The general population has increasingly become the key contributor to irrational antibiotic use in China, which fuels the emergence of antibiotic resistance. This study aimed to estimate the prevalence of the general population’s irrational use behaviors of antibiotics and identify the potential reasons behind them. A systematic review and meta-analysis were performed concerning four main behaviors relevant to easy access and irrational use of antibiotics and common misunderstandings among the population about antibiotics. Four databases were searched, and studies published before 28 February 2021 were retrieved. Medium and high-level quality studies were included. Random effects meta-analysis was performed to calculate the prevalence of the general population’s irrational behaviors and misunderstandings relevant to antibiotic use. A total of 8468 studies were retrieved and 78 met the criteria and were included. The synthesis showed the public can easily obtain unnecessary antibiotics, with an estimated 37% (95% CI: 29–46) of the population demanding antibiotics from physicians and 47% (95% CI: 38–57) purchasing non-prescription antibiotics from pharmacies. This situation is severe in the western area of China. People also commonly inappropriately use antibiotics by not following antibiotic prescriptions (pooled estimate: 48%, 95% CI: 41–55) and preventatively use antibiotics for non-indicated diseases (pooled estimate: 35%, 95% CI: 29–42). Misunderstanding of antibiotic use was also popular among people, including incorrect antibiotic recognition, wrong antibiotic use indication, inappropriate usage, and ignorance of potential adverse outcomes. Over-and inappropriate use of antibiotics is evident in China and a multifaceted antibiotic strategy targeted at the general population is urgently required.

BackgroundThe public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants.MethodsA mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated.ResultsA total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect.ConclusionSystemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.

Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing.Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics.Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a “wait and see” strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p < 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p < 0.001; AOR = 1.257 for broad-spectrum antibiotics, p < 0.001).Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.

Background Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring’s health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers’ breastfeeding behaviors based on the health belief model (HBM). Methods A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers’ knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers’ breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM. Results The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF. Conclusion To promote EBF, physicians’ education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

BackgroundGestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.ObjectiveTo explore the experience of disease among mothers with GDM and how they develop feeding behaviors.MethodsThis study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers’ experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.Results16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.ConclusionTo promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

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