Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe – implications of a qualitative study in four countries

Abstract

Background Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use. The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use. Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used. Results Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries. Conclusions Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

Socio-cultural determinants of antibiotic resistance: a qualitative study of Greeks’ attitudes, perceptions and values

“…In contrast to the findings of the present study, participants in focus groups in Spain showed a relative lack of knowledge and a lack of perception of the problem of antibiotic resistance [50]. The normative role of individuals' social circle, mainly friends and families, was recognized also by Westerling et al [51]. With regards to the notion of responsibility for ABR, a notable difference was detected with the findings from Essilini et al [52].…”

“…In addition, however, people's actual normative and evaluative commitments, such as those found in this study, need to be understood to ensure feasibility of policies based on such principles [38,55]. In terms of concrete measures tackling specific obstacles, lack of trust in healthcare institutions and perceived low individual self-efficacy, if confirmed in quantitative investigations, could be addressed in adequately framed communication campaigns as well as in doctor-patient communication, as suggested also by other research [32,51,52]. Some limitations should be noted.…”

“…Some comparisons can be made with similar studies performed in other countries with relatively high rates of antibiotic use and antibiotic resistance in the WHO European region [49]. The centrality of trust in health professionals and health institutions as a factor promoting a judicious use of antibiotics -and conversely, lack of trust as a hindering factor -was emphasized by recent research on the Spanish, Turkish, and French public [50][51][52]. In contrast to the findings of the present study, participants in focus groups in Spain showed a relative lack of knowledge and a lack of perception of the problem of antibiotic resistance [50].…”

Knowledge, perceptions and practices on antibiotic use among Sri Lankan doctors

“…Antimicrobial resistance (AMR) has been identified as one of the ten threats to global health in 2019 by the World Health Organization (WHO) [ 1 ]. The rapid emergence of resistant microorganisms is a consequence of inappropriate use of antibiotics in many sectors including health sector [ 2 ] and has a negative impact on patient outcomes [ 3 ].…”

“…Doctors are the main prescriber in many countries including Sri Lanka. In addition to the high workload and lack of facilities limiting the opportunities to deliver evidence-based care, [ 2 ] a prescriber’s decision may also be influenced by factors such as updated knowledge [ 12 ], fear of losing patients’ and lack of information on rational antibiotic use [ 13 ].…”