards antibiotics and also identify the social network influences on these in the process of help seeking for self-limiting illnesses. METHODS From a social network approach the methods used were a personal community mapping exercise which was carried out ahead of a semi-structured interview. A purposive sample was drawn from across the Wessex region and participants were recruited via GP practices and pharmacists. In total 14 adults, and 10 parents of children, who had received a prescription for antibiotics for a self-limiting illness within the 3 months preceding the interview were recruited and interviewed. RESULTS Three network types were identified; diverse, family and friend and restricted. The type of network an individual has appears to have an influence on antibiotic attitudes and behaviours. Most notably, the more diverse a network the more likely the individual will delay in help seeking from healthcare professionals as they draw upon self-care strategies advised by network members. The role of the GP varies according to network type too. Individuals' with diverse networks draw upon GP network members to provide clarity and certainty following a period of self-care. People with restricted networks are more reliant upon the GP, seek help quicker and also more likely to prioritise the GPs advice over other sources of information. CONCLUSION The understanding a social network approach brings to help seeking behaviour for antibiotics could help practitioners modify their consultation approach to mitigate some uncertainties and perceptions around prescribing behaviour.
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Affiliation(s)
- J Ellis
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK.
| | - I Vassilev
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - A Kennedy
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - M Moore
- NIHR CLAHRC Wessex, Primary Care and Population Science, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - A Rogers
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
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Teasdale E, Lalonde A, Muller I, Chalmers J, Smart P, Hooper J, El‐Gohary M, Thomas K, Santer M. Patients' understanding of cellulitis and views about how best to prevent recurrent episodes: mixed-methods study in primary and secondary care. Br J Dermatol 2019; 180:810-820. [PMID: 30451281 PMCID: PMC6487809 DOI: 10.1111/bjd.17445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately one-third of cases. The only proven strategy to reduce the risk of recurrence is long-term, low-dose antibiotics. Given current concerns about antibiotic resistance and the pressure to reduce antibiotic prescribing, other prevention strategies are needed. OBJECTIVES To explore patients' views about cellulitis and different ways of preventing recurrent episodes. METHODS Adults aged ≥ 18 years with a history of first-episode or recurrent cellulitis were invited through primary care, hospitals and advertising to complete a survey, take part in an interview or both. RESULTS Thirty interviews were conducted between August 2016 and July 2017. Two hundred and forty surveys were completed (response rate 17%). Triangulation of quantitative and qualitative data showed that people who have had cellulitis have wide-ranging beliefs about what can cause cellulitis and are often unaware of risk of recurrence or potential strategies to prevent recurrence. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were more popular potential strategies than the use of compression stockings or long-term antibiotics. Participants expressed caution about long-term oral antibiotics, particularly those who had experienced only one episode of cellulitis. CONCLUSIONS People who have had cellulitis are keen to know about possible ways to prevent further episodes. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were generally viewed to be more acceptable, feasible strategies than compression or antibiotics, but further research is needed to explore uptake and effectiveness in practice.
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Affiliation(s)
- E.J. Teasdale
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - A. Lalonde
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - I. Muller
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - J. Chalmers
- Centre for Evidence Based DermatologyUniversity of NottinghamNottinghamU.K
| | | | | | - M. El‐Gohary
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
| | - K.S. Thomas
- Centre for Evidence Based DermatologyUniversity of NottinghamNottinghamU.K
| | - M. Santer
- Primary Care and Population ScienceFaculty of MedicineUniversity of SouthamptonSouthamptonU.K
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Bakhit M, Del Mar C, Gibson E, Hoffmann T. Exploring patients' understanding of antibiotic resistance and how this may influence attitudes towards antibiotic use for acute respiratory infections: a qualitative study in Australian general practice. BMJ Open 2019; 9:e026735. [PMID: 30867203 PMCID: PMC6429901 DOI: 10.1136/bmjopen-2018-026735] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To explore patients' or parents of child patients' understanding of antibiotic resistance and aspects of resistance such as resistance reversibility and its spread among those in close proximity, along with how this may influence attitudes towards antibiotic use for acute respiratory infections (ARIs). DESIGN Qualitative semistructured interview study using convenience sampling and thematic analysis by two researchers independently. SETTING General practices in Gold Coast, Australia. PARTICIPANTS 32 patients or parents of child patients presenting to general practice with an ARI. RESULTS Five themes emerged: (1) antibiotic use is seen as the main cause of antibiotic resistance, but what it is that becomes resistant is poorly understood; (2) resistance is perceived as a future 'big problem' for the community, with little appreciation of the individual impact of or contribution to it; (3) poor awareness that resistance can spread between family members but concern that it can; (4) low awareness that resistance can decay with time and variable impact of this knowledge on attitudes towards future antibiotic use and (5) antibiotics are perceived as sometimes necessary, with some awareness and consideration of their harms. CONCLUSIONS Patients' or parents of child patients' understanding of antibiotic resistance and aspects of it was poor. Targeting misunderstandings about resistance in public health messages and clinical consultations should be considered as part of a strategy to improve knowledge about it, which may encourage more consideration about antibiotic use for illnesses such as ARIs.
