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Sievert EDC, Korn L, Gross M, Santana AP, Böhm R, Betsch C. Communicating diagnostic uncertainty reduces expectations of receiving antibiotics: Two online experiments with hypothetical patients. Appl Psychol Health Well Being 2024; 16:1459-1478. [PMID: 38500005 DOI: 10.1111/aphw.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024]
Abstract
The overprescription of antibiotics due to diagnostic uncertainty and inappropriate patient expectations influence antimicrobial resistance. This research assesses (i) whether communicating diagnostic uncertainty reduces expectations of receiving antibiotics and (ii) which communication strategies minimise unintended consequences of such communication. In two experimental online studies conducted in January and April 2023, participants read a vignette describing a doctor consultation for an ear infection and expressed their expectations of receiving antibiotics, trust in their doctor, rated the doctor's reputation and provided their intention to get a second doctor's opinion. Study 1 (N = 2213) investigated whether communicating diagnostic uncertainty and social externalities of antibiotic use (the negative social impacts of developing antibiotic resistance) decreases expectations for antibiotics and explores potential unintended consequences on the doctor-patient relationship. In Study 2 (N = 527), we aimed to replicate and extend the findings by adding specific treatment recommendations. Disclosing diagnostic uncertainty (vs. certainty) and communicating (vs. not communicating) the social externalities of antibiotic overuse reduced patients' expectations of receiving antibiotics. Yet, communicating uncertainty impaired trust in the doctor and the doctor's reputation. Combining the communication of uncertainty with specific treatment recommendations-particularly delayed antibiotic prescriptions-showed important to prevent these unintended consequences.
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Affiliation(s)
- Elisabeth D C Sievert
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lars Korn
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marina Gross
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ana Paula Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Cornelia Betsch
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Sirota M, Juanchich M. Seeing an apocalyptic post-antibiotic future lowers antibiotics expectations and requests. COMMUNICATIONS MEDICINE 2024; 4:141. [PMID: 38997505 PMCID: PMC11245540 DOI: 10.1038/s43856-024-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Antibiotic resistance is an ongoing pandemic which represents a global public health threat. To encourage the judicious use of antibiotics, public health discourse and campaigns often engage in threat-based messaging depicting an apocalyptic post-antibiotic future. We studied the effectiveness of the strategy because of mixed evidence for its success, and because it is unclear how experiencing the COVID-19 pandemic might have influenced it. METHODS We conducted a randomised controlled trial with 378 participants in three waves (before and during the pandemic in 2021 and 2022). Participants were randomly allocated to either the baseline arm, featuring a control film, or the intervention arm featuring a short film, Catch, depicting a post-antibiotic future. Participants expressed expectations and intended requests for antibiotics for a hypothetical ear infection and their adherence to a prescribed antibiotic for a hypothetical kidney infection. In waves 2 and 3, they also reported any COVID-19-related changes to their antibiotic desires. RESULTS Showing participants a film about a post-antibiotic future substantially lowers clinically inappropriate expectations for antibiotics and their intended requests. Participants report that the experience of the COVID-19 pandemic decreased their desire for antibiotics but only when they watched the intervention film. The intervention slightly decreases participants' adherence intentions towards a prescribed antibiotic treatment. CONCLUSIONS Presenting a film about an apocalyptic post-antibiotic future lowers expectations and intended requests for antibiotics and therefore has the potential to encourage judicious use of them. However, the adverse effects of such messaging on adherence to a course of antibiotics should be proactively managed.
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Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK.
