Internet and social media use for antibiotic-related information seeking: Findings from a survey among adult population in Italy

Internet and social media preferences of orthopaedic patients vary according to factors such as age and education levels

BACKGROUND

Patients can often access the internet and social media for health information but it is not clear how much they trust and use the information retrieved.

OBJECTIVE

To investigate the social media and internet use rates and preferences of orthopaedic patients, to reveal to what extent they self-treat, and to probe the affecting factors.

METHODS

Two thousand fifty-eight patients admitted to an orthopaedic polyclinic were asked to fill out a survey (voluntarily) consisting of 15 items, to collect demographic data, preference for platforms and sources used, trusted sources, and the extent to which information obtained was used for self-care.

RESULTS

The most preferred and most trusted sources of information were Google and other search engines, and physicians' personal websites (p < 0.001).

DISCUSSION

Variables such as age, gender, educational level and occupation affect the research preferences. Reliance on social media decreases with increasing educational levels (p < 0.001).

CONCLUSION

Health information and knowledge services should work with health professionals to improve aspects of health literacy among orthopaedic patients.

Behavioral practices towards antibiotic use among health care workers - Sierra Leone, 2021: a facility-based cross-sectional study

Introduction

globally, antimicrobial resistance (AMR) kills around 1.27 million 700,000 people each year. In Sierra Leone, there is limited information on antibiotic use among healthcare workers (HCWs). We assessed antibiotic prescribing practices and associated factors among HCWs in Sierra Leone.

Methods

we conducted a cross-sectional survey among HCWs. We collected data using a questionnaire containing a Likert scale for antibiotic prescribing practices. We categorized prescribing practices into good and poor practices. We calculated adjusted odds ratios (aOR) to identify risk factors.

Results

out of 337 (100%) HCWs, 45% scored good practice. Out of the total, 131 (39%) of HCWS considered fever as an indication of antibiotic resistance and 280 (83%) HCWs prescribed antibiotics without performing microbiological tests and 114 (34%) prescribed a shorter course of antibiotics. Factors associated with good practice were being a doctor (aOR=1.95; CI: 1.07, 3.56), the internet as a source of information (aOR=2.00; CI: 1.10, 3.66), having a high perception that AMR is a problem in the health-facility (aOR=1.80; CI: 1.01, 3.23) and there is a connection between one´s prescription and AMR (aOR=2.15; CI: 1.07, 4.32).

Conclusion

this study identified a low level of good practice toward antibiotic prescription. We initiated health education campaigns and recommended continuous professional development programs on antibiotic use.

Influences on treatment-seeking and antibiotic use for common illnesses in eastern China

BACKGROUND

Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China.

METHODS

Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project.

RESULTS

Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use.

CONCLUSIONS

People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.

Insights from a Cross-Sectional Study on Knowledge, Attitudes and Behaviors Concerning Antibiotic Use in a Large Metropolitan Area: Implications for Public Health and Policy Interventions

The overuse and inappropriate use of antibiotics pose a grave threat to public health, contributing significantly to the accelerated development of antimicrobial resistance (AMR) and increased rates of morbidity and mortality, making it a leading cause of death globally. To examine the relationship between demographic variables and knowledge, attitudes, and behaviors concerning antibiotic use, a survey-based cross-sectional study was conducted involving 1158 individuals. The questionnaire included two sections: in the first section, participants' socio-demographic characteristics were analyzed; the second investigated knowledge, attitudes, and behaviors concerning antibiotics utilization using a total of 36 questions. Descriptive statistics were used, and then a multiple linear regression analysis (MLRA) using three models was carried out. In Model I, knowledge about antibiotics exhibited correlations with smoking habits and educational attainment. In Model II, attitudes were significantly associated with gender, smoking habits, age, education, relationship status, and knowledge. In Model III, behaviors related to antibiotics were correlated with educational attainment, having children, knowledge, and attitudes. Implementing tailored public health programs could be a cost-effective intervention to enhance behaviors associated with antibiotic use in the general population. This study offers valuable insights into the determinants of knowledge, attitudes, and behaviors regarding antibiotics in the general population.

Investigation of the relationship between rational drug use and healthy lifestyle behaviours of university students

AIM

the aim of this research is to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students.

METHOD

this descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019-2020 academic year. In the collection of data, 'Student Introduction Form', 'The Rational Drug Use Scale' and 'The Health-Promoting Lifestyle Profile II' were used. Ethical approval was obtained from the Batman University Ethics Committee. In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students. Descriptive statistics, number, percentage, independent t-test, ANOVA test and Spearman's rank correlation were used in the Statistical Package for Social Science (SPSS) 22.0 package software to analyse the data.

RESULTS

the average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.200 Turkish Lira. Some 28.1% of them were third-year students, 59% had graduated from Anatolian high school, 59.6% were living with their nuclear family, 49.1% had an equal level of income and expenditure, 7.7% had no chronic disease, and 9% had regular medication. Some 57.8% of them had health insurance. The Health-Promoting Lifestyle Profile II scale mean score of the students was 124.12 ± 21.37 and the Rational Drug Use Scale mean score was 33.65 ± 6.75. A statistically significant difference was found between the students' class, income, and the total mean scores of the health-promoting lifestyle profile II scale (p < 0.05). A statistically significant difference was found between the school type, family type and income status of the students and the total mean scores of the rational drug use scale (p < 0.05).

CONCLUSION

a strong positive correlation was found between rational drug use scale and the health-promoting lifestyle profile II scales.

Addressing Consumer Misconceptions on Antibiotic Use and Resistance in the Context of Sore Throat: Learnings from Social Media Listening

A misunderstanding of the mechanism of action and bacterial targets of antibiotics by consumers may drive inappropriate antibiotic use and antimicrobial resistance (AMR). Tackling AMR requires an in-depth understanding of consumer beliefs and misconceptions. We explored consumer conversations on a number of social media platforms on antibiotic use and AMR in the context of sore throat and how coronavirus disease 2019 (COVID-19) affected online conversations between 1 January 2018 and 25 November 2021 across eight countries. Five distinct consumer groups were identified (antibiotic-preserving peer educators, antibiotic-cautious consumers, medication-resistant antibiotic opponents, believers in the strength of antibiotics, determined pro-antibiotic consumers) with a wide spectrum of beliefs around antibiotics in sore throat. Many opinions were based upon misconceptions, the most prominent of which was that antibiotics are strong medications that can treat all types of sore throat. COVID-19 had a multifaceted effect on the sore throat and AMR conversation. Sore throat triggered anxiety as consumers feared it may be a COVID-19 symptom while engagement in conversations around antibiotics for COVID-19 increased. Finally, consumers sought multiple routes to access antibiotics, such as directly from the pharmacy or by attempting to persuade physicians to prescribe. Knowledge obtained from this study could be used to develop focused approaches to dispel consumer misconceptions and mitigate AMR.

Acceptance of recommended vaccinations during pregnancy: a cross-sectional study in Southern Italy

Background

Vaccine administration is a recommended, safe, and effective measure to protect pregnant women against vaccine-preventable diseases (VPDs). Despite available guidance, maternal immunization rates for vaccination against influenza and with the reduced antigen content tetanus-diphtheria-acellular pertussis vaccine (Tdap) in Italy remain incredibly low. The primary goal of the study was to explore what Italian pregnant women knew about VPDs and immunization during pregnancy and what factors affected their decision to be vaccinated.

Methods

This cross-sectional study took place between October 2021 and April 2022 in the Southern part of Italy. All consecutive pregnant women, from those attending the selected facilities on randomly selected days, were approached to request participation. The inclusion criteria for participation were age ≥18 years, the ability to understand, speak, and read Italian, and being pregnant at any gestational age. The questionnaire, using a combination of checkboxes and free text answers, consisted of 32 items divided into five parts and lasted ~10 min.