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Affiliation(s)
- Mina Bakhit
- Centre for Research in Evidence-Based Practice, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Centre for Research in Evidence-Based Practice, Gold Coast, Queensland, Australia
| | - Elizabeth Gibson
- Centre for Research in Evidence-Based Practice, Gold Coast, Queensland, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Gold Coast, Queensland, Australia
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Assessing the impact of Medical Microbiology classes using active strategies on short- and long-term retention on medical students: an innovative study. Braz J Microbiol 2018; 50:165-173. [PMID: 30637632 DOI: 10.1007/s42770-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022] Open
Abstract
One of teachers' concerns, with students in general and medical students in particular, is to ensure as much as possible that information goes from students' short-term memories to their long-term memories. The present study focuses on knowledge retention in Medical Microbiology and assesses the effectiveness of some strategies implemented for short- and long-term retention. A pre- and post-test was used to assess student's learning. This study involved students of Porto University (test group). Test group participants were all attending the third year of the Medicine Degree Program. The results of post-test 1 were considered very positive and support the importance of these applied active activities and/or methodologies in Medical Microbiology for short-term retention. However, the results obtained in post-test 2 showed that knowledge retention after 9 months, despite substantial, decreases.
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Govindan B. Bacterial Survivor: An Interactive Game that Combats Misconceptions about Antibiotic Resistance. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2018; 19:19.3.101. [PMID: 30377473 PMCID: PMC6203629 DOI: 10.1128/jmbe.v19i3.1675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
The growing threat of antibiotic resistant infections remains a huge public health concern. While many people are aware of “superbugs”, the vast majority of the general public does not understand how antibiotic resistance arises in a population of bacteria, and how exactly over use or misuse of antibiotics contributes to this problem. We developed an active learning exercise called “Bacterial Survivor” in order to combat misconceptions about antibiotic resistance in a large undergraduate non-majors microbiology course. The game models the random nature of genetic change, the impact of environment on survival, and illustrates the basic principles of evolution. This hands-on approach has been effective in counteracting student misconceptions about this important topic.
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Affiliation(s)
- Brinda Govindan
- Department of Biology, San Francisco State University, San Francisco, CA 94132
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Ancillotti M, Eriksson S, Veldwijk J, Nihlén Fahlquist J, Andersson DI, Godskesen T. Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions. BMC Public Health 2018; 18:1153. [PMID: 30285689 PMCID: PMC6171135 DOI: 10.1186/s12889-018-6047-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High consumption of antibiotics has been identified as an important driver for the increasing antibiotic resistance, considered to be one of the greatest threats to public health globally. Simply informing the public about this consequence is insufficient to induce behavioral change. This study explored beliefs and perceptions among Swedes, with the aim of identifying factors promoting and hindering a judicious approach to antibiotics use. The study focused primarily on the medical use of antibiotics, also considering other aspects connected with antibiotic resistance, such as travelling and food consumption. METHODS Data were collected through focus group discussions at the end of 2016. Twenty-three Swedes were recruited using an area-based approach and purposive sampling, aiming for as heterogeneous groups as possible regarding gender (13 women, 10 men), age (range 20-81, mean 38), and education level. Interview transcripts were analyzed using qualitative content analysis. The Health Belief Model was used as a theoretical framework. RESULTS Antibiotic resistance was identified by participants as a health threat with the potential for terrible consequences. The severity of the problem was perceived more strongly than the actual likelihood of being affected by it. Metaphors such as climate change were abundantly employed to describe antibiotic resistance as a slowly emerging problem. There was a tension between individual (egoistic) and collective (altruistic) reasons for engaging in judicious behavior. The individual effort needed and antibiotics overprescribing were considered major barriers to such behavior. In their discussions, participants stressed the need for empowerment, achieved through good health communication from authorities and family physicians. CONCLUSIONS Knowledge about antibiotic consumption and resistance, as well as values such as altruism and trust in the health care system, has significant influence on both perceptions of individual responsibility and on behavior. This suggests that these factors should be emphasized in health education and health promotion. To instead frame antibiotic resistance as a slowly emerging disaster, risks diminish the public perception of being susceptible to it.
