Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis

Background Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use. Methods National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public’s KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model. Results Policies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden. Conclusions Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.

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Public knowledge, attitudes and practices related to antibiotic use and resistance in Singapore: a cross-sectional population survey

BMJ Open ◽

10.1136/bmjopen-2020-048157 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048157

Author(s):

Jane M Lim ◽

Minh Cam Duong ◽

Alex R Cook ◽

Li Yang Hsu ◽

Clarence C Tam

Keyword(s):

Antibiotic Resistance ◽

Public Awareness ◽

Action Plan ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Primary Care Doctor ◽

Public Knowledge ◽

Cross Sectional ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

ObjectivesThe WHO’s Global Action Plan on Antimicrobial Resistance (AMR) includes increasing overall public awareness of appropriate antibiotic use and resistance as a key priority area. We aimed to measure public knowledge, attitudes and practices of antibiotics and antibiotic resistance in Singapore, as well as their healthcare-seeking behaviours relating to respiratory illnesses, providing baseline data against which to measure the progress of future interventions.DesignA cross-sectional study.SettingThe general population in Singapore.ParticipantsBetween May and June 2019, we conducted a survey via an online panel in Singapore with 706 respondents.ResultsOur findings indicated common misconceptions surrounding antibiotic effectiveness and mechanisms of antibiotic resistance—most participants thought that resistance occurs when our bodies become resistant to antibiotics (62.5%) or when antibiotics become less powerful (48.5%). In multivariable analyses, better knowledge scores were associated with more favourable antibiotic attitudes (β=0.29; 95% CI 0.20 to 0.37). In addition, more favourable attitude scores were associated with lower odds of both expecting (OR: 0.84, 95% CI 0.72 to 0.99) and being prescribed antibiotics by a primary care doctor (OR: 0.76, 95% CI 0.63 to 0.90).ConclusionsThis study presents important information about population perceptions towards antibiotics and antibiotic resistance in Singapore. Results from this study emphasise the importance of effective public communication strategies to promote responsible antibiotic use locally and should be used to inform future implementation of programmes and activities as laid out in Singapore’s National Strategic Action Plan on AMR.

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Changes in the Framing of Antimicrobial Resistance in Print Media in Australia and the United Kingdom (2011–2020): A Comparative Qualitative Content and Trends Analysis

Antibiotics ◽

10.3390/antibiotics10121432 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1432

Author(s):

Chris Degeling ◽

Victoria Brookes ◽

Tarant Hill ◽

Julie Hall ◽

Anastacia Rowles ◽

...

Keyword(s):

United Kingdom ◽

Antimicrobial Resistance ◽

Scientific Discovery ◽

Public Awareness ◽

Media Framing ◽

Public Health Response ◽

Large Hospital ◽

The United Kingdom ◽

Health Response ◽

Community Outbreaks

Educating the public about antimicrobial resistance (AMR) is considered a key part of an optimal public health response. In both media depictions and policy discourses around health risks, how a problem is framed underpins public awareness and understanding, while also guiding opinions on what actions can and should be taken. Using a mixed methods approach we analyse newspaper content in Australia and the United Kingdom (UK) from 2011 to 2020 to track how causes, consequences and solutions to AMR are represented in countries with different policy approaches. Analyses demonstrate greater variability in the frames used in UK newspapers reflecting large hospital and community outbreaks and a sustained period of policy reform mid-decade. Newspapers in Australia focus more on AMR causes and consequences, highlighting the importance of scientific discovery, whereas UK coverage has greater discussion of the social and economic drivers of AMR and their associated solutions. Variations in the trends of different frames around AMR in UK newspapers indicate greater levels of public deliberation and debate around immediate and actionable solutions; whereas AMR has not had the same health and political impacts in Australia resulting in a media framing that potentially encourages greater public complacency about the issue.

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Knowledge, Attitudes and Practices of Veterinarians Towards Antimicrobial Resistance and Stewardship in Nigeria

Antibiotics ◽

10.3390/antibiotics9080453 ◽

2020 ◽

Vol 9 (8) ◽

pp. 453

Author(s):

Usman O. Adekanye ◽

Abel B. Ekiri ◽

Erika Galipó ◽

Abubakar Bala Muhammad ◽

Ana Mateus ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Online Survey ◽

Action Plan ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Health Concern ◽

Attitudes And Practices ◽

Laboratory Services ◽

Knowledge Attitudes And Practices

Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner’s inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.