| | - Marie Juanchich
- Department of Psychology, University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK
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Tisch M, Roháč L, Reineke T, Burkart M, Kostev K. Long-term benefits of EPs ® 7630 in patients with acute sinusitis: a real-world cohort study. Front Pharmacol 2024; 15:1358879. [PMID: 38562459 PMCID: PMC10982470 DOI: 10.3389/fphar.2024.1358879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Background: We evaluated whether EPs® 7630 prescription in patients with acute sinusitis (AS) is associated with less frequent recurrence of AS, occurrence of chronic sinusitis or nasal polyps, or fewer antibiotic prescriptions. Methods: This retrospective cohort study used electronic medical records from the IQVIA Disease Analyzer database. Associations between initial therapy [EPs® 7630, antibiotics, intranasal corticosteroid (INCS), or corticosteroid-free nasal spray within 3 days of AS diagnosis] and AS recurrence, incidence of chronic sinusitis or nasal polyps or rate of antibiotic prescription were studied using multivariable Cox or logistic regression models, adjusting for sex, age, insurance status, month of diagnosis, and comorbidity. Results: A total of 216,360 patients were analyzed. INCS prescription was associated with a higher risk of recurrent AS (HR: 1.40; 95% CI: 1.01-1.92) and a higher incidence of chronic sinusitis or nasal polyp diagnosis (HR: 1.39; 95% CI: 1.01-1.92) compared to EPs® 7630. Initial antibiotic therapy was significantly associated with higher risk of new antibiotic prescription in the period of 31-365 days after the index date compared to EPs® 7630 (OR: 2.20; 95% CI: 1.66-2.92). Conclusion: EPs® 7630 prescription is associated with long-term benefits in AS patients. EPs® 7630 can help to reduce inappropriate antibiotic use and might reduce the risk of chronic sinusitis or nasal polyps.
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Affiliation(s)
- Matthias Tisch
- Department of Otorhinolaryngology, Head- and Neck Surgery, Bundeswehrkrankenhaus, Ulm, Germany
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Santana AP, Korn L, Betsch C, Böhm R. Promoting prosociality toward future generations in antibiotic intake. J Health Psychol 2023; 28:1024-1037. [PMID: 36721947 DOI: 10.1177/13591053221149526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Understanding individuals' preferences for antibiotics can help mitigate the acceleration of antibiotic resistance. Similar to the climate crisis, individuals "today" need to appropriately use antibiotics to reduce the negative consequences of antibiotic resistance for individuals "tomorrow." We use an established-yet novel in this research field-behavioral game approach to investigate individuals' preferences for antibiotics in the face of a between-generations conflict. In an online study, we investigated whether a between-generations (vs within-generations) conflict in antibiotic intake leads to larger overuse and how to promote appropriate use of antibiotics. Results indicate that overuse in the face of a between-generations (vs within-generations) conflict increased. Eliciting empathy toward future generations in the case of a between-generations conflict decreased overuse. Findings suggest that different representations of this social dilemma can influence people's preferences for antibiotics, and that empathy-based interventions might promote appropriate antibiotic use.
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Affiliation(s)
| | - Lars Korn
- Media and Communication Science, University of Erfurt, Germany
| | - Cornelia Betsch
- Media and Communication Science, University of Erfurt, Germany
- Faculty of Psychology, University of Vienna, Austria
| | - Robert Böhm
- Department of Psychology, University of Copenhagen, Denmark
- Faculty of Psychology, University of Vienna, Austria
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Huang Z, Kuan WS, Tan HY, Seow E, Tiah L, Peng LL, Weng Y, Chow A. Antibiotic expectation, behaviour, and receipt among patients presenting to emergency departments with uncomplicated upper respiratory tract infection during the COVID-19 pandemic. J Glob Antimicrob Resist 2023; 33:89-96. [PMID: 36906173 PMCID: PMC9998126 DOI: 10.1016/j.jgar.2023.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVES Pre-COVID-19 pandemic, patients who attended the emergency department (ED) for upper respiratory tract infection (URTI) were more likely to receive antibiotics if they expected them. These expectations could have changed with the change in health-seeking behaviour during the pandemic. We assessed the factors associated with antibiotics expectation and receipt for uncomplicated URTI patients in four Singapore EDs during the COVID-19 pandemic. METHODS We conducted a cross-sectional study on adult patients with URTI from March 2021 to March 2022 in four Singapore EDs and assessed the determinants of antibiotics expectation and receipt using multivariable logistic regression models. We also assessed the reasons patients expect antibiotics during their ED visit. RESULTS Among 681 patients, 31.0% expected antibiotics while 8.7% received antibiotics during their ED visit. Factors (adjusted odds ratio [95% confidence interval]) that significantly influenced expectation for antibiotics include: 1) prior consultation for current illness with (6.56 [3.30-13.11]) or without (1.50 [1.01-2.23]) antibiotics prescribed; 2) anticipation for COVID-19 test (1.56 [1.01-2.41]); and 3) poor (2.16 [1.26-3.68]) to moderate (2.26 [1.33-3.84]) knowledge on antibiotics use and resistance. Patients expecting antibiotics were 10.6 times (10.64 [5.34-21.17]) more likely to receive antibiotics. Those with tertiary education were twice (2.20 [1.09-4.43]) as likely to receive antibiotics. CONCLUSION In conclusion, patients with URTI who expected antibiotics to be prescribed remained more likely to receive it during the COVID-19 pandemic. This highlights the need for more public education on the non-necessity for antibiotics for URTI and COVID-19 to address the problem of antibiotic resistance.