Results

The results showed that 61% knew that the influenza vaccine is recommended and 48.7% knew that influenza could be risky during pregnancy; 74.1% wrongly reported that the Measles-Mumps-Rubella (MMR) vaccine is recommended during pregnancy. Seven out of 10 pregnant women believed that strong evidence supported the safety of vaccinations during pregnancy, and more than half (55.6%) thought they were at increased risk of severe illness with COVID-19. Women in the sample believed that vaccines received during pregnancy pose a risk of adverse events to the unborn child with a median value of 6 (IQR 3-9), on a scale ranging from 1 to 10. Similarly, the fear of contracting pertussis and influenza during pregnancy showed a median value of 6 (IQR 3-9) and 5 (IQR 3-8), respectively. Only 21.1% and 36.5% of women received influenza and Tdap vaccines during pregnancy.

Conclusion

Unrealistic risk perception with a negative attitude toward vaccines in pregnancy and a low percentage of vaccinated pregnant women confirm the urgency of training women to make informed choices to increase overall vaccine uptake.

Health information seeking on social media: the diversification approach

Purpose

Internet studies have rarely addressed gender and/or ethnic differences in health information seeking on social media. Moreover, the role of locality size in explanation of this phenomenon has been overlooked. This study proposed a diversification approach to address these issues. According to it, belonging to numerous disadvantaged groups increases the probability of health-related Internet/social media use.

Design/methodology/approach

The data were collected via telephone survey. The sample consisted of 798 Israeli Internet users who reported using social media for any purpose, gender, ethnic affiliation and locality of residence. The data were analysed using a logistic regression technique.

Findings

Arab female social media users, who resided in small localities, were more likely than the other studied social groups to seek both non-medical and medical information on social media. Furthermore, Arab female social media users were found having the highest likelihood among all studied social groups to seek information regarding physical activity and medications on social media.

Practical implications

The findings largely supported the diversification approach and signal a major need for a greater supply of public health information for members of minority groups, especially those residing in small localities.

Originality/value

The study investigates triple social disadvantage in health-related social media use.

Exploring medical and veterinary student perceptions and communication preferences related to antimicrobial resistance in Ontario, Canada using qualitative methods

BACKGROUND

Antimicrobial resistance (AMR) threatens our ability to treat and prevent infectious diseases worldwide. A significant driver of AMR is antimicrobial use (AMU) in human and veterinary medicine. Therefore, education and awareness of AMR among antimicrobial prescribers is critical. Human and animal health professionals play important roles in the AMR issue, both as contributors to the emergence of AMR, and as potential developers and implementers of effective solutions. Studies have shown that engaging stakeholders prior to developing communication materials can increase relevance, awareness, and dissemination of research findings and communication materials. As future antimicrobial prescribers, medical and veterinary students' perspectives on AMR, as well as their preferences for future communication materials, are important. The first objective of this study was to explore medical and veterinary student perceptions and understanding of factors associated with emergence and spread of AMR. The second objective was to identify key messages, knowledge translation and transfer (KTT) methods, and dissemination strategies for communication of AMR information to these groups.

METHODS

Beginning in November 2018, focus groups were conducted with medical and veterinary students in Ontario, Canada. A semi-structured format, using standardized open-ended questions and follow-up probing questions was followed. Thematic analysis was used to identify and analyze patterns within the data.

RESULTS

Analyses showed that students believed AMR to be an important global issue and identified AMU in food-producing animals and human medicine as the main drivers of AMR. Students also highlighted the need to address society's reliance on antimicrobials and the importance of collaboration between different sectors to effectively reduce the emergence and transmission of AMR. When assessing different communication materials, students felt that although infographics provide easily digestible information, other KTT materials such as fact sheets are better at providing more information without overwhelming the target audiences (e.g., professional or general public).

CONCLUSION

Overall, the study participants felt that AMR is an important issue and emphasized the need to develop different KTT tools for different audiences. This research will help inform the development of future communication materials, and support development of AMR-KTT tools tailored to the needs of different student and professional groups.

Influence of Social Media Uses and Gratifications on Family Health among U.S. Parents: A Cross-Sectional Study

Some research suggests that parents on social media have access to greater social support and health information. However, evidence also connects parental social media use to negative outcomes including increased parental stress, depression, and distraction. Using the uses and gratification theory, this study goes beyond measures of parents' individual mental health and explores social media use and its association with family well-being. Family health outcomes were predicted to vary with parents' use and gratifications of social media, with parents who use social media primarily for information and connection scoring higher on family health and parents who used social media for entertainment scoring worse on family health. The sample included 482 heterosexual married or cohabiting partners recruited through a Qualtrics panel. All participants were parents of children ages of 3-13, with mothers and fathers each completing the survey. Findings indicated that fathers' use of social media for entertainment and connecting with family and friends was associated with better family well-being and health resources (p < 0.01). However, mothers' use of social media did not have a statistically meaningful relationship with family health variables. There was no evidence that parental social media use was associated with negative family health outcomes. Longitudinal data is needed to determine the temporal relationship between social media use and family health. Public health professionals interested in improving family health may consider how to better reach fathers on social media to increase health resources.

Social Media Role and Its Impact on Public Health: A Narrative Review

Social media refers to online social networking sites and is a broad example of Web 2.0, such as Twitter, YouTube, TikTok, Facebook, Snapchat, Reddit, Instagram, WhatsApp, and blogs. It is a new and ever-changing field. Access to the internet, social media platforms and mobile communications are all tools that can be leveraged to make health information available and accessible. This research aimed to conduct an introductory study of the existing published literature on why to choose and how to use social media to obtain population health information and to gain knowledge about various health sectors like disease surveillance, health education, health research, health and behavioral modification, influence policy, enhance professional development and doctor-patient relation development. We searched for publications using databases like PubMed, NCBI, and Google Scholar, and combined 2022 social media usage statistics from PWC, Infographics Archive, and Statista online websites. The American Medical Association (AMA) policy about Professionalism in Social Media Use, American College of Physicians-Federations of State Medical Boards (ACP-FSMB) guidelines for Online Medical Professionalism, and Health Insurance Portability and Accountability Act (HIPAA) social media violations were also briefly reviewed. Our findings reflect the benefits and drawbacks of using web platforms and how they impact public health ethically, professionally, and socially. During our research, we discovered that social media's impact on public health concerns is both positive and negative, and we attempted to explain how social networks are assisting people in achieving health, which is still a source of much debate.

Nurses’ knowledge, motivation, behaviors, and information sources on antibiotic use and resistance in Jordan

<b>Aim:</b> This study aims to examine the nurse knowledge, motivation, and behavior about antibiotics and antibiotic resistance. A secondary objective was to study the preferred information sources used by Jordanian nurses, as well as their knowledge of the information available to promote rational prescription practices in the Jordanian health system.<b> </b><br /> <b>Method: </b>The study was cross-sectional in design and nurses (n=1,093) completed an online survey using Google Forms. Participation in the study was completely optional, and participants were free to drop out at any point. During the months of February-May 2022, nurses were asked to participate in a survey<br /> <b>Results:</b> The study found 48.2% of nurses given prescribed antibiotics to the patients daily or multiple times a day in the preceding week; 13.3% of nurses provided support on daily or more frequent antibacterial drugs use or infection management. The reason for not giving advice regarding antibiotics were no leaflet regarding the use of the antibiotics (42.3%) and the patients do not get attention for the information (30.4%).<br /> <b>Conclusion:</b> In conclusion, the findings of this study show that public health actions are needed (e.g., educational or communication campaigns). Nurses must be educated on the proper use of antibiotics and the emergence of antibiotic resistance. Antibiotic stewardship can benefit from the findings, which can be used to develop interventions aimed at improving antibiotic usage.