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Affiliation(s)
- Mirko Ancillotti
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
| | - Stefan Eriksson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
| | - Jorien Veldwijk
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
- Institute of Health Policy and Management, Erasmus University, Bayle (J) building - Campus Woudestein, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - Jessica Nihlén Fahlquist
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
| | - Dan I. Andersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Box 582, 751 23 Uppsala, Sweden
| | - Tove Godskesen
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Ersta Sköndal Bräcke högskola, Stigbergsgatan 30, 100 61 Stockholm, Sweden
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Dekker ARJ, de Groot E, Sebalj T, Yardley L, Cals JWL, Verheij TJM, van der Velden AW. Parents' attitudes and views regarding antibiotics in the management of respiratory tract infections in children: a qualitative study of the influence of an information booklet. BJGP Open 2018; 2:bjgpopen18X101553. [PMID: 30564719 PMCID: PMC6184094 DOI: 10.3399/bjgpopen18x101553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Respiratory tract infection (RTI) is the most common reason to consult a GP during childhood, and often results in unnecessary prescribing of antibiotics. Using an information booklet during the consultation has been shown to be a promising tool to reduce antibiotic prescribing. The influence of such information on parents' views, knowledge, and expectations has not been investigated yet. AIM To explore the reported attitude and knowledge of parents towards antibiotics and management of childhood RTI, as well as the added influence of an information booklet, as perceived by parents. DESIGN & SETTING Qualitative interviews were conducted with Dutch parents who consulted the GP with their child for RTI symptoms and received an information booklet. METHOD Semi-structured interviews were audio-recorded, transcribed, coded, and analysed using framework analysis by open-axial coding and describing themes. RESULTS Eighteen parents were interviewed. Four themes were identified: prior reticence towards antibiotics; expectations of the consultation and trust in the GPs' treatment decision; confirmation and reassurance by the booklet; self-management and future consultation intentions. Dutch parents felt reassured and more confident about their pre-existing reticent attitude towards antibiotic treatment; therefore, they thought their opinion and attitude had not really been changed by the booklet. CONCLUSION In a low-prescribing country like the Netherlands, information should focus on enhancing self-efficacy and providing concrete safety-netting advice. For other countries with less reticence towards antibiotics, it is recommended that the knowledge, attitude, and perceptions of the population is studied, in order to be able to tailor interventions.
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Affiliation(s)
- Anne RJ Dekker
- GP Trainee and PhD Candidate, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Esther de Groot
- Postdoctoral Researcher, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom Sebalj
- Psychology Student, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lucy Yardley
- Professor of Health Psychology, Academic Unit of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Jochen WL Cals
- GP and Postdoctoral Researcher, Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Theo JM Verheij
- Professor of Primary Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alike W van der Velden
- Postdoctoral Researcher, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Hayhoe B, Butler CC, Majeed A, Saxena S. Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children in primary care. J Antimicrob Chemother 2018; 73:2298-2304. [DOI: 10.1093/jac/dky223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Benedict Hayhoe
- Child Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St Dunstan’s Road, London, UK
| | - Christopher C Butler
- Nuffield Department of Primary Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St Dunstan’s Road, London, UK
| | - Sonia Saxena
- Child Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St Dunstan’s Road, London, UK
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Shortened Courses of Antibiotics for Bacterial Infections: A Systematic Review of Randomized Controlled Trials. Pharmacotherapy 2018; 38:674-687. [DOI: 10.1002/phar.2118] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Will CM. Editorial: Beyond behavior? Institutions, interactions and inequalities in the response to antimicrobial resistance. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:E1-E9. [PMID: 29574948 DOI: 10.1111/1467-9566.12735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Catherine M Will
- School of Law, Politics and Sociology, Freeman Building G44, University of Sussex, BN1 9QE
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McDermott L, Leydon GM, Halls A, Kelly J, Nagle A, White J, Little P. Qualitative interview study of antibiotics and self-management strategies for respiratory infections in primary care. BMJ Open 2017; 7:e016903. [PMID: 29180593 PMCID: PMC5719297 DOI: 10.1136/bmjopen-2017-016903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore perceptions of illness, the decisions to consult and the acceptability of delayed antibiotic prescriptions and self-help treatments for respiratory tract infections (RTIs). DESIGN Qualitative semistructured interview study. SETTING UK primary care. PARTICIPANTS 20 adult patients who had been participating in the 'PIPS' (Pragmatic Ibuprofen Paracetamol and Steam) trial in the South of England. METHOD Semistructured telephone interviews were conducted with participants to explore their experiences and views on various treatments for RTI. RESULTS Participants had concerns about symptoms that were not clinically serious and were mostly unaware of the natural history of RTIs, but were aware of the limitations of antibiotics and did not expect them with every consultation. Most viewed delayed prescriptions positively and had no strong preference over which technique is used to deliver the delayed antibiotic, but some patients received mixed messages, such as being told their infection was viral then being given an antibiotic, or were sceptical about the rationale. Participants disliked self-help treatments that involved taking medication and were particularly concerned about painkillers in combination. Steam inhalation was viewed as only moderately helpful for mild symptoms. CONCLUSION Delayed prescribing is acceptable no matter how the delay is operationalised, but explanation of the rationale is needed and care taken to minimise mixed messages about the severity of illnesses and causation by viruses or bacteria. Better access is needed to good natural history information, and the signs and symptoms requiring or not requiring general practitioner advice. Significant concerns about paracetamol, ibuprofen and steam inhalation are likely to need careful exploration in the consultation.