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UK initiatives to reduce antimicrobial resistant infections, 2013-2018

International Journal of Health Governance ◽

10.1108/ijhg-02-2016-0013 ◽

2016 ◽

Vol 21 (3) ◽

pp. 131-138 ◽

Cited By ~ 4

Author(s):

Susan Hopkins

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Government Policy ◽

Design Methodology ◽

Antibiotic Use ◽

Content Type ◽

Uk Government ◽

The Many ◽

The Uk ◽

The Impact

Purpose – The purpose of this paper is to highlight the local, national and global actions from the UK to reduce the impact of antimicrobial resistance (AMR) on human health. Design/methodology/approach – Synthesis of UK government policy, surveillance and research on AMR. Findings – Activities that are taking place by the UK government, public health and professional organisations are highlighted. Originality/value – This paper describes the development and areas for action of the UK AMR strategy. It highlights the many interventions that are being delivered to reduce antibiotic use and antimicrobial resistant infections.

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A between-Species Comparison of Antimicrobial Resistance in Enterobacteria in Fecal Flora

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.44.6.1479-1484.2000 ◽

2000 ◽

Vol 44 (6) ◽

pp. 1479-1484 ◽

Cited By ~ 56

Author(s):

Monica Österblad ◽

Antti Hakanen ◽

Raija Manninen ◽

Tiina Leistevuo ◽

Reijo Peltonen ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Length Of Hospital Stay ◽

Antibiotic Use ◽

University Hospital ◽

Fecal Flora ◽

E Coli ◽

Defined Daily Doses ◽

Hospital Patients ◽

Resistance Patterns ◽

Resistance Data

ABSTRACT Enterobacteria in fecal flora are often reported to be highly resistant. Escherichia coli is the main species; resistance data on other species are rare. To assess the effect of the host's environment, antimicrobial resistance was determined in fecal species of the family Enterobacteriaceae from three populations: healthy people (HP)(n = 125) with no exposure to antimicrobials for 3 months preceding sampling, university hospital patients (UP) (n = 159) from wards where the antibiotic use was 112 defined daily doses (DDD)/bed/month, and geriatric long-term patients (LTP) (n = 74) who used 1.8 DDD/bed/month. The mean length of hospital stay was 5 days for the UP and 22 months for the LTP. The isolates were identified to at least genus level, and MICs of 16 antimicrobials were determined. From the university hospital, resistance data on clinicalEnterobacteriaceae isolates were also collected. Resistance data for on average two different isolates per sample (range, 1 to 5) were analyzed: 471 E. coli isolates and 261 otherEnterobacteriaceae spp. Resistance was mainly found amongE. coli; even in HP, 18% of E. coli isolates were resistant to two or more antimicrobial groups, with MIC patterns indicative of transferable resistance. Other fecal enterobacteria were generally susceptible, with little typically transferable multiresistance. Clinical Klebsiella andEnterobacter isolates were significantly more resistant than fecal isolates. The resistance patterns at both hospitals mirrored the patterns of antibiotic use, but LTP E. coli isolates were significantly more resistant than those from UP. Conditions permitting an efficient spread may have been more important in sustaining high resistance levels in the LTP. E. coli was the main carrier of antimicrobial resistance in fecal flora; resistance in other species was rare in the absence of antimicrobial selection.

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Changes in public knowledge and perceptions about antibiotic use and resistance in Jordan: a cross-sectional eight-year comparative study

BMC Public Health ◽

10.1186/s12889-021-10723-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Suzanne Abdelmalek ◽

Rowan AlEjielat ◽

Walid Abu Rayyan ◽

Nidal Qinna ◽

Dana Darwish

Keyword(s):

Multiple Testing ◽

Public Awareness ◽

Age Groups ◽

Antibiotic Use ◽

Public Knowledge ◽

Snowball Sampling ◽

Self Medication ◽

Chi Square ◽

Cross Sectional ◽

Social Settings

Abstract Background Resistance to antibiotics is a growing problem, worldwide and particularly in developing countries like Jordan. Raising public awareness on appropriate antibiotic use is crucial to combat this problem. The current study describes the change in public Knowledge and attitudes towards the use of antibiotics over a period of 8 years. Methods Two cross-sectional studies were performed 8 years apart on Jordanians of different age groups, and social settings, residing in Amman, Jordan. Convenience non-probability sampling techniques were used. In 2010, a questionnaire was distributed in paper form, whereas in 2018 snowball sampling was used to disseminate an identical electronic questionnaire. Chi-square test and post hoc analysis were done using the z-test to compare column proportions, adjustment for multiple testing using the Bonferroni method. Multiple logistic regression was used to adjust for case mix for each survey. Comparisons were made across the two studies and within each study. Results A total of 711 participants in 2010 and 436 participants in 2018 were surveyed. Over the 8-year period, there was a significant improvement in the beliefs regarding the use of antibiotics such as disagreeing to keeping left over antibiotics for later use from 57 to 70% (p < 0.05) and disagreeing to buying antibiotics without physicians’ consent increased from 80 to 89% (P value < 0.001). There was no significant change in the beliefs that support self-medication such as: using antibiotics from a friend (72 to 77%) buying antibiotics without a prescription (42 to 45%), and getting information about medication use from leaflet without referring to a health care professional (60 to 63%). There were some areas of confusion regarding antibiotic range of effectiveness, and origin of resistance. Agreement about antibiotic resistance being a problem in Jordan increased significantly from 44 to 60% (p < 0.001). In addition, there was a significant increase in the percentage of participants who said that they don’t request antibiotics from physicians (56 to 75% (P ≤ 0.001) and who said they would trust physicians’ decisions about the necessity of antibiotics (70 to 83% P < 0.05). Conclusion Findings indicate the need for better suited, and more inclusive, public educational campaigns.