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Affiliation(s)
- Zhilian Huang
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore; Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore.
| | - Win Sen Kuan
- Department Emergency Medicine, National University Hospital, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hann Yee Tan
- Acute and Emergency Care Department, Khoo Teck Puat Hospital, Singapore.
| | - Eillyne Seow
- Acute and Emergency Care Department, Khoo Teck Puat Hospital, Singapore.
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore.
| | - Li Lee Peng
- Department Emergency Medicine, National University Hospital, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Yanyi Weng
- Department Emergency Medicine, Tan Tock Seng Hospital, Singapore.
| | - Angela Chow
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore.
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Hill EM. An examination of health locus of control in relation to antibiotic resistance perceptions and antibiotic use behaviors among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 37167584 DOI: 10.1080/07448481.2023.2208227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Objective: The aim of the present study was to examine the role of health locus of control (HLOC; internal, chance, powerful others) in antibiotic resistance perceptions and antibiotic use behaviors among college students. Participants: Participants were 366 students recruited from the introductory psychology pool at a university in the northeastern United States. Methods: Participants completed the study via Qualtrics in 2015 (October-December). They completed the Multidimensional Health Locus of Control Scale (measuring internal, chance, powerful others HLOC) and questions about their antibiotic use and antibiotic resistance perceptions. Results: Linear regression analyses were employed to examine the role of the HLOC in antibiotic use behaviors and antibiotic resistance perceptions. With the exception of the regression with antibiotic resistance concern as an outcome, powerful others HLOC was the strongest predictor across all models. Conclusions: Antibiotic misuse was prevalent in our sample and powerful others HLOC was associated with problematic antibiotic use.
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Affiliation(s)
- Erin M Hill
- Department of Psychology, West Chester University, West Chester, Pennsylvania, USA
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Chan AHY, Beyene K, Tuck C, Rutter V, Ashiru-Oredope D. Pharmacist beliefs about antimicrobial resistance and impacts on antibiotic supply: a multinational survey. JAC Antimicrob Resist 2022; 4:dlac062. [PMID: 36035318 PMCID: PMC9400174 DOI: 10.1093/jacamr/dlac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pharmacists have important antimicrobial stewardship (AMS) roles yet limited literature exists on pharmacists' knowledge and beliefs about antimicrobial resistance (AMR) and antimicrobials and how these beliefs influence antimicrobial supply in different countries. Methods A cross-sectional survey was disseminated to pharmacists around the world via the Commonwealth Pharmacists' Association and related networks. Data were collected on demographics, antibiotic supply practices, and knowledge and beliefs about AMR. Results A total of 546 pharmacists responded from 59 countries, most commonly from Africa (41%) followed by Asia (26%) and Oceania (22%). Respondents supplied a mean of 46 ± 81 antibiotic prescriptions/week, 73%±35% of which were given in response to a prescription. Overall, 60.2% dispensed antibiotics at least once without a prescription. Respondents had good knowledge (mean 9.6 ± 1.3 (out of 12), and held positive beliefs about AMR [mean 3.9 ± 0.6 (out of 5)]. Knowledge about antibiotics and beliefs about AMR were positively correlated. The odds of supplying antibiotics without a prescription were 7.4 times higher among respondents from lower income countries [adjusted odds ratio (AOR) = 7.42, 95% CI 4.16-13.24]. Conversely, more positive AMR beliefs were associated with a lower odds of supplying antibiotics without a prescription (AOR = 0.91, 95% CI 0.86-0.95). Conclusions Most pharmacists had the good knowledge about antibiotics and positive beliefs about AMR. These beliefs were influenced by knowledge, work setting, and country income. A proportion of respondents provided antibiotics without a prescription; the likelihood of this occurring was higher in those who held more negative beliefs about AMR.
