Barriers and Facilitators to Appropriate Consumer Use of Antibiotics: What Do Community Members Know, Believe and Practice When It Comes to Antibiotic Use?

Background:

Increasing antibiotic resistance is a significant global health crisis. Without the proper use of antibiotics, many diseases may no longer be treatable leading to increased morbidity and mortality, and significant social and economic costs. The CDC estimates that at least two million illnesses and 23,000 deaths in the U.S. are caused by antibiotic resistant bacteria annually. Data do support the relationship between community consumption of antibiotics and the rise and emergence of new resistant strains, however, there is limited data on urban community knowledge, beliefs, and experiences with antibiotics. A multidisciplinary team of researchers sought to 1) improve understanding of consumers’ knowledge, perceptions and experiences regarding antibiotic use; 2) improve understanding of the role of perceived access to healthcare and communication between consumers and providers; and 3) identify information resources about antibiotics used by consumers and consumers’ trust in those resources.

Methods:

Utilizing a public health KABB model, 505 intercept surveys were conducted across six community-based and clinic sites. Residents were randomly selected for the study as they exited libraries, health clinics, human service organizations, and senior centers. Measures included self-rated health, use of antibiotics, knowledge of antibiotics with a composite knowledge measure of 18 true/false statements, an index of misbeliefs, 10-item inappropriate antibiotic behavior index, supportive communication scale and antibiotic information sources and healthcare utilization.

Results:

Data indicate that respondents generally knew that antibiotics should be used to treat bacterial infections, however a significant percentage of respondents also indicated that antibiotics are used to treat viral infections. Women and clinic populations had significantly greater antibiotic knowledge than men and community populations.  Those respondents with high blood pressure, diabetes and substance abuse have slightly lower knowledge scores. 

Approximately 84% of respondents reported filling their antibiotic prescriptions and 80% completed the prescribed dose, yielding approximately 20% of antibiotic prescriptions not being used appropriately by survey respondents. In addition, 29% stated that they can tell ‘by the way they feel’ whether they should use antibiotics and 43% regularly request antibiotics from their health provider.

Health providers are highly trusted in terms of information about antibiotics. However, over 40% respondents also trust family members and 30% trust the internet. Overall, respondents report good communication between themselves and their health provider. Over 37% of respondents self-treat when they are sick. There is evidence that poorer communication/relationship with a provider was found to be associated with greater inappropriate use behaviors.

Implications:

There continues to be significant misperceptions about appropriate use of antibiotics particularly in relation to use for viral infections.  The good news is that, respondents did report trust in their health providers and endorsed having good communication. Leveraging the patient/trusted health provider relationship provides a potential mechanism for medical social workers and others to educate consumers about antibiotic use.  In addition, employing marketing/educational messaging via the internet or technologically driven mechanisms is important to educate consumers about reliable health information sites (e.g., CDC) to ensure that they are receiving up-to-date accurate information.