Towards a better understanding of patients' perspectives of antibiotic resistance and MRSA: a qualitative study

Abstract

Many primary care patients are unaware of what antibiotic resistance is and how it arises. The causes of, and responsibility for, antibiotic resistance are usually attributed to external rather than personal factors and patients perceive that its solutions are outside of their control.

‘The Body Gets Used to Them’: Patients’ Interpretations of Antibiotic Resistance and the Implications for Containment Strategies

“…35 Our study builds on Brooks and colleagues and Hawkings and colleagues findings to confirm that patient interpretations of the term antibiotic resistance are often at odds with scientific understanding, and this is commonplace across Europe. 3,4 Previous research in this area is limited. Gould and colleagues examined patients' and public knowledge, sources of information and perceptions about healthcare-associated infection but did not address the issue of patients understanding of antibiotic resistance.…”

“…3 In line with UK based research, interviewees in our European study already connected antibiotic resistance with antibiotic overuse. 3,4 The concept of the resistance as a property of organisms selected out by antibiotics and transferred between organisms and people was far less commonly understood. This is unsurprising given that Huttner and colleagues' review of 22 large-scale public campaigns in high-income countries indicate that only nine dealt with transferability by advocating hand-washing to prevent the spread of organisms but still did not explicitly link this with the transfer of resistant organisms and antibiotic resistance.…”

“…[3][4][5][6] There have been public campaigns in many European countries promoting appropriate antibiotic prescription and use with mixed results. 7 Formal evaluations of some campaigns suggest that they contributed to more careful antibiotic use, especially in high antibiotic prescribing countries.…”

“…[8][9][10] However, two recent studies noted that patients have two different, perhaps overlapping, understandings of antibiotic resistance -that of resistance in the body versus the scientifically 'correct' understanding of resistance in bacteria. 3,4 Research into the public perception of antibiotic resistance has been undertaken largely without an awareness of multiple interpretations of the term 'antibiotic resistance'. 11,12 For example, surveys examining patients' attitudes have used fixed questions with little or no opportunity for follow-up of patients' views or understanding.…”

“…Although two recent qualitative studies have explored patient and public attitudes towards antibiotic resistance, they were limited to the United Kingdom, and the wider implications were not considered in depth. 3,4 To our knowledge, there have been no in-depth international qualitative studies that have examined patients' interpretations of the concept and given an impression of the extent to which the different understandings of resistance occur, and indeed to what extent interpretations differ by country. Acute cough is one of the commonest reasons for seeking health care, and although studies have shown little or no benefit from antibiotic treatment in otherwise well people [18][19][20] , patients continue to expect antibiotics and clinicians continue to prescribe them for this condition.…”