Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China
Abstract
:1. Introduction
2. Participants and Methods
2.1. Settings
2.2. Theoretical Framework
- Complacency: prescribing antibiotics to satisfy patient demands and expectations;
- Fear: prescribing antibiotics for fear of losing patients or losing in potential disputes with patients;
- Ignorance: a lack of concern in relation to antibiotic resistance resulting from over-prescriptions of antibiotics;
- Indifference: a lack of motivation to change antibiotic prescribing practices; and
- Responsibility avoidance: a belief that others (patients, governments and other professionals) are responsible for the problem of antibiotic resistance.
2.3. Survey Instruments
2.4. Sampling and Data Collection
2.5. Data Analysis
3. Results
3.1. Characteristics of Respondents
3.2. Knowledge, Attitudes, and Behavioral Intentions Toward Antibiotic Prescriptions
3.3. Associations between Knowledge, Attitudes, and Behavioral Intentions
4. Discussion
4.1. Knowledge
4.2. Attitudes
4.3. Policy Implications
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
List of Abbreviations
References
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Characteristics | Mean ± SD */N (%) |
---|---|
Age (years) | 43.27 ± 10.43 |
Gender | |
Male | 436 (69.76) |
Female | 189 (30.24) |
Facility | |
Urban community health center | 137 (21.92) |
Rural township health center | 488 (78.08) |
Medical sub-specialization | |
General practitioner | 264 (42.24) |
Internist/pediatrician | 154 (24.64) |
Surgeon | 77 (12.32) |
Gynecologist | 87 (13.92) |
Chinese medical practitioner | 43 (6.88) |
Professional title | |
Junior doctor | 324 (51.84) |
Attending doctor | 236 (37.76) |
Associate senior or senior consultant | 65 (10.40) |
Level of education | |
Vocational training | 51 (8.16) |
Associate degree | 329 (52.64) |
University degree | 245 (39.20) |
Annual household income (Chinese RMB ¥) | |
<40,000 | 169 (27.04) |
40,000~ | 305 (48.80) |
80,000~ | 107 (17.12) |
≥120,000 | 44 (7.04) |
Clinical experience (years) | 16.64 ± 11.11 |
Training about antibiotics over the last year | |
Yes | 477 (76.32) |
No/Not aware | 148 (23.68) |
Knowledge Questions | Number (Percentage) of Respondents Giving a Correct Answer | p *-Value | |||||
---|---|---|---|---|---|---|---|
Total n = 625 | General Practitioner n = 264 | Internist/Pediatrician n = 154 | Surgeon n = 77 | Gynecologist n = 87 | Chinese Medical Practitioner n = 43 | ||
Antibiotics should not be prescribed for non-febrile diarrhea | 591 (94.56) | 253 (95.83) | 149 (96.75) | 70 (90.91) | 84 (96.55) | 39 (90.70) | 0.171 |
Antibiotics should not be prescribed for upper respiratory tract infections | 36 (5.76) | 15 (5.68) | 9 (5.84) | 5 (6.49) | 5 (5.75) | 2 (4.65) | 0.998 |
Dosage reduction of antibiotics is needed for renal failure | 64 (10.24) | 21 (7.95) | 11 (7.14) | 12 (15.58) | 17 (19.54) | 3 (6.98) | 0.011 |
Amoxicillin is a safe antibiotic product for pregnant patients | 596 (95.36) | 254 (96.21) | 148 (96.10) | 72 (93.51) | 87 (100.00) | 35 (81.40) | <0.001 |
Metronidazole has the best activity against anaerobes | 601 (96.16) | 261 (98.86) | 150 (97.40) | 73 (94.81) | 80 (91.95) | 37 (86.05) | <0.001 |
