Assessing the overuse of antibiotics in children in Saudi Arabia: validation of the parental perception on antibiotics scale (PAPA scale)

Abstract

BackgroundAntibiotics overuse is a global public health issue influenced by several factors, of which some are parent-related psychosocial factors that can only be measured using valid and reliable psychosocial measurement instruments. The PAPA scale was developed to measure these factors and the content validity of this instrument was assessed.AimThis study further validated the recently developed instrument in terms of (1) face validity and (2) construct validity including: deciding the number and nature of factors, and item selection.MethodsQuestionnaires were self-administered to parents of children between the ages of 0 and 12 years old. Parents were conveniently recruited from schools’ parental meetings in the Eastern Province, Saudi Arabia. Face validity was assessed with regards to questionnaire clarity and unambiguity. Construct validity and item selection processes were conducted using Exploratory factor analysis.ResultsParallel analysis and Exploratory factor analysis using principal axis factoring produced six factors in the developed instrument: knowledge and beliefs, behaviours, sources of information, adherence, awareness about antibiotics resistance, and parents’ perception regarding doctors’ prescribing behaviours. Reliability was assessed (Cronbach’s alpha = 0.78) which demonstrates the instrument as being reliable.ConclusionThe ‘factors’ produced in this study coincide with the constructs contextually identified in the development phase of other instruments used to study antibiotic use. However, no other study considering perceptions of antibiotic use had gone beyond content validation of such instruments. This study is the first to constructively validate the factors underlying perceptions regarding antibiotic use in any population and in parents in particular.

Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections

“…Children younger than six years of age are more susceptible to adverse effects from antibiotics than adults, due to alterations in pharmacokinetics (Alomar, 2014;Alumran, Hou, & Hurst, 2013;Fernandez et al, 2011). Children have higher total body water and less body fat than adults, causing increased drug distribution (Fernandez et al, 2011).…”

“…Antibiotic prescribing patterns for URIs in children are due to several factors, the most common being PCP to parent communication, unique PCP prescribing patterns, time constraints, and appearance of the child with a URI (Alumran, Hou, & Hurst, 2013).…”

“…The unnecessary use of antibiotics is a worldwide public health issue (Alumran, Hou & Hurst, 2013;Lucas et al, 2015;Dwibedi et al, 2015;Kutty, 2011;Llor & Bjerrum, 2014;Rouusounides et al, 2011). There are multiple factors that cause concern regarding unnecessary antibiotic use, including complications related to antibiotic resistant bacteria, side effects of antibiotic use, and the possibility that antibiotics will become ineffective against bacteria.…”

“…Preschool aged children account for the highest rate of unnecessary antibiotic prescriptions (Alumran, Hou, & Hurst, 2013;Clavenna & Bonati, 2011;Vodicka, et al, 2013). Within the preschool population, unnecessary antibiotics are most commonly prescribed for viral upper respiratory infections (URIs) (Clavenna & Bonati, 2011;Kutty, 2011).…”

“…There are multiple factors that cause concern regarding unnecessary antibiotic use, including complications related to antibiotic resistant bacteria, side effects of antibiotic use, and the possibility that antibiotics will become ineffective against bacteria. The overuse of antibiotics carries a large cost for health care (Alumran, Hou, & Hurst, 2013;Lowman & Bowden, 2010), with over one billion dollars spent annually in Canada on treatment of resistant bacteria alone (Outhwaite & Taylor, 2015).…”