Awareness of and interaction with physician rating websites: A cross-sectional study in Austria

To date, the digital assessment of service experiences represents a decisive process step of a feedback culture in numerous economic areas. In view of this digitalization of service assessments, the importance of Physician Rating Websites (PRWs) has also increased steadily in recent years. Even though these websites could be perceived as a powerful communication tool for the exchange of health specific information, the knowledge about whether and how different population segments use these portals has been limited so far. For this reason, our aim was to investigate the level of awareness regarding PRWs among the study population and to discover how users interact with this specific type of online portals. We performed an online survey including 558 participants. To ensure the attention and integrity of participants, attention checks were included in the questionnaire. Study participants who did not exceed the mentioned security levels were excluded from the study. Statistical analyses were carried out, using IBM SPSS Statistics 27. To illustrate the relationship between demographic variables and dependent variables, two tailed chi square tests were performed. Comparison of means and t-testing was used to investigate the relationship between psychographic variables and the dependent variables. In addition to that, the awareness levels regarding different rating portals were evaluated using descriptive methods. Our results suggest that the general awareness regarding PRWs is relatively high (75.6%, 423/558), especially among female (x21 = 9.880, P = .002), middle-aged (x29 = 26.810, P = .002), more highly educated (x24 = 19.038, P = .001), urban (x21 = 6.274, P = .012), digitally literate (t203 = 2.63, P = .009) individuals and particularly among respondents with a higher eHealth literacy (t203 = 2.37, P = .019). Even though more than three quarters of the respondents know that PRWs exist, compared to other rating platforms, they are only in the lower midfield. The upper ranks are taken by websites on which restaurant visits (98.9%, 552/558), hotel stays (97.7%, 545/558) or movies (95.5%, 533/558) can be rated. The most popular PRWs in Austria include Docfinder.at (31.3%, 175/558; 77.8%, 434/558) followed by the evaluation tools provided by Google.at (8.24%, 46/558; 70.3%, 392/558) and Herold.at (1.61%, 9/558; 44.8%, 250/558). In Austria, PRWs seem to be characterized by a high degree of interaction (89.2%, 498/558) with a wide variety of different types of interactions. While many respondents use PRWs to retrieve general information (83.2%, 464/558), there are significantly fewer who read physicians' reviews (60.9%, 340/558) and use this portal to select a physician (60.6%, 338/558). Respondents who have already rated a doctor themselves belong to the smallest group accounting for just 14.7% (82/558). Significant effects regarding the interaction with PRWs exist between different genders, ages, education levels, marital statuses, occupations and areas of living. In addition to that, respondents with better feelings towards the internet, greater digital literacy as well as a higher eHealth literacy were also characterized with a higher interaction rate regarding PRWs. According to the high level of awareness of and interaction with PRWs within our study population, PRWs appear to be a successful medium for health-related communication. Especially for female, middle-aged, more highly educated, urban and more technology savvy population segments, PRWs seem to represent an effective tool to support the health-specific decision-making process.

Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China

There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China

Objective

The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China.

Methods

From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model.

Result

Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions.

Conclusion

The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Using a social media based intervention to enhance eye health awareness of members of a deprived community in India

Deprived communities in India experience a range of health challenges as the result of a mixture of lack of access to information technologies, and difficulties in accessing health information and provision. This article reports on an intervention centred on the use of the social media platform, WhatsApp, in order to promote eye health communication. The case study based research was conducted in the village of Chowbaga, close to Kolkata, in West Bengal, with women participants who had low levels of education and high levels of unemployment. The women were invited to participate in a WhatsApp intervention that comprised five educational sessions. Participants were recruited through the local school that their children attended. Shortly after the conclusion of the intervention, focus groups were conducted with the participants in order to develop an understanding of participants views of the beneficial characteristics of such a social media based intervention, and, more specifically, the benefits of WhatsApp in increasing awareness of eye problems within their community. This research demonstrates and summarises the benefits of WhatsApp as a communications medium for deprived communities, as well as its potential for increasing awareness of eye problems. In particular, participants were of the view that future access to WhatsApp and other mobile-based platforms empowered them to take better care of their own and their family’s health.

Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination

Background

Few studies explored Indonesian understanding of cervical cancer (CC) and the human papillomavirus (HPV) vaccination. We aimed to investigate the association between knowledge, attitudes, and practices (KAP) and socio-demographical influences related to HPV, CC, and vaccination among Indonesian urban citizens.

Methods

We conducted an online survey during March 2020-August 2021 using the Snowball sampling technique. The socio-demographic characteristic and KAP responses were collected via Google Forms from 400 respondents in Jakarta. The knowledge and attitudes were divided into HPV and CC (aspect 1) and HPV vaccination (aspect 2). Correlation between KAP scores was performed using Spearman’s test, and multiple logistic regression analyses were conducted to determine KAP predictors.

Results

Indonesian urban citizens in Jakarta were found to have poor knowledge in individual aspects of the inquiry but moderate knowledge overall, good attitude in inquiry both in each aspect and overall, and unsatisfying practices. Overall, in the general population, men, and women respectively: 50.8%, 32.4%, and 53.6% had good knowledge; 82.0%, 75.2%, and 84.4% expressed positive attitude; and 30.3%, 15.2%, and 35.6% applied favorable practice regarding questions inquired. Knowledge was weakly correlated towards attitude (ρ = 0.385) but moderately correlated with practice (ρ = 0.485); attitude was moderately correlated with practice (ρ = 0.577), all results: p<0.001. Significant odds ratio (OR) for predictors to good knowledge were female sex (OR = 2.99), higher education (OR = 2.91), and higher mother’s education (OR = 2.15). Factors related to positive attitudes were higher mother’s education (OR = 4.13), younger age (OR = 1.86), and better results in the knowledge inquiries (OR = 2.96). Factors that suggested better practices were female sex (OR = 2.33), being employed (OR = 1.68), excellent knowledge scores (OR = 4.56), and positive attitudes expressions (OR = 8.05). Having done one vaccination dose and intention to receive vaccines were significantly influenced by good KAP.

Conclusions

KAP had inter-association to successful CC and HPV prevention programs, and socio-demographical characteristics are critical to influencing better KAP.

What the public in England know about antibiotic use and resistance in 2020: a face-to-face questionnaire survey

OBJECTIVES

To describe public attitudes and knowledge around antibiotic activity, resistance and use.

DESIGN

Face-to-face household 18 question survey using computer-assisted data collection undertaken by Ipsos Market and Opinion Research International.

SETTING

Randomly selected households across England, January-February 2020.

PARTICIPANTS

2022 adults (aged 15+,) including 521 black, Asian and minority ethnic (BAME) participants, and 406 aged 15-25 years olds.

MAIN OUTCOME MEASURES

Responses to questions about antibiotic activity, resistance and expectations for antibiotics and trust in healthcare professionals. Analyses were weighted to obtain estimates representative of the population with multivariable analysis undertaken for questions with five or more significant univariate variables.

RESULTS

84% stated they would be pleased if their general practitioner (GP) said they did not need antibiotics. Trust in GPs to make antibiotic decisions remains high (89%) and has increased for nurses (76%) and pharmacists (71%). Only 21% would challenge an antibiotic decision; this was significantly greater in BAME participants (OR 2.5; 95% CI 1.89 to 3.35). 70% reported receiving advice when prescribed antibiotics. Belief in benefits of antibiotics for ear infections was very high (68%). Similar to 2017, 81% agreed that antibiotics work for bacterial, 28% cold and influenza viruses. 84% agreed antibiotic resistant bacteria (ARB) are increasing, only 50% agreed healthy people can carry ARB and 39% agreed there was nothing they personally could do about ARB. Social grade DE and BAME participants, and those with less education had significantly less understanding about antibiotics and resistance.