Methicillin resistant staphylococcus aureus is resistant to beta- lactam antibiotics | 182 (29.12) | 86 (32.58) | 49 (31.81) | 13 (16.88) | 19 (21.84) | 15 (34.88) | 0.027 |
Ceftriaxone most effectively crosses the blood-brain barrier | 246 (39.36) | 120 (45.45) | 53 (34.41) | 27 (35.07) | 33 (37.93) | 13 (30.23) | 0.102 |
Aminoglycosides are very active if they are administered as parenteral once daily | 286 (45.76) | 126 (47.73) | 66 (42.85) | 36 (46.75) | 43 (49.43) | 15 (34.88) | 0.483 |
Bacterial pneumonia (including one of the following symptoms: fast breathing, chest in-drawing or stridor) requires antibiotic treatment | 311 (49.76) | 145 (54.92) | 83 (53.89) | 33 (42.86) | 33 (37.93) | 17 (39.53) | 0.017 |
Antibiotics do not reduce the duration and the occurrence of complications of upper respiratory tract infections | 380 (60.80) | 177 (67.05) | 113 (73.37) | 35 (45.45) | 36 (41.38) | 19 (44.19) | <0.001 |
The average number of patients taking antibiotics should be below 30 per 100 in a primary care facility | 478 (76.48) | 218 (82.58) | 119 (77.27) | 51 (66.23) | 57 (65.52) | 33 (76.74) | <0.001 |
Overall score (mean ± SD) | 6.04 ± 1.46 | 6.34 ± 1.36 | 6.16 ± 1.43 | 5.55 ± 1.53 | 5.68 ± 1.34 | 5.30 ± 1.70 | <0.001 |
Measurement | Scores (Mean ± SD) | p * | Cronbach’s Alpha | |||||
---|---|---|---|---|---|---|---|---|
Total n = 625 | General Practitioner n = 264 | Internist/Pediatrician n = 154 | Surgeon n = 77 | Gynecologist n = 8 7 | Chinese Medical Practitioner n = 43 | |||
Attitude | ||||||||
Complacency | 1.29 ± 0.65 | 1.26 ± 0.65 | 1.30 ± 0.68 | 1.22 ± 0.69 | 1.41 ± 0.56 | 1.36 ± 0.69 | 0.173 | 0.912 |
Fear | 1.11 ± 0.63 | 1.07 ± 0.64 | 1.09 ± 0.64 | 1.00 ± 0.62 | 1.31 ± 0.54 | 1.27 ± 0.67 | 0.002 | 0.797 |
Ignorance | 1.28 ± 0.43 | 1.32 ± 0.44 | 1.24 ± 0.42 | 1.21 ± 0.41 | 1.26 ± 0.38 | 1.27 ± 0.57 | 0.140 | 0.694 |
Indifference | −0.29 ± 0.70 | −0.29 ± 0.70 | −0.27 ± 0.67 | −0.32 ± 0.77 | −0.36 ± 0.64 | −0.22 ± 0.74 | 0.775 | 0.669 |
Responsibility avoidance | −1.15 ± 0.45 | −1.22 ± 0.45 | −1.19 ± 0.46 | −1.15 ± 0.46 | −1.14 ± 0.39 | −1.17 ± 0.48 | 0.286 | 0.385 |
Behavioral intention | ||||||||
Prescribe antibiotics for upper respiratory tract infections | 3.98 ± 2.21 | 3.94 ± 2.09 | 3.86 ± 2.28 | 4.58 ± 2.57 | 3.92 ± 2.14 | 3.65 ± 2.02 | 0.221 | N/A |
Prescribe antibiotics | 0.86 ± 0.63 | 0.84 ± 0.61 | 0.83 ± 0.62 | 0.86 ± 0.73 | 0.95 ± 0.59 | 0.86 ± 0.67 | 0.761 | 0.898 |
Reduce antibiotic prescriptions | 1.29 ± 0.54 | 1.31 ± 0.52 | 1.24 ± 0.55 | 1.30 ± 0.54 | 1.36 ± 0.50 | 1.22 ± 0.64 | 0.694 | 0.893 |
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Liu, C.; Liu, C.; Wang, D.; Zhang, X. Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China. Int. J. Environ. Res. Public Health 2019, 16, 2385. https://doi.org/10.3390/ijerph16132385
Liu C, Liu C, Wang D, Zhang X. Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China. International Journal of Environmental Research and Public Health. 2019; 16(13):2385. https://doi.org/10.3390/ijerph16132385
Chicago/Turabian StyleLiu, Chenxi, Chaojie Liu, Dan Wang, and Xinping Zhang. 2019. "Knowledge, Attitudes and Intentions to Prescribe Antibiotics: A Structural Equation Modeling Study of Primary Care Institutions in Hubei, China" International Journal of Environmental Research and Public Health 16, no. 13: 2385. https://doi.org/10.3390/ijerph16132385