Consumers' knowledge, attitude, and behavior towards antimicrobial resistance and antimicrobial use in food production in China

Abstract

BackgroundAntimicrobial resistance (AMR) can be induced by overuse or misuse of antimicrobials. Few researches were involved in consumers' knowledge and attitude toward antimicrobial use (AMU) in food production. This study was designed to investigate the knowledge and awareness, perception, and attitude of Chinese consumers toward AMU in food production. Their behavior, purchase intention of antimicrobial-free food products, and confidence in information sources were also investigated.MethodsAs a descriptive cross-sectional study, an online electronic survey questionnaire was conducted between February 25 and March 8, 2022, involving 1,065 consumers in China. Factor analysis was conducted to identify underlying patterns of the attitudes and information sources. Spearman correlations were employed to determine the relationship between knowledge, attitudes and the intention to pay extra. The differences in knowledge and attitudes were performed by independent t-test and one-way analysis of variance (ANOVA) test, and the difference in intention was performed by Chi-square test, when compared with demographic factors.ResultsThe findings showed that even though 75.0% of them heard of AMR, and 48.2% knew the definition of AMR, the level of consumers' knowledge of AMU in farming production and food regulations in China was not high (48.9% of participants replied correctly). About half viewed AMU and AMR as a potential risk to their health. Of these participants, 61.3% claimed that they were more likely looking for specific information about AMU on food packaging, and 58.3% changed their eating or cooking habits due to the concern. In addition, 79.8% were willing to pay extra for antimicrobial-free food products. Information sources from professionals and authorities were considered more accurate than those from media, the internet, word of mouth, and others.ConclusionsChinese consumers had insufficient knowledge and neutral attitudes about AMU in farming production and food regulations in China. A large proportion of the participants were willing to purchase antimicrobial-free food products. Most of them obtained related information from the media. This study highlighted the importance of updated education and effective communication with consumers in China. It helps to develop the reliable foodborne AMR surveillance system along food chain and improve government communication and consumer awareness.

Antimicrobial resistance research in Singapore – mapping current trends and future perspectives

“…In Japan, AMR awareness had not significantly changed despite WHO World Antimicrobial Awareness Week campaigns since 2015 [19]. Surveys conducted in Japan also showed continued misconceptions about antibiotics use [20], which was again echoed by a Chinese survey showing insufficient knowledge and neutral attitudes on AMR among consumers in the food sector [21]. Although culturally dissimilar, the similarities with a recent study on AMR knowledge and awareness among Singaporeans [22] demonstrated the need to improve AMR education.…”

Consumer Preferences and Attitudes towards Antibiotic Use in Food Animals

“…Data from other research [38] suggest that while US consumers are generally supportive of such labels, they are less willing to pay for them. Goddard [27] found that 9% of German and 15% of Canadian respondents indicated they would be willing to pay for reduced antibiotic use, while Ding et al [24] found that an astonishing 79.8% of Chinese respondents were willing to pay extra for products free from antibiotics. Whether such stated willingness would be repeated in making purchases remains a question.…”

“…Studies of consumers have highlighted their lack of knowledge and widespread misconceptions about the nature of antibiotic resistance and the multitude of potential pathways to resistance [10,11,21,22]. Nevertheless, AMR is widely perceived by consumers to be a potential threat to human health, e.g., in Chile [23], China [24], the USA [25,26], Italy [26], Germany [26,27], the UK [28], Canada [27,29] and the European Union [29]. Swiss consumers were generally not aware of any risks of AMR from food, having a high degree of trust that their food was safe, although expressing some concern about food from other countries [10]; however, this qualitative research was conducted using a very small sample of 14 consumers.…”

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“…Especially in recent years, due to easier access to media communication, Chinese people have increasing resistance to food additives and are reluctant to buy foods containing large amounts of additives; therefore, it is important to ensure the proper use of food additives and their production. 47 As necessary additives to foods for infants and young children, middle-aged and elderly people, and in certain efficacious foods, the use of nutritional fortification should be regulated. 48,49 Therefore, China has set strict requirements on the addition of vitamins, niacin, folic acid, pantothenic acid, inositol, biotin, choline, amino acids, functional peptides and minerals.…”

“…The national standard for food additives GB 2760‐2014 regulates the upper limit of additives such as colorants, flavor enhancers, emulsifiers, anti‐caking agents, coating agents, preservatives and sweeteners in food. Especially in recent years, due to easier access to media communication, Chinese people have increasing resistance to food additives and are reluctant to buy foods containing large amounts of additives; therefore, it is important to ensure the proper use of food additives and their production 47 . As necessary additives to foods for infants and young children, middle‐aged and elderly people, and in certain efficacious foods, the use of nutritional fortification should be regulated 48,49 .…”