Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions

Abstract

BackgroundHigh consumption of antibiotics has been identified as an important driver for the increasing antibiotic resistance, considered to be one of the greatest threats to public health globally. Simply informing the public about this consequence is insufficient to induce behavioral change. This study explored beliefs and perceptions among Swedes, with the aim of identifying factors promoting and hindering a judicious approach to antibiotics use. The study focused primarily on the medical use of antibiotics, also considering other aspects connected with antibiotic resistance, such as travelling and food consumption.MethodsData were collected through focus group discussions at the end of 2016. Twenty-three Swedes were recruited using an area-based approach and purposive sampling, aiming for as heterogeneous groups as possible regarding gender (13 women, 10 men), age (range 20–81, mean 38), and education level. Interview transcripts were analyzed using qualitative content analysis. The Health Belief Model was used as a theoretical framework.ResultsAntibiotic resistance was identified by participants as a health threat with the potential for terrible consequences. The severity of the problem was perceived more strongly than the actual likelihood of being affected by it. Metaphors such as climate change were abundantly employed to describe antibiotic resistance as a slowly emerging problem. There was a tension between individual (egoistic) and collective (altruistic) reasons for engaging in judicious behavior. The individual effort needed and antibiotics overprescribing were considered major barriers to such behavior. In their discussions, participants stressed the need for empowerment, achieved through good health communication from authorities and family physicians.ConclusionsKnowledge about antibiotic consumption and resistance, as well as values such as altruism and trust in the health care system, has significant influence on both perceptions of individual responsibility and on behavior. This suggests that these factors should be emphasized in health education and health promotion. To instead frame antibiotic resistance as a slowly emerging disaster, risks diminish the public perception of being susceptible to it.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6047-8) contains supplementary material, which is available to authorized users.

‘Always take your doctor’s advice’: Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations?

“…First, prior research suggests that the level of trust people have in someone can explain why some people are more persuasive than others (Glaeser & Sunstein 2013; Pornpitakpan, 2004; Tormala et al , 2006) and, more importantly, why some patients are more likely to report adhering to their physicians’ instructions than others (Freburger et al , 2003; Safran et al , 1998). Second, population‐level surveys and qualitative interviews have proffered that public trust in physicians plays a key role in whether they will accept their physician’s antibiotic prescribing decision (Ancillotti et al , 2018; André et al , 2010; Brookes‐Howell et al , 2014; Faber et al , 2010).…”

“…Indeed, evidence indicates that more trustworthy sources are more persuasive (Glaeser & Sunstein 2013; Pornpitakpan, 2004; Tormala, Brinol, & Petty, 2006). Thus, prompting patients to trust their physicians might lead to greater acceptance of the information provided by physicians (Ancillotti et al , 2018; André, Vernby, Berg, & Lundborg, 2010; Brookes‐Howell et al , 2014), which in turn might lead to a greater effect of information provision at reducing inappropriate antibiotic expectations from primary care patients.…”

“…Faber, Heckenbach, Velasco, and Eckmanns (2010) noted that, in Germany, respondents who did not trust their physicians’ prescribing decisions not only admitted that they would not accept the decision, but would attempt to convince the physician to give them antibiotics anyway or go and visit another physician who would. Interviews with patients also report that trust appears to be a key factor in whether they accept their physicians’ antibiotic prescribing decisions (Ancillotti et al , 2018; Brookes‐Howell et al , 2014).…”

Action bias in the public’s clinically inappropriate expectations for antibiotics.

“…information provision may be necessary, it is not sufficient to convince patients that antibiotics are not always helpful (Ancillotti et al, 2018;van Rijn, Haverkate, Achterberg, & Timen, 2019). Hence, researchers have recently been encouraged to consider other factors that might also be important drivers of inappropriate desires for antibiotics (Donald, 2016).…”

Are antibiotics substandard in Lebanon? Quantification of active pharmaceutical ingredients between brand and generics of selected antibiotics

“…It is a type of drug resistance, where survival of usually sensitive bacteria, is observed after exposure to the antibiotic. This change in definitive survival is accelerated on the basis of factors related to human practices, with subsequent resistance selectivity in animals, humans and the environment [10]. Many theories have been put forward to explain the reason for this substantial increase in multiple pathogenic bacterial strains and their inevitable resistance to antibiotics worldwide, such as antibiotic misuse, antibiotic resistance and related treatment failures, in addition to poor quality of available medicines in developing countries (substandard drugs) with inadequate compliance with manufacturing practices, and lack of proper quality control [11].…”