Antimicrobial resistance (AMR) is a global health emergency affecting humans and animals, diminishing the effectiveness of medication used to treat illness. The agri-food sector has attracted increased attention for imprudent antimicrobial use (AMU) and its contribution to AMR. Thus, ascertaining farmers’ and veterinarians’ behaviours surrounding AMU is essential to address imprudent AMU and generate behaviour change within the agri-food sector. Therefore, the aim of this critical review is to investigate, assess and collate the current body of evidence to identify psychosocial factors including knowledge, understanding, perceptions, attitudes and behaviours surrounding AMU. Database searches were limited to articles utilizing qualitative and quantitative methodologies, available in English with no restriction on publication year. Of the 1156 articles identified, 103 were retained for this review. Findings on the psychosocial aspects were thematically analysed. Five key themes emerged from the data: (i) knowledge and awareness of antimicrobials; (ii) attitudes towards antimicrobials; (iii) influential relationships; (iv) resources; and (v) factors influencing AMU. Results indicated that to overcome barriers experienced by key stakeholders, a carefully considered, evidence-based approach, incorporating behaviour change theory, is required when designing intricate interventions/strategies, in order to elicit successful and sustained AMU behaviour change.
To tackle antimicrobial resistance, it is vital that dairy farmers and veterinarians antimicrobial use behaviors and attitudes towards resistance are understood to identify how beliefs and motives influence practices. Current literature details qualitative and quantitative research exploring dairy farmer and veterinarian's knowledge, attitudes and perceptions on antimicrobial resistance and antimicrobial practices with varied and conflicting reported findings. Our objective was therefore to conduct a systematic review to assess the evidence and knowledge gaps in published literature. Articles were identified via database searches of Embase, Medline, PubMed, Scopus and Web of Science and were limited to published articles available in English with no publication year restrictions. Article screening was conducted at 3 levels: title, abstract and full text. Of the 349 articles identified, 35 were retained for systematic review. Transparency of reporting was assessed for each study using the Consolidated Criteria for Reporting Qualitative Research (COREQ) framework. Quality was assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Findings relating to dairy farmers and veterinarian's knowledge, attitudes and perceptions on antimicrobial resistance and practices were thematically analysed. Comprehensiveness of reporting was variable: studies reported between 5 and 26 of the 32 COREQ checklist items. Five key themes emerged from the data: (1) Knowledge and awareness of antimicrobial resistance, (2) Factors influencing farmer and veterinarian decision making, (3) Perceived barriers and facilitators to reduced antimicrobial use, (4) Perceived responsibility to antimicrobial resistance and (5) The role of the farmer and veterinarian relationship in reducing antimicrobial use. Awareness of prudent antimicrobial use was not uniform between reviewed studies. Many factors influence farmer and veterinarian's decisions to use antimicrobials including animal welfare and available resources. The farmer-veterinarian relationship is considered a potential barrier or facilitator of reduced antimicrobial use, depending on the DAIRY ANTIMICROBIAL USE: A SYSTEMATIC REVIEW 3 perceived relationship dynamic. Encouraging collaboration between farmers and veterinarians could lead to a shared responsibility to reducing antimicrobial use. This review provided a coherent picture of what is currently known and identified gaps in the current knowledge to be used to inform future behavioural intervention research. Increased knowledge, skill development, increased resources, increased engagement, and further research to address the gaps identified are the main recommendations to effectively overcome barriers and elicit appropriate behavior change to achieve reduced antimicrobial use in dairy cattle.
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