CONCLUSIONS

As trust in healthcare practitioners is high, we need to continue antibiotic education and other interventions at GP surgeries and community pharmacies but highlight that most ear infections are not benefitted by antibiotics. Targeted interventions are needed for socioeconomic DE, BAME groups and previous antibiotic users. We need to explore if increasing perceived personal responsibility for preventing ARB reduces antibiotic use.

Gender Differences in Knowledge and Attitude towards HPV and HPV Vaccine among College Students in Wenzhou, China

Objective: This study aimed to determine human papillomavirus (HPV)-related awareness and willingness to receive HPV vaccination among college students, in Wenzhou, and its associated factors. Methods: A cross-sectional epidemiological study was conducted among college students in Wenzhou to investigate their knowledge, attitude, and factors affecting their willingness to receive HPV vaccination. Results: A total of 1035 questionnaires were collected, of which 1002 were valid (males: 374, females: 628). In total, 904 (90.2%) college students had heard of HPV, with a lower rate among males than females (85.3% vs. 93.2%, p < 0.05) and 693 (69.2%) had heard of the HPV vaccine, with a significantly lower rate among males than females (53.7% vs. 78.3%, p < 0.05). Overall awareness of HPV and HPV vaccine among males and females was moderate, with lower awareness among males. A total of 55.9% of males and 80.4% of females indicated that they would be willing to receive the HPV vaccine, a significant difference (p < 0.001). The price, safety of HPV vaccine, and lack of knowledge about HPV and HPV vaccine were the major barriers to HPV vaccination for college students. Compared to females, inadequate knowledge of HPV was the main barrier factor for HPV vaccination among male college students. Conclusions: The overall knowledge level of males is lower than that of females. For male college students, providing more knowledge about HPV infection is helpful to promote their willingness to vaccinate. It is necessary to promote HPV-related knowledge for male and female college students, respectively.

Estimating Patient Empowerment and Nurses' Use of Digital Strategies: eSurvey Study

Patient empowerment is seen as the capability to understand health information and make decisions based on it. It is a competence that can improve self-care, adherence and overall health. The COVID-19 pandemic has increased the need for information and has also reduced the number of visits to health centers. Nurses have had to adapt in order to continue offering quality care in different environments such as the digital world, but this entails assessing the level of their patients’ empowerment and adapting material and educational messages to new realities. The aim of this study is, on the one hand, to assess nurses’ use of digital resources to provide reinforcing information to their patients and, on the other hand, to evaluate how they assess the level of empowerment of their patients. To perform the study, 850 nurses answered 21 questions related to their own digital literacy and patients’ empowerment. The ability to make decisions is the characteristic most selected by nurses (70%) as useful in measuring patient empowerment, whereas 9.19% do not measure it in any way. Printed material is most often used by nurses to offer additional information to patients (71.93%), mobile applications are the least used option (21.58%), and elder nurses are those who most recommend digital resources. In this study, younger nurses make little or no use of technology as a resource for training and monitoring patients. In spite of some limitations concerning the study, digital health needs to be promoted as an indisputable tool in the nurse’s briefcase in the future to ensure that older patients can manage electronic resources in different fields.

The Internet: Friend or Foe of Antibiotic Resistance? Results of a Cross-Sectional Study among Italian University Students

The study aims were to investigate knowledge and attitudes towards antibiotics and antibiotic resistance (ABR), and to assess the extent of practices regarding antibiotic consumption and Internet use among university students in Southern Italy. Data were collected through an anonymous online questionnaire from 1 April to 14 April 2021. The eligibility criteria for the study were: (i) age between 18 and 30 years and (ii) registered as an undergraduate student at the university. Among the 1051 sampled students, only 7.4% gave the correct answer to all 7 knowledge statements about antibiotics and ABR. The main determinants of knowledge were being younger and attending to medical or life sciences majors. Almost two-thirds took an antibiotic in the previous 12 months and 24.6% reported having self-medicated with antibiotics. More than half of the sample used the Internet to seek information about antibiotics and/or ABR, and it was the strongest predictor of self-medication with antibiotics. The study findings highlighted gaps in knowledge, considerable antibiotic consumption, sometimes without prescription, together with an extensive Internet use to seek health-related information. To facilitate the health-promoting use of the Internet in conjunction with health care providers, we could make young adults aware of the rational use of antibiotics.

Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan

Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians' preferred sources of information and evaluate physicians' awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers' views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately.

The Role of Sources and Types of Health Information in Shaping Health Literacy in Cervical Cancer Screening Among African Immigrant Women: A Mixed-Methods Study

BACKGROUND

Health literacy is a strong determinant of health outcomes among immigrants. How sources and types of health information influence health literacy in the context of cervical cancer screening among African immigrant women remains unknown.

OBJECTIVE

This study was undertaken to explore how various sources and types of health information influence information sharing and health literacy in the context of cervical cancer screening among African immigrant women.

METHODS

Using a mixed-methods approach, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of survey participants. The relationship between sources and types of health information and health literacy was assessed using multivariate logistic regression. Emergent themes were identified in the qualitative interviews using content analysis. Qualitative and quantitative data were merged to describe differences and similarities in African immigrant women's experiences and display of health literacy by different sources and types of health information.

KEY RESULTS

Health care providers (78%), women friends (46%), and internet (45%) were the most common sources of health information used by African immigrant women, followed by women relatives (32%), television (22%), social media (17%), and church (16%). Content analysis revealed that the health care provider was rated as the most credible source; personal experiences of family and friends made health information more relatable; and church was the least endorsed source. Health information presented verbally (adjusted odds ratio of 5.51, p = .01) was associated with higher health literacy even after controlling for covariates. Most African immigrant women had health information presented in verbal form (80%), with pictures (43%) being the least popular type of health information.

CONCLUSIONS

Study findings suggest that verbal communication is associated with health literacy in the context of cervical cancer screening among African immigrant women. Health interventions that use peer educators (women friends and family) and incorporate verbal communication may be a more effective strategy in promoting positive cervical cancer health behaviors among African immigrant women. [HLRP: Health Literacy Research and Practice. 2021;5(2):e96-e108.] Plain Language Summary: For this mixed-methods study, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of the survey participants. Study findings show a strong association between verbal communication and health literacy in the context of cervical cancer screening among African immigrant women.

Paediatric nurses', children's and parents' adherence to infection prevention and control and knowledge of antimicrobial stewardship: A systematic review

INTRODUCTION

Infection prevention and control precautions help to decrease microbial transmission, and through the appropriate use of antibiotics, Antimicrobial Stewardship programs aim to decrease the prevalence and emergence of Antimicrobial Resistance.

METHODS

A systematic review was undertaken to critically appraise and synthesise evidence for nurses', children's and parents' knowledge and understanding of antimicrobial stewardship, and of infection prevention and control in acute paediatric care settings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. Studies were included if they examined the factors that contributed to nurses' adherence to, or consumers' practice in relation to, antimicrobial stewardship and infection prevention and control.