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Food supply chains and the antimicrobial resistance challenge: On the framing, accomplishments and limitations of corporate responsibility

Environment and Planning A Economy and Space ◽

10.1177/0308518x211015255 ◽

2021 ◽

pp. 0308518X2110152

Author(s):

Alex Hughes ◽

Emma Roe ◽

Suzanne Hocknell

Keyword(s):

Supply Chain ◽

Antimicrobial Resistance ◽

Supply Chains ◽

Value Chain ◽

Food System ◽

Antibiotic Use ◽

Wicked Problem ◽

Meat Production ◽

Drug Resistant ◽

The Uk

This paper presents a critique of supply chain responses to a particular global wicked problem – antimicrobial resistance (AMR). It evaluates the understanding of AMR (and drug-resistant infections) as a food system challenge and critically explores how responsibility for addressing it is framed and implemented. We place the spotlight on the AMR strategies applied in UK retailers’ domestic poultry and pork supply chains. This provides a timely analysis of corporate engagement with AMR in light of the 2016 O’Neill report on Tackling Drug Resistant Infections Globally, which positioned supermarket chains, processors, and regulators as holding key responsibilities. Research included interviews with retailers, industry bodies, policy makers, farmers, processors, consultants and campaigners. We evaluate how strategy for tackling AMR in the food system is focused on antimicrobial stewardship, particularly targets for reducing antibiotic use in domestic food production. The global value chain notion of multipolar governance, where influence derives from multiple nodes both inside and outside the supply chain, is blended with more-than-human assemblage perspectives to capture the implementation of targets. This conceptual fusion grasps how supply chain responsibility and influence works through both a distributed group of stakeholders and the ecological complexity of the AMR challenge. The paper demonstrates in turn: how the targets for reducing antibiotic use in domestic meat production represent a particular and narrowly defined strategic focus; how those targets have been met through distributed agency in the UK supply chain; and the geographical and biological limitations of the targets in tackling AMR as a wicked problem.

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Does gonorrhoea screening intensity play a role in the early selection of antimicrobial resistance in men who have sex with men (MSM)? A comparative study of Belgium and the United Kingdom

F1000Research ◽

10.12688/f1000research.14869.2 ◽

2018 ◽

Vol 7 ◽

pp. 569 ◽

Cited By ~ 5

Author(s):

Chris R. Kenyon ◽

Irith De Baetselier ◽

Tania Crucitti

Keyword(s):

United Kingdom ◽

Antimicrobial Resistance ◽

The United States ◽

National Surveillance ◽

Surveillance Programme ◽

The Past ◽

The United Kingdom ◽

Sex With Men ◽

The Uk ◽

Selection Of

Background: It is unclear why antimicrobial resistance in Neisseria gonorrhoeae in the United Kingdom (UK) and the United States has tended to first appear in men who have sex with men (MSM). We hypothesize that increased exposure to antimicrobials from intensive STI screening programmes plays a role. Methods: We assess if there is a difference in the distribution of azithromycin, cefixime and ceftriaxone minimum inhibitory concentrations (MICs) between MSM and women in the United Kingdom (UK) where 70% of MSM report STI screening in the past year vs. Belgium where 9% report STI screening in the past year. Our hypothesis is that MICs of the MSM should be higher than those of the women in the UK but not Belgium. Data for the MICs were taken from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in the UK in 2010/2011 and 2014 and a similar national surveillance programme in Belgium in 2013/2014 (the first most complete available data). We used the Mann–Whitney test to compare the MIC distributions between MSM and women within each country Results: In the UK the MICs for all three antimicrobials were significantly higher in MSM than women at both time points (P all <0.0005). In Belgium only the MIC distribution for azithromycin was higher in MSM (P<0.0005). Conclusion: The findings for cefixime and ceftriaxone, but not azithromycin are compatible with our hypothesis that screening-intensity could contribute to the emergence of AMR. Numerous other interpretations of our results are discussed.

