Perspectives on Non-Prescription Antibiotic Use among Hispanic Patients in the Houston Metroplex

Abstract

Background: Non-prescription antibiotic use includes taking an antibiotic without medical guidance (e.g., leftovers, from friends/relatives, or purchased without a prescription). Non-prescription use contributes to antimicrobial resistance, adverse drug reactions, interactions, superinfection, and microbiome imbalance. Qualitative studies exploring perspectives regarding non-prescription use among Hispanic patients are lacking. We used the Kilbourne Framework for Advancing Health Disparities Research to identify factors influencing patients' non-prescription use and organize our findings.Methods: Our study includes Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews explored the factors promoting non-prescription use in Hispanic adults. Interviews were conducted remotely, in English or Spanish, between May 2020 and October 2021. Inductive coding and thematic analysis identified motives for non-prescription use.Results: Participants (n = 35) were primarily female (68.6%) and aged 27 to 66. Participants reported obtaining antibiotics through trusted persons, sold under-the-counter in US markets, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare (due to insurance constraints, costs, and clinic wait times), and communication difficulties (e.g., language barriers with clinicians and perceived staff rudeness). Participants expressed confidence in medical recommendations from pharmacists and trusted community members.Conclusions: Patient, healthcare system, and clinical encounter factors contribute to non-prescription use in Hispanic communities. Antibiotic stewardship interventions that involve pharmacists and trusted persons, improve access to care, and address communication barriers and cultural competency in the clinic may help reduce non-prescription use in these communities.

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

“…Our findings also highlight some specific healthcare barriers, including the high costs of doctor visits, long clinic waits (e.g., to schedule appointments or during doctor visits), and a lack of health insurance or health coverage, which impact Hispanic patients’ decisions to use non-prescription antibiotics [ 3 , 12 ]. Patients who experience the burden of high costs during a doctor’s visit also had three times higher intended non-prescription antibiotic use from the US and friends and relatives in comparison to patients that did not report high costs during a doctor’s visit as a problem.…”

“…Another study also found that individuals without health insurance were over three times more likely to purchase antibiotics outside the US, presumably without a prescription [ 11 ]. In our previous qualitative study, high copayments (for a doctor’s visit and subsequent prescription medications), regardless of patients having healthcare coverage, drove some patients to seek informal medical advice and source non-prescription medications using their social networks [ 12 ]. Future research should leverage and promote appropriate antibiotic use as a social norm for Hispanic patients with and without healthcare coverage [ 13 , 29 ].…”

“…In the United States (US), Hispanic communities have one of the highest reported prevalence rates of non-prescription antibiotic use, with the prevalence ranging from 19 to 66% [ 9 ]. Prior studies have identified that these Hispanic communities use non-prescribed antibiotics from a variety of sources, including leftover prescriptions (e.g., from self, friends, or family); purchasing illegally under-the-counter through informal sources in the US (e.g., flea markets and ethnic or herbalist shops); or outside the US without a prescription (e.g., across the border in another country, including Mexico) [ 3 , 9 , 10 , 11 , 12 ].…”

“…Sociocultural factors include an individual’s level of acculturation and their subjective norms. Acculturation and subjective norms can impact health behaviors in Hispanic communities [ 10 , 11 , 12 ]. Acculturation is “the process by which individuals adopt the attitudes, values, customs, beliefs, and behaviors of another culture” [ 13 , 14 ].…”

“…A recent study of a Hispanic community along the Texas border found that a higher generation score, a proxy measure of acculturation, was associated with lower cross-border purchases of antibiotics [ 11 ]. Another qualitative study of Hispanic primary care patients in Houston found that patients’ subjective norms (e.g., friends and family frequently purchase non-prescription antibiotics) and social networks (e.g., friends, family, or other “trusted” persons) influenced their decisions to use non-prescription antibiotics [ 12 ]. However, these studies included medically underserved, impoverished Hispanic individuals and did not study the independent effects of sociocultural and healthcare system factors on non-prescription antibiotic use in sociodemographically diverse Hispanic communities.…”