RESULTS

Of the 16,957 papers identified, 50 studies conducted in acute paediatric settings met the eligibility criteria, and were included. Most studies were of low methodological quality. Fourteen studies evaluated nurses' knowledge and self-reported adherence to Infection Prevention and Control principles and identified consistent practice gaps by nurses. Six studies evaluating the effectiveness of education programs reported modest improvements in nurses' knowledge and adherence to infection prevention and control. There were 15 studies, that investigated consumers' involvement in infection prevention and control that identified the following themes: Consumer knowledge and attitudes to infection prevention and control and transmission-based precautions, and parents' willingness to take an active role in infection prevention. Six studies focused on paediatric nurses' role in antimicrobial stewardship, exploring the following themes: (1) nurses' understanding and beliefs of antimicrobial stewardship roles, and (2) barriers to nurses taking a greater role in antimicrobial stewardship. Nine studies explored the role of consumers in antimicrobial stewardship and identified consumers' misconceptions about the benefits and downplayed concerns regarding antibiotic use.

DISCUSSION

Although consumers articulated a willingness to be actively involved in infection prevention, observed practice remained lower than that required to consistently prevent infection transmission.

CONCLUSION

These findings highlight a critically important gap in current practice. In relation to optimal use of antimicrobials, although paediatric nurses were involved in supporting antimicrobial stewardship processes and educating consumers, they identified limited antimicrobial stewardship knowledge. Consumers appeared to lack understanding about the benefits of antibiotics and negated concerns regarding antibiotic use.

Determinants of clinic doctors' attitudes concerning antimicrobial prescription for patients with common colds or bronchitis: Additional analysis of a nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases

BACKGROUND

In 2019, the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases reported nationwide, cross-sectional questionnaire survey data investigating the clinical status of clinic doctors' attitudes to antimicrobial stewardship. This study aimed to identify factors determining clinic doctors' attitudes concerning antimicrobial prescription for patients with a common cold or bronchitis.

METHODS

In February 2018, 1500 randomly selected community-based medical clinics in Japan were sent a questionnaire. Primary and secondary endpoints were clinic doctors' attitudes concerning antimicrobial prescription, and antimicrobial medication types prescribed for patients with a common cold or bronchitis, respectively. We used multivariable linear regression analysis to identify factors associated with primary and secondary outcomes.

RESULTS

We analyzed 269 of 274 responses (response rate, 18.3%). Linear regression analysis was used to identify determinants of proactive attitudes to antimicrobial prescription, including whether clinic doctors encountering patients with upper respiratory symptoms and no underlying illnesses, and diagnosed with a common cold would prescribe antimicrobial medication (β = 0.283, t = 4.279, p = 0.000); whether clinic doctors frequently experienced requests from patients (or their families) with a common cold to prescribe antimicrobial medication (β = 0.389, t = 6.133, p = 0.000), and; clinic doctors' awareness of antimicrobial stewardship in the past year (β = -0.157, t = -2.456, p = 0.015). Determinants of proactive attitudes to prescribing broader-spectrum antimicrobials for patients with a common cold included clinic doctors' attitudes concerning antimicrobial prescription (β = 0.165, t = 2.622, p = 0.009), whether the respondent was a pediatrician (β = -0.288, t = -4.583, p = 0.000), and clinic doctors' attitudes to antimicrobial prescription (β = 0.262, t = 4.075, p = 0.000) for patients with bronchitis.

CONCLUSION

This study identified factors among clinic doctors that determined their attitudes to antimicrobial prescription concerning patients with a common cold or bronchitis. Identification and targeting of clinic doctors who unnecessarily prescribe antimicrobial medication is urgently required to promote antimicrobial stewardship in an outpatient setting.

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician's therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

Before and after case reporting: A comparison of the knowledge, attitude and practices of the Jordanian population towards COVID-19

Coronavirus disease- 2019 (COVID-19) is an emerging contagious infectious disease. It is pandemic and has affected more than 21 million people and resulted in more than 750,000 deaths worldwide (https://www.worldometers.info/coronavirus/#countries; 14/08/20). Our research group initiated a study to ascertain the knowledge, attitude and practices (KAP) of Jordanians toward COVID-19 prior to any initial case report in Jordan. This project was underway when the first Jordanian case was reported. We extended our study to identify how case reporting would alter public KAP towards COVID-19. This cross-sectional study randomly selected and recruited 2104 Jordanian adults. A four-section questionnaire was devised to address the sociodemographic characteristics of the subjects and their KAP toward COVID-19. The mean knowledge score for the study population was 15.9 ± 2.2 (out of the 20 knowledge questions), with 60.9% of the participants having good knowledge about COVID-19. Participants’ practices to prevent transmission of COVID-19 were adequate in more than 60% of participants. Most participants had positive attitudes regarding their role in preventing COVID-19 and many of the participants’ attitudes and practices changed to more appropriate ones after reporting the first case of COVID-19 in Jordan. The percentage of participants who trust the government in confronting COVID-19 increased significantly (p value < 0.001). However, one alarming and unexpected finding was that the prevention practice score of participants working in the medical field was similar to those from the general population. This may necessitate stricter training and guidelines for this group who will be in the frontline in combating the disease. Impact of this study: The data generated from this study shows that when cases of disease were reported, the public’s attitudes and practices improved in many aspects, and that confidence in the government to contain the disease was boosted. We believe that this study is important in allowing other, international governments to develop an understanding of public KAP during pandemic disease outbreaks.

How COVID-19 Changed the Information Needs of Italian Citizens

Italy was the first European country to be affected by COVID-19, facing an unprecedented situation. The reaction required drastic solutions and highly restrictive measures, which severely tested the trust of the Italian people. Nevertheless, the effectiveness of the introduced measures was not only linked to political decisions, but also to the choice of the Italian people to trust and rely on institutions, accepting such necessary measures. In this context, the role of information sources was fundamental, since they strongly influence public opinion. The central focus of this research was to assess the information seeking behavior (ISB) of the Italian citizens, to understand how they related to information and how their specific use of information influenced public opinion. By making use of a survey addressed to 4260 Italian citizens, we identified extraordinarily virtuous behavior in the population: people strongly modified their ISB in order to address the most reliable sources. In particular, we found a very high reliance on scientists, which is particularly striking, if compared to the past. Moreover, starting from the survey results, we used social simulation to estimate the evolution of public opinion. Comparing the ISB during and before COVID-19, we discovered that the shift in the ISB, during the pandemic, may have actually positively influenced public opinion, facilitating the acceptance of the costly restrictions introduced.

Knowledge and practices regarding antibiotics use: Findings from a cross-sectional survey among Italian adults

Background and objectives

This study aimed to assess the knowledge on antibiotics and antimicrobial resistance (AMR) and the antibiotic use among the general public in Southern Italy and to analyze whether sociodemographic characteristics could be associated with poor knowledge and improper practices.

Methodology

From March to November 2019, a face-to-face interview was conducted with adult subjects attending the waiting room of 27 randomly selected general practitioners (GPs) in Southern Italy. The questionnaire covered sociodemographic characteristics, knowledge on antibiotics and AMR and practices regarding the consumption of and self-medication with antibiotics.

Results

The response rate was 89.7%. In the sample, 29.2% thought that antibiotics are effective for viral infections, and 49.5% correctly recognized the definition of AMR. Predictors of good knowledge about antibiotics and AMR were female gender and a higher education level. Almost half of the respondents had used antibiotics in the previous year and 23.6% took antibiotics to treat a common cold and/or fever. Among participants, 25.5% reported to have bought antibiotics without a prescription, and 30.6% were classified as antibiotic self-medication users. Use of antibiotics in the previous 12 months and having taken an antibiotic after a phone consultation with the GP were positively associated with both antibiotic use for a common cold and/or fever and self-medication with antibiotics.

Conclusions and implications

The findings of this study highlighted a considerable antibiotic consumption in the adult population of Southern Italy together with misconceptions regarding the correct indication for antibiotic use that could foster indiscriminate antibiotic use.