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Affiliation(s)
- Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Geraldine M Leydon
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amy Halls
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jo Kelly
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda Nagle
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jennifer White
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- Department of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Lum EPM, Page K, Nissen L, Doust J, Graves N. Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice. BMC Public Health 2017; 17:799. [PMID: 29017473 PMCID: PMC5635573 DOI: 10.1186/s12889-017-4813-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/02/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Consumers receive over 27 million antibiotic prescriptions annually in Australian primary healthcare. Hence, consumers are a key group to engage in the fight against antibiotic resistance. There is a paucity of research pertaining to consumers in the Australian healthcare environment. This study aimed to investigate the perspectives, attitudes and behaviours of Australian consumers on antibiotic use and antibiotic resistance, to inform national programs for reducing inappropriate antibiotic consumption. METHOD Semi-structured interviews with 32 consumers recruited via convenience and snowball sampling from a university population in South East Queensland. Interview transcripts were deductively and inductively coded. Main themes were identified using iterative thematic analysis. RESULTS Three themes emerged from the analysis, to elucidate factors affecting antibiotic use: (a) prescription type; (b) consumer attitudes, behaviours, skills and knowledge; and (c) consumer engagement with antibiotic resistance. Consumers held mixed views regarding the use of delayed antibiotic prescriptions, and were often not made aware of the use of repeat antibiotic prescriptions. Consumers with regular general practitioners were more likely to have shared expectations regarding minimising the use of antibiotics. Even so, advice or information mediated by general practitioners was influential with all consumers; and helped to prevent inappropriate antibiotic use behaviours. Consumers were not aware of the free Return of Unwanted Medicines service offered by pharmacies and disposed of leftover antibiotics through household waste. To engage with mitigating antibiotic resistance, consumers required specific information. Previous public health campaigns raising awareness of antibiotics were largely not seen by this sample of consumers. CONCLUSIONS Australian consumers have specific information needs regarding prescribed antibiotics to enable appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.
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Affiliation(s)
- Elaine P. M. Lum
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Katie Page
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, QLD 4000 Australia
| | - Jenny Doust
- Centre for Research in Evidence Based Practice, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Nicholas Graves
- The Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
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Halls A, Van't Hoff C, Little P, Verheij T, Leydon GM. Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care. BMJ Open 2017; 7:e015701. [PMID: 28918409 PMCID: PMC5640115 DOI: 10.1136/bmjopen-2016-015701] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. DESIGN Qualitative semistructured interview study. SETTING UK primary care. PARTICIPANTS 23 parents of children aged 6 months to 10 years presenting with LRTI in primary care. METHOD Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI. RESULTS Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor's attention. CONCLUSION Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic recommendation or delayed antibiotic recommendation is made.