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Antibiotic Consumption and Knowledge of Antimicrobial Resistance: Online Survey

10.20944/preprints202005.0362.v1 ◽

2020 ◽

Author(s):

Nurul Shaheera Shahpawee ◽

Li Ling Chaw ◽

Siti Hanna Muharram ◽

Poh Hui Goh ◽

Zahid Hussain ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Internal Consistency ◽

Online Survey ◽

Public Awareness ◽

Antibiotic Use ◽

Antibiotic Usage ◽

The Body ◽

World Health ◽

Brunei Darussalam

Background: Public misconception and demand for the indication of antibiotics could lead to inappropriate prescribing and consumption. Successful treatment can only be achieved when the public and industrial users have knowledge on antibiotic use and resistance. This survey is aimed to assess antibiotic usage and knowledge regarding antibiotics and antimicrobial resistance (AMR) among undergraduate students of Universiti Brunei Darussalam (UBD), public university located in Brunei Darussalam. Methods: A cross-sectional study was performed using a self-administered questionnaire. The questionnaire was adapted from the World Health Organization (WHO) Antibiotic Resistance, Multi-country public awareness survey distributed online. Students at UBD were invited to participate in the online survey through internal email. The questionnaire consisted of 5 sections: demographic information, antibiotic usage, knowledge on antibiotics, antibiotic resistance (AMR) and use of antibiotics in agriculture. Data were analyzed descriptively and appropriate inferential statistics was used accordingly. Cronbach’s alpha was also done to determine the internal consistency. The section on antibiotic use and knowledge showed good internal consistency of Cronbach’s alpha 0.66 and 0.86 respectively. Research ethics approval was obtained from the PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam (UBD). Results: A total of 145 students returned the complete questionnaire. The result of the study found that 50% of the students had good level of knowledge of antibiotic and antimicrobial resistance with a mean total knowledge score of 11.4 out of 14. Respondents reported the use of antibiotic in the past (69%). Many of the students could identify the use of antibiotics for the treatment of bacterial infection. However, there were also students who incorrectly thought that antibiotics can be used for cold and flu (43%) and fever (41%). Moreover, 76% of the respondents mistakenly believed that antibiotic resistance is the result of the body becoming resistant to antibiotics. Only 12% of the respondents were found to have poor knowledge in the study. Conclusions: Misconceptions in regards to the use of antibiotics for conditions related to viral illnesses was noticed among the respondents in our study. Thus, improving knowledge on antibiotics is crucial to address those beliefs.

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Using Weibo and WeChat social media channels to assess public awareness and practices related to antimicrobial resistance, China, 2019

BMC Public Health ◽

10.1186/s12889-021-10648-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lei Wang ◽

Sujian Situ ◽

Jeanette J. Rainey ◽

Bin He ◽

Xiaoge Su ◽

...

Keyword(s):

Social Media ◽

Antimicrobial Resistance ◽

Text Messaging ◽

Bacterial Infections ◽

Online Survey ◽

Viral Infections ◽

Public Awareness ◽

Antibiotic Use ◽

Tract Infections ◽

Media Channels

Abstract Background Antimicrobial resistance (AMR) is a global healthcare problem, including in China where high rates of resistance to common bacterial infections have been documented. In 2016, the National Health and Family Planning Commission (NHFPC) in China established a comprehensive strategic plan to increase awareness about AMR through education programs. Methods We conducted an online survey to assess changes in public knowledge, awareness and practices related to AMR in China since 2016. The survey was administered using China’s national and provincial level 12320 Health Hotline Weibo (micro-blog site) and WeChat (text messaging service) social media accounts from April 12, 2019 to May 7, 2019. All persons ≥16 years of age able to read Chinese were eligible to participate. Results A total of 2773 respondents completed the survey. Of the 2633 respondents indicating recent use of antibiotics, 84% (2223) reported obtaining their course of antibiotics from a hospital or pharmacy, 9% (246) of respondents reported using antibiotics saved from a previous prescription or treatment course, and 42% (1115) of respondents reported that they had stopped taking antibiotics as soon as they started feeling better. Most respondents correctly indicated that antibiotics can effectively treat urinary tract infections (86% [2388]) and skin infections (76% [2119]), but many incorrectly indicated that antibiotics can also treat viral infections such as measles (32% [889]) or a cold or flu (26% [726]). Of all respondents, 95% (2634) had heard of ‘antibiotic resistance’. Almost half (47% [1315]) reported using antibiotics within the last 6 months. Conclusion While awareness of AMR was high in this survey of social media users in China, inappropriate antibiotic use remains common, including the believe that antibiotics can effectively treat viral infections. Multiple interventions targeting the correct use of antibiotics and information on the cause AMR are likely needed. The 12320 Health Hotline provides a platform for conducting routine surveys to monitor antibiotic use and knowledge about AMR.

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