Lay Summary

The findings of this study highlighted a considerable antibiotic consumption in the adult Italian population together with misconceptions regarding the correct indication for antibiotic use that could foster indiscriminate antibiotic use. Almost a quarter of the respondents took antibiotics to treat a common cold and/or fever and reported to have bought antibiotics without a prescription.

Targeting Perceptions of Risk from Injudicious Antibiotic Use: An Application of the Risk Information Seeking and Processing Model

Enhancing knowledge about antibiotic-associated risks is key to reducing injudicious antibiotic use and slowing antibiotic resistance. Using the Risk Information Seeking and Processing (RISP) model, the study identified predictors of individuals' seeking and avoidance of information about antibiotic risks and tested the effectiveness of exposure to a RISP-informed video intervention against exposure to a CDC-produced video and a control group. In a national sample (N = 1000), risk judgment led to greater negative affect toward risks of antibiotics and lower positive affect toward antibiotic usefulness. In turn, positive and negative affect shaped information insufficiency, which interacted with perceived information gathering capacity to influence risk information seeking and avoidance. In addition, informational subjective norms and affective responses directly shaped individuals' information behavior. Results showed that relative to the control group, participants viewing the RISP-informed video had greater risk judgment, perceived current knowledge about antibiotic risks, perceived information gathering capacity, and informational subjective norms, as well as lower levels of positive affect toward antibiotics. The RISP-informed video and CDC-produced video performed equivalently well. Implications of the findings for the design of antibiotic stewardship messages are discussed.

Factors associated with sufficient knowledge of antibiotics and antimicrobial resistance in the Japanese general population

We conducted two online surveys about antibiotics targeted at the Japanese general population in March 2017 and February 2018. In total, 6,982 participants completed the questionnaire. Factors associated with knowledge of antibiotics, knowledge of antimicrobial resistance (AMR) and appropriate behavioural changes were evaluated by a machine learning approach using DataRobot. Factors strongly associated with three dependent variables in the model were extracted based on permuation importance. We found that the strongest determinant of knowledge of antibiotics and AMR was education level. Knowledge of antibiotics was strongly associated with the frequency of internet use. Exposure to primary information was associated with motivation for appropriate behavioural changes. Improving the availability of primary information would be a beneficial intervention. Individuals lacking higher education and without opportunities to obtain primary information should be considered a target population for effective interventions.

A nationwide web-based survey of a sample of Italian community pharmacists' perceptions and opinions about online sales of medicines and falsified drugs

Background

Throughout Europe, legal online pharmacies increasingly sell online drugs as well as other products such as dietary supplements. Online sale of pharmaceuticals however is closely connected to the phenomenon of drug falsification.

Objective

The aim of this study was to assess the opinions of a sample of Italian community pharmacists towards the sale of pharmaceuticals on the web, as well as their knowledge and experience with falsified drugs.

Methods

A self-administered questionnaire was distributed by means of an online platform between October 2016 and January 2017. Collected information included: demographics, workplace and role, opinions towards the online sale of pharmaceuticals, whether the pharmacy has a website, knowledge and opinions about falsified drugs.

Results

A total of 668 community pharmacists completed the questionnaire (mean age: 48.5, SD 12.4 years, 52.3% women). Favourable opinions about online sale of pharmaceuticals were expressed by 4.9% of participants for prescription drugs, 25.4% for nonprescription drugs, and 51.6% for other products. Favourable opinions occurred more often among males and owners/directors of pharmacies in comparison to females and employees, and among pharmacists working in pharmacies with websites doing e-commerce. Knowledge about falsified drugs was limited, with 24.5% of respondents failing to indicate that falsified drugs may contain less or different ingredients, 46.4% less and/or different excipients, and 72.3% ignoring that falsified drugs may be lethal. One in 3 respondents didn't know about falsified drugs in Italy, however 51 participants had previous experience with falsified drugs and 21 provided specific information.

Conclusions

Italian community pharmacists have low confidence in the online sale of pharmaceuticals, as well as alarmingly limited knowledge about falsified drugs, even if many of them reported previous experiences. Results may support targeted interventions to increase pharmacists' knowledge about pharmaceuticals and the web, as well as concerning falsified drugs, and suggest community pharmacies as key components of integrated systems aimed at monitoring falsified drugs.

Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members

BACKGROUND

Antimicrobial resistance (AMR) is a serious public health problem and a global concern. The inappropriate use of antibiotics has been identified by the World Health Organization as a major risk factor for AMR.

METHODS

The purpose of this research study is to assess the prevalence of inappropriate antibiotic use among Qatar University students and their family members, detect sociodemographic factors associated with inappropriate use, evaluate the knowledge and attitude towards antibiotic use, and assess respondents' opinions on healthcare providers' antibiotic prescription practices. Participants (N = 596) completed a self-administered questionnaire. Descriptive analysis, the Pearson chi-squared test, and multivariate logistic regression analyses were performed.

RESULTS

The major inappropriate antibiotic use practices followed by the respondents were using antibiotics without prescription (82%), not completing the antibiotic course (45%), and obtaining antibiotics from the pharmacy without prescription (23%). The chi-square test results showed that age (p = 0.031) and nationality (p = 0.041) were associated with using antibiotics without prescription. In addition, respondents less than 21 years of age (p<0.001), who had only a secondary education (p = 0.007), and who lived in one of the large and crowded cities in Qatar (p = 0.011) had higher odds of stopping the antibiotic before completing the course. Our study also revealed that almost 60% of the respondents had inadequate knowledge and a negative attitude towards antibiotic use. Nationality and municipality were the independent factors associated with having appropriate knowledge of antibiotic use. Univariate logistic regression analyses in our study demonstrated that older (>26 years), married and university-graduated participants were more likely to have a positive attitude towards antibiotic use than others. Respondents also reported that neither doctors nor pharmacists were providing adequate patient education about appropriate antibiotic use. The Socio-Ecological Model was applied to interpret the findings and frame implications.

CONCLUSION

The findings shed light on various factors shaping antibiotic use practices and provide evidence to design multilevel behavioral interventions to improve public practices of antibiotic use.

Public understanding and use of antibiotics in England: findings from a household survey in 2017

OBJECTIVES

To describe public understanding and use of antibiotics.

DESIGN

Ipsos MORI Capibus survey of randomly-selected households.

SETTING

England, January-April 2017.

PARTICIPANTS

2283 adults (≥15 years) including 777 parents of children <5 years old.

DATA COLLECTION AND ANALYSIS

The main survey was undertaken in January 2017 (n=1691); data from an additional sample of parents were collected in April 2017 (n=592). Analyses were weighted to obtain estimates representative of the population.

MAIN OUTCOME MEASURES

Responses to questions about antibiotics (awareness and perceptions), recent illness (expectations and experience), delayed and leftover antibiotics, and child illness stratified by demographic and socioeconomic characteristics.

RESULTS

Most respondents (83% (1404/1691)) recognised that antibiotics kill bacteria/treat bacterial infections, but a sizeable minority (35% (592/1691)) thought that antibiotics kill viruses/treat viral infections. Overall levels of understanding have not changed substantially since similar surveys in 2003 and 2008/2009. One sixth of respondents who were prescribed antibiotics reported having leftovers (14% (64/498)) and 33% (22/64) kept these for possible future use. 1.3% of all respondents (23/1691) reported taking left-over antibiotics in the past year and 1.6% (26/1691) reported taking antibiotics obtained without a prescription. Higher social grade and educational qualifications were strongly positively associated with antibiotic knowledge; youngest (15-24 years), oldest (65 +years) and black, Asian and minority ethnic adults were less knowledgeable. Among 1319 respondents who had an infection or antibiotics within the past year, 43% (568/1319) said that they had not received any advice or information about antibiotics.