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Affiliation(s)
- Amy Halls
- Faculty of Medicine, Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | | | - Paul Little
- Faculty of Medicine, Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Theo Verheij
- Department of General Practice, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Geraldine M Leydon
- Faculty of Medicine, Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
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van Hecke O, Wang K, Lee JJ, Roberts NW, Butler CC. Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis. Clin Infect Dis 2017; 65:371-382. [PMID: 28369247 PMCID: PMC5850316 DOI: 10.1093/cid/cix233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/14/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Antibiotic use is the main driver for carriage of antibiotic-resistant bacteria. The perception exists that failure of antibiotic treatment due to antibiotic resistance has little clinical impact in the community. METHODS We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to 15 April 2016 without language restriction. We included studies conducted in community settings that reported patient-level data on laboratory-confirmed infections (respiratory tract, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were reconsultation, further antibiotic prescriptions, symptom duration, and symptom severity. Where possible, we calculated odds ratios with 95% confidence intervals by performing meta-analysis using random effects models. RESULTS We included 26 studies (5659 participants). Clinical response failure was significantly more likely in participants with antibiotic-resistant Escherichia coli urinary tract infections (odds ratio [OR] = 4.19; 95% confidence interval [CI] = 3.27-5.37; n = 2432 participants), Streptococcus pneumoniae otitis media (OR = 2.51; 95% CI = 1.29-4.88; n = 921 participants), and S. pneumoniae community-acquired pneumonia (OR = 2.15; 95% CI = 1.32-3.51; n = 916 participants). Clinical heterogeneity precluded primary outcome meta-analysis for Staphylococcus aureus skin or soft-tissue infections. CONCLUSIONS Antibiotic resistance significantly impacts on patients' illness burden in the community. Patients with laboratory-confirmed antibiotic-resistant urinary and respiratory-tract infections are more likely to experience delays in clinical recovery after treatment with antibiotics. A better grasp of the risk of antibiotic resistance on outcomes that matter to patients should inform more meaningful discussions between healthcare professionals and patients about antibiotic treatment for common infections.
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Affiliation(s)
- Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Joseph J Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Nia W Roberts
- Bodleian Health Care Libraries, Knowledge Centre, Oxford, United Kingdom
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford
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Santer M, Chandler D, Lown M, Francis NA, Muller I. Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums. Br J Dermatol 2017; 177:751-757. [PMID: 28218972 DOI: 10.1111/bjd.15398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acne vulgaris is common and can significantly impair quality of life, yet little is known about patients' understanding of acne and its treatments. Oral antibiotics are widely used for acne despite concerns about antibiotic resistance. People are increasingly turning to online discussion forums for advice, and information on these sites may influence health beliefs and treatment adherence. OBJECTIVES To explore understandings about the use of oral antibiotics for acne and advice shared among messages posted on online forums. METHODS We systematically searched for online forums and identified four where acne was frequently discussed. Discussion threads relating to oral antibiotics were analysed thematically. RESULTS We extracted 136 pages of data comprising 65 discussions among 294 participants. We found a wide range of perceptions around effectiveness of antibiotics for acne and concerns about adverse effects. The delayed onset of action of antibiotics was a source of frustration and compounded dissatisfaction with healthcare providers, who were perceived by people as 'fobbing them off' with prolonged courses of ineffective treatment. Advice ranged from when to ask for or insist on referral to use of costly cleansers. Forum posts related to a wide range of severities, from 'spots' to severe acne, which may make it confusing for users to assess appropriateness of information. CONCLUSIONS Online forums offer opinions that could confuse patients, or lead to early abandonment of treatments, challenging consultations and patient dissatisfaction. Users expressed frustration about the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects.
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Affiliation(s)
- M Santer
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - D Chandler
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - M Lown
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - N A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, U.K
| | - I Muller
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
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Davis M, Whittaker A, Lindgren M, Djerf-Pierre M, Manderson L, Flowers P. Understanding media publics and the antimicrobial resistance crisis. Glob Public Health 2017; 13:1158-1168. [PMID: 28594309 DOI: 10.1080/17441692.2017.1336248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Antimicrobial resistance (AMR) imperils health for people across the world. This enormous challenge is being met with the rationalisation of prescription, dispensing and consumption of antimicrobials in clinical settings and in the everyday lives of members of the general population. Individuals need to be reached outside clinical settings to prepare them for the necessary changes to the pharmaceutical management of infections; efforts that depend on media and communications and, therefore, how the AMR message is mediated, received and applied. In 2016, the UK Review on Antimicrobial Resistance called on governments to support intense, worldwide media activity to promote public awareness and to further efforts to rationalise the use of antimicrobial pharmaceuticals. In this article, we consider this communications challenge in light of contemporary currents of thought on media publics, including: the tendency of health communications to cast experts and lay individuals in opposition; the blaming of individuals who appear to 'resist' expert advice; the challenges presented by negative stories of AMR and their circulation in public life, and; the problems of public trust tied to the construction and mediation of expert knowledge on the effective management of AMR.
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Affiliation(s)
- Mark Davis
- a School of Social Sciences , Monash University , Melbourne , Australia
| | - Andrea Whittaker
- a School of Social Sciences , Monash University , Melbourne , Australia
| | - Mia Lindgren
- b School of Media, Film and Journalism , Monash University , Melbourne , Australia
| | - Monika Djerf-Pierre
- c Department of Journalism, Media and Communication , University of Gothenburg , Gothenburg , Sweden
| | - Lenore Manderson
- d School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Paul Flowers
- e School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
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