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Affiliation(s)
- Amy Hai Yan Chan
- Commonwealth Pharmacists’ Association, London, UK
- School of Pharmacy, University of Auckland, Grafton, Auckland, New Zealand
- UCL School of Pharmacy, University College London, London, UK
| | - Kebede Beyene
- School of Pharmacy, University of Auckland, Grafton, Auckland, New Zealand
| | - Chloe Tuck
- Commonwealth Pharmacists’ Association, London, UK
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Kyabaggu R, Marshall D, Ebuwei P, Ikenyei U. Health Literacy, Equity, and Communication in the COVID-19 Era of Misinformation: Emergence of Health Information Professionals in Infodemic Management. JMIR INFODEMIOLOGY 2022; 2:e35014. [PMID: 35529308 PMCID: PMC9066383 DOI: 10.2196/35014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
The health information management (HIM) field's contribution to health care delivery is invaluable in a pandemic context where the need for accurate diagnoses will hasten responsive, evidence-based decision-making. The COVID-19 pandemic offers a unique opportunity to transform the practice of HIM and bring more awareness to the role that frontline workers play behind the scenes in safeguarding reliable, comprehensive, accurate, and timely health information. This transformation will support future research, utilization management, public health surveillance, and forecasting and enable key stakeholders to plan and ensure equitable health care resource allocation, especially for the most vulnerable populations. In this paper, we juxtapose critical health literacy, public policy, and HIM perspectives to understand the COVID-19 infodemic and new opportunities for HIM in infodemic management.
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Affiliation(s)
- Ramona Kyabaggu
- Johnson-Shoyama Graduate School of Public Policy University of Regina Regina, SK Canada
- Department of Health Information Sciences Faculty of Information and Media Studies Western University London, ON Canada
| | - Deneice Marshall
- Division of Health Sciences Barbados Community College Saint Michael Barbados
| | - Patience Ebuwei
- College of Health Professions, Health Information Management Coppin State University Baltimore, MD United States
| | - Uche Ikenyei
- Department of Health Information Sciences Faculty of Information and Media Studies Western University London, ON Canada
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A Peer Educational Tool to Promote Antimicrobial Stewardship on a University Campus. PHARMACY 2021; 9:pharmacy9040199. [PMID: 34941631 PMCID: PMC8703290 DOI: 10.3390/pharmacy9040199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is a major public health threat. Patient education on the appropriate use of antibiotics is a key component in combating antimicrobial resistance. The purpose of this study was to analyze the utility of an origami fortune teller as a novel peer educational tool in promoting antimicrobial stewardship on a university campus. An origami fortune teller, with various case scenarios to demonstrate key antibiotic principles, was developed and used by peer educators to educate students attending a university wellness fair. The case studies included: antibiotic indications; differentiation between viral vs. bacterial infection; proper use of antibiotics; non-pharmacologic measures to combat infection; and antibiotic resistance. Students were asked to take an assessment pre and post working with the tool. One hundred and forty-three students received education using the novel tool. A significant improvement in the assessment score was observed after education was completed using the novel tool (69.5 vs. 96.6 p ≤ 0.05).
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Community Use of Antibiotics in Turkey: The Role of Knowledge, Beliefs, Attitudes, and Health Anxiety. Antibiotics (Basel) 2021; 10:antibiotics10101171. [PMID: 34680752 PMCID: PMC8532753 DOI: 10.3390/antibiotics10101171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 12/29/2022] Open
Abstract
Turkey has been among the leading countries in antibiotic consumption. As a result of the 4-year National Action Plan for Rational Drug Use, antibiotic prescriptions had declined from 34.9% in 2011 to 24.6% in 2018. However, self-medication with antibiotics without prescription is common, which is not reflected in official statistics. The present study aims at investigating antibiotic use in the community and the factors related to it. A web-based survey was conducted among 945 Turkish-speaking respondents (61.3% female). The questionnaire included questions about antibiotic use for different illnesses, ways to obtain and handle leftover antibiotics, knowledge, beliefs of the antibiotic effectiveness, attitudes, health anxiety, and background factors. According to the results, 34.2% of the sample had self-medicated themselves with antibiotics without a valid prescription. The most common way to self-medicate was to use leftover antibiotics. While 80.4% knew that antibiotics are used to treat bacterial infections, 51.4% thought that antibiotics are effective for viral diseases. The most important predictor of antibiotic use frequency was the belief in their efficiency for various illnesses and symptoms, followed by negative attitudes to antibiotics, health anxiety, knowledge level, positive attitudes, and health status. The results underline the importance of targeting misbeliefs about antibiotics in future campaigns.
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