CONCLUSIONS

Despite many campaigns, public understanding of antibiotics in England continues to combine correct basic knowledge held by most people with less prevalent but persistent and potentially harmful misunderstandings. These could be addressed through active provision of advice and information during primary and secondary care consultations and more effective public health interventions.

Longitudinal trends of and factors associated with inappropriate antibiotic prescribing for non-bacterial acute respiratory tract infection in Japan: A retrospective claims database study, 2012-2017

Background

Inappropriate antibiotic prescribing is a cause of antimicrobial resistance. Acute Respiratory Tract Infections (ARTI) are common diseases for those antibiotics are most likely prescribed in outpatient setting.

Objectives

To clarify factors associated with antibiotic prescribing for non-bacterial acute respiratory tract infections (NB-ARTI) and identify targets for reducing inappropriate prescribing for NB-ARTI in Japan.

Methods

We conducted a retrospective, observational study using longitudinal claims data between April 2012 and June 2017. We assessed the rate of and factors associated with inappropriate antibiotic prescribing in outpatient settings for all NB-ARTI consultations included in the database.

Results

The mean monthly antibiotic prescribing rate per 100 NB-ARTI consultations during the study period was 31.65. The monthly antibiotic prescribing rate per 100 NB-ARTI consultations decreased by 19.2% from April 2012 to June 2017. Adolescents (13–18 years) and adults of working age (19–29 and 30–39 years) were more likely prescribed antibiotics compared with elderly patients ≥ 60 years (aOR: 1.493 [95%CI: 1.482–1.503], 1.585 [95%CI: 1.575–1.595], and 1.507 [95%CI: 1.498–1.516], respectively). Outpatient clinics registered as internal medicine or ear, nose, and throat specialty were more likely to prescribe antibiotics than those of paediatric specialty or other specialties. Among health facility type, clinics without beds (aOR 2.123 [95%CI: 2.113–2.133]) and clinics with beds (aOR: 1.752 [95%CI: 1.7371–1.767]) prescribed significantly more antibiotics for NB-ARTI than outpatient departments inside general hospitals.

Conclusions

Inappropriate antibiotic prescribing for NB-ARTI is common in Japan. Although the antibiotic prescribing rate has decreased, further interventions are required to promote antimicrobial stewardship (ASP). Education and awareness for adults and promotion of ASP among physicians in clinics without beds are key drivers to reduce inappropriate antibiotic prescribing in Japan.

Knowledge and use of antibiotics in Thailand: A 2017 national household survey

BACKGROUND

The Thailand National Strategic Plan on Antimicrobial Resistance (AMR) 2017-2021, endorsed by the Thai Cabinet in 2016, aims to increase public knowledge about antibiotics and AMR awareness by 20% by 2021. This study assesses the prevalence of antibiotics use, clinical indications and sources; knowledge and access to information related to antibiotics and AMR; and factors related to level of knowledge and access to information among Thai adult population.

METHODS

An AMR module was developed and embedded into the 2017 Health and Welfare Survey; a cross-sectional, two-stage stratified sampling, nationally representative household survey carried out biannually by National Statistical Office. The survey applied a structured interview questionnaire. The survey was conducted in March 2017 where 27,762 Thai adults were interviewed of the AMR module. Data were analyzed using descriptive and inferential statistics.

RESULTS

The one-month prevalence of antibiotic use was 7.9% for three common conditions; flu (27.0%), fever (19.2%) and sore throat (16.8%). The majority of antibiotics (70.3%) were provided by public or private healthcare facilities, and 26.7% by pharmacies. Thai adults have low levels of knowledge about antibiotics; only 2.6 gave correct answers to all six statements related to antibiotics, while 13.5% gave wrong answers to all six statements. A few factors associated with knowledge and having received information on antibiotics were assessed. People who have higher education levels, and belong to richer wealth quintiles, and receive antibiotics and AMR information have significantly higher levels of knowledge about antibiotics. In the last 12 months, only 17.8% of respondents had heard information about the proper use of antibiotics and AMR; mostly from doctors (36.1%), health workers (24.8%) and pharmacists (17.7%).

CONCLUSIONS

There is a large gap of public knowledge about the use of antibiotics. The main communication channel is through healthcare professionals, which indicates they are key persons in communicating information about the proper use of antibiotics to the public.

Knowledge, practice and attitude towards HPV vaccination among college students in Beijing, China

This cross-sectional study aimed to assess the knowledge, practice and attitude towards HPV vaccination among college students in Beijing, China. Furthermore, the factors influencing vaccination were analyzed. The data were collected via self-administered anonymous questionnaires completed by 884 college students who were recruited from a random sample at Peking University in China between September and December 2018. In total, 72.6% of the participants had previously heard of but had insufficient knowledge about HPV and the vaccine. The level of knowledge was significantly associated with the participants' age, major, and family members' or friends' vaccination status. In total, 68.8% of the students viewed college education as the primary source from which they hoped to receive information about the vaccine. Only 9.5% of the females had received the vaccine. Relationships with doctors, sexual experience and a high level of knowledge were positive predictors of vaccine uptake. Limited knowledge about the HPV vaccine was the primary and most common reason for refusing vaccination and not recommending the vaccine to others. Knowledge of the HPV vaccine among college students at Peking University was low to moderate, and the vaccine uptake was low. Policies and measures, such as college health education, are needed to increase college students knowledge of HPV and the vaccine, which may help improve the vaccination rate.

What we know about media communication on antibiotics and antimicrobial resistance: A systematic review of the scientific literature

OBJECTIVE

Systematically review the literature regarding media communication about antibiotics and anti-microbial resistance (AMR) to synthesise its key characteristics and impact effectiveness, identifying gaps and areas for further research.

METHODS

A comprehensive systematic review covering five international databases for articles published between 1^st September 2008 and 1^st September 2018 was performed using the registered protocol (PROSPERO: CRD42018116464). The search using terms related to media communication and antibiotics or AMR yielded 19 eligible studies, which were analysed and qualitatively synthesised.

RESULTS

Research on media communication regarding antibiotics or AMR has rapidly increased in the last decade. 74% of studies used a media content analysis method, while the remaining studies collected data via surveys. Print media were examined in 53% (n = 10), with 74% (n = 14) focused on English language media.

CONCLUSION

Currently, knowledge regarding media communication of antibiotics and AMR is very restricted to English-speaking print media. Further research is required to understand communication on this topic from other media (types and geographical regions) as well as how media effects attitude and behaviour change.

PRACTICE IMPLICATIONS

Better understanding of media communication regarding antibiotics and AMR may be crucial for policymakers and public health experts when planning strategies to tackle this issue.

Self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia

Background

Self-medication is the use of any drug or medication to treat an illness or ailment without the supervision of a licensed medical doctor/health care providers. Self-medication practice in Eastern Ethiopia is quite common. However, there is little information with regard to magnitude and associated factors. The objective of this study was to assess the magnitude of self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia.

Methods

A community based cross-sectional study was conducted from June 27- July 12, 2017. Multistage sampling method was used and the number of kebeles and Sub-kebeles were selected using simple random sampling technique. Finally, sampled households in the Sub-kebeles were selected using systematic random sampling. Data were collected using face to face interview with 547 adult (≥18 years) participants. It was entered and cleaned using EPI-Data version 3.02 and exported to Statistical Package for Social Science (SPSS) Version 23 for further analysis. Bi-variable and multivariable logistic regression models were carried out to identify factors associated with the self-medication.

