The Drivers of Antibiotic Use and Misuse: The Development and Investigation of a Theory Driven Community Measure

Abstract

Background: Antimicrobial resistance is a global public health concern, with extensive associated health and economic implications. Actions to slow and contain the development of resistance are imperative. Despite the fact that overuse and misuse of antibiotics are highlighted as major contributing factors to this resistance, no sufficiently validated measures aiming to investigate the drivers behind consumer behaviour amongst the general population are available. The objective of this study was to develop and investigate the psychometric properties of an original, novel and multiple-item questionnaire, informed by the Theory of Planned Behaviour, to measure factors contributing to self-reported antibiotic use within the community. Method: A three-phase process was employed, including literature review and item generation; expert panel review; and pre-test. Investigation of the questionnaire was subsequently conducted through a cross-sectional, anonymous survey. Orthogonal principal analysis with varimax rotation, cronbach alpha and linear mixed-effects modelling analyses were conducted. A 60 item questionnaire was produced encompassing demographics, social desirability, three constructs of the Theory of Planned Behaviour including: attitudes and beliefs; subjective norm; perceived behavioural control; behaviour; and a covariate-knowledge.Results: 373 participants completed the survey. 80 participants (21%) were excluded due to social desirability concerns, with data from the remaining 293 participants analysed. Results showed modest but acceptable levels of internal reliability, with high inter-item correlations within each construct. All four variables and the outcome variable of antibiotic use behaviour comprised four items with the exception of social norms, for which there were two items, producing a final 18 item questionnaire.Perceived behavioural control, social norms, the interaction between attitudes and beliefs and knowledge, and the presence of a healthcare worker in the family were all significant predictors of antibiotic use behaviour. All other predictors tested produced a nonsignificant relationship with the outcome variable of self-reported antibiotic use.Conclusion: This study successfully developed and validated a novel tool which assesses factors influencing community antibiotic use and misuse. The questionnaire can be used to guide appropriate 3 intervention strategies to reduce antibiotic misuse in the general population. Future research is required to assess the extent to which this tool can guide community-based intervention strategies.

Evaluation of knowledge, attitudes and practices of human healthcare students about antimicrobial drug use and resistance: a cross-sectional study in University of Maiduguri, Nigeria

“…In this study, it was found that most of the human healthcare students were males and within the age group of 21 -25 years with the majority of them in 400 Level. These findings coincide with previous studies on knowledge and practices in the use of antibiotics among a group of Nigerian university students [14].…”

Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

“…One of the main drivers behind the development of AMR is the misuse and overuse of antibacterial agents [ 18 , 19 ]. As the utilisation of antibacterials can be controlled [ 20 ], rationalization of use is of pivotal importance to curb AMR. Emergency care departments (EDs) are unique in the health care system, providing an interface between ambulatory care and hospital care settings [ 21 ].…”

Inadequate knowledge on appropriate antibiotics use among clients in the Moshi municipality Northern Tanzania

“…For example, antibiotics are often believed to be “wonder drugs” with the ability to cure any ailment. Such attitudes greatly influence the irrational use of antibiotics in the community [ 3 , 6 ]. Lack of knowledge about the activity of antibiotics on bacteria and in the inactivity of antibiotics on other pathogens (such as viruses, fungi and parasites), and about the emergence of antibiotic resistance in case of inappropriate antibiotic use, also influence irrational use [ 7 , 8 ].…”