Result

The magnitude of self-medication was found to be 37.5% (95% CI: (33.6%–41.7%). Educational status of secondary school [(AOR = 0.46; 95% CI: (0.22–0.98)], high income [(AOR = 3.00; 95% CI: (1.77–5.06)], advised by neighbors, friends or relatives to take drug for their complaint [(AOR = 2.59; 95% CI: (1.62–4.14)], used old prescription /past experience to bought drugs [(AOR = 12.19; 95% CI: (6.65–22.35)], follow advertisements of drugs by television [(AOR = 0.21; 95% CI: (0.05–0.85)], and perception about Hospital drugs (clinics, health centers and hospitals) do not work [(AOR = 2.36; 95% CI: (1.39–3.99)] were significantly associated with self-medication.

Conclusion

High income, advice by neighbors, friends or relatives to take drug for their complaint, old prescription/past experience use to bought drugs, and perception of hospital drugs do not work was positively associated with self-medication. Therefore, health education should be given to the community on the importance of hospital drugs (clinics, health centers and hospitals) to shift their perception.

Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China

Purpose

Overuse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients.

Methods

Medical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use.

Results

A total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics.

Conclusion

Overuse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.

Knowledge, attitudes, and practices related to antibiotic use in Paschim Bardhaman District: A survey of healthcare providers in West Bengal, India

Introduction

Antibiotic misuse is widespread and contributes to antibiotic resistance, especially in less regulated health systems such as India. Although informal providers are involved with substantial segments of primary healthcare, their level of knowledge, attitudes, and practices is not well documented in the literature.

Objectives

This quantitative study systematically examines the knowledge, attitudes, and practices of informal and formal providers with respect to antibiotic use.

Methods

We surveyed a convenience sample of 384 participants (96 allopathic doctors, 96 nurses, 96 informal providers, and 96 pharmacy shopkeepers) over a period of 8 weeks from December to February using a validated questionnaire developed in Italy. Our team created an equivalent, composite KAP score for each respondent in the survey, which was subsequently compared between providers. We then performed a multivariate logistic regression analysis to estimate the odds of having a low composite score (<80) based on occupation by comparing allopathic doctors (referent category) with all other study participants. The model was adjusted for age (included as a continuous variable) and gender.

Results

Doctors scored highest in questions assessing knowledge (77.3%) and attitudes (87.3%), but performed poorly in practices (67.6%). Many doctors knew that antibiotics were not indicated for viral infections, but over 87% (n = 82) reported prescribing them in this situation. Nurses, pharmacy shopkeepers, and informal providers were more likely to perform poorly on the survey compared to allopathic doctors (OR: 10.4, 95% CI 5.4, 20.0, p<0.01). 30.8% (n = 118) of all providers relied on pharmaceutical company representatives as a major source of information about antibiotics.

Conclusions

Our findings indicate poor knowledge and awareness of antibiotic use and functions among informal health providers, and dissonance between knowledge and practices among allopathic doctors. The nexus between allopathic doctors, pharmaceutical company representatives, and informal health providers present promising avenues for future research and intervention.

A cross-sectional national survey of community pharmacy staff: Knowledge and antibiotic provision

Background

Pharmacists’ knowledge about the clinical and legal aspects of antibiotic supply has an impact on appropriate dispensing practice. There are limited studies evaluating community pharmacists’ knowledge of antibiotic dispensing in low and middle-income countries, including Sri Lanka. We aimed (i) to evaluate community pharmacy staff’s self-reported knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription, and (ii) to identify possible factors impacting their antibiotic dispensing behaviour.

Methods

A cross-sectional survey was conducted among a random sample (n = 369) of community pharmacies across all nine provinces in Sri Lanka using a self-administered questionnaire on their antibiotic knowledge and dispensing practice. Data were analysed using descriptive and inferential statistics including; t-test, one-way ANOVA or chi-square test, and binary and multiple logistic regression.

Results

A total of 265 pharmacy staff (210 (79%) pharmacists and 55 (21%) assistants) responded. Overall mean antibiotic knowledge score was 26.1 (SD 3.9; range 1–33, max possible score 34). The overall mean knowledge score t(263) = 2.41, p = 0.017, specific knowledge about antibiotic resistance (ABR) t(262) = 4.98, p = 0.021 and legal aspects of antibiotic dispensing χ²(1, N = 265) = 8.55, p = 0.003) were significantly higher among pharmacists than assistants. One in every three pharmacy staff reported that they dispensed antibiotics without a prescription on patient request; however the proportion was close to half when the patient was known to them. About 30% of the staff reported to have supplied antibiotics for minor infections in the week prior to the survey. However, there was no significant difference in the supply between pharmacists and assistants except for acute sore throat (12% vs 23%, respectively; p = 0.040). Those pharmacists with higher ABR knowledge were less likely to give out antibiotics without a prescription for viral infections in adults (Adj. OR = 0.73, 95% CI: 0.55–0.96; p = 0.027) and children (Adj. OR = 0.55, 95% CI: 0.38–0.80; p = 0.002). Awareness of legal aspects of antibiotic supply reduced overall dispensing (Adj. OR = 0.47, 95% CI: 0.30–0.75; p = 0.001), and specifically for bacterial infections in adults (Adj. OR = 0.45, 95% CI: 0.20–0.99; p = 0.047). Knowledge about antibiotic use and misuse reduced the likelihood of illegal dispensing for common cold (Adj. OR = 0.75, 95% CI: 0.60–0.94; p = 0.011) and acute diarrhoea (Adj. OR = 0.76, 95% CI: 0.58–0.99; p = 0.048).

Conclusion

Despite the law prohibiting provision, antibiotic dispensing without a prescription continues in community pharmacies in Sri Lanka. Appropriate antibiotic dispensing was associated with high levels of pharmacists’ legal and clinical knowledge about antibiotics. Strategies to change the current practice are urgently needed.

Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies

Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.

Parental digital health information seeking behavior in Switzerland: a cross-sectional study

Background

Digital media are increasingly abundant and used to seek health information, however, to date very little is known on parents’ seeking behavior in the context of child’s health and development outside English-speaking and Scandinavian countries. By investigating the prevalence of, and reasons for use, we studied parents’ perception of the Internet as a resource for improving their health-related knowledge.

Methods

The survey was conducted in a random sample of 2573 Swiss-German parents with at least one child aged less-than 2 years old. Parents received a mailed invitation to fill in an online questionnaire. Two reminders were sent, the later with a paper questionnaire attached. The questionnaire included questions on use of print, digital, and personal information sources, as well as different information situations: general health and development or illness. We ran descriptive analyses on information seeking behavior, type of digital media used, reasons of use. We also conducted regression analyses to explore factors associated with parental perceptions with regard to the Internet’s utility as a source for health information.

Results

A total of 769 questionnaires were returned (response rate 30%). Nearly all parents (91%) used digital media for seeking information on their child’s health and development, and the main reason for use was indicated as being the 24/7 availability of information. Search engines (55%) and webpages for parents (47%) were by far the most frequently used digital media. Generally, the internet is perceived as a good resource, especially by fathers (OR = 1.80, 95% CI: 1.03–3.16). However, a large percentage of parents are skeptical about the correctness of online info (91%), are unsure about their interpretive understanding, and ask for guidance from their pediatrician (67%).

Conclusions

The Internet has become a highly frequented source of information for Swiss-German parents on children’s health with largely valuable perceptions of its utility. Digital media are used in addition to and not in replacement of print media and personal contacts. Increasing parental guidance by health and public health professionals could improve parental digital health utilization and empower parents in the new role they adopt.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6524-8) contains supplementary material, which is available to authorized users.