Deschepper Reginald, Grigoryan Larissa, Lundborg Cecilia Stålsby, Hofstede Geert, Cohen Joachim, Kelen Greta Van Der, Deliens Luc, Haaijer-Ruskamp Flora M
Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
BMC Health Serv Res. 2008 Jun 6;8:123. doi: 10.1186/1472-6963-8-123.
Antibiotics are widely-used medicines for which a more prudent use has been advocated to minimize development of resistance. There are considerable cross-national differences that can only partially be explained by epidemiological difference and variations in health care structure. The aim of this study was to explore whether cross-national differences in use of antibiotics (prescribed and non-prescribed) are associated with differences between national cultures as described in Hofstede's model of cultural dimensions (Power Distance, Individualism, Masculinity, Uncertainty Avoidance and Long-Term Orientation).
Country-level data of prescribed antibiotic use and self-medication with antibiotics were correlated to country-specific scores of cultural dimensions obtained from Hofstede. Data on use of antibiotics were provided by three European studies, based on different methods and/or countries: Self-medication with Antibiotics and Resistance in Europe (SAR), based on a survey in 2003 on reported use of antibiotics in 19 countries, the European Surveillance on Antimicrobial Consumption, based on distribution and reimbursement of antibiotics in ambulatory care (1997-2002), and the 2002 interview-based Eurobarometer study, asking whether respondents had taken antibiotics in the previous 12 months. These studies provided data on antibiotics use for 27 European countries in total, for which scores of cultural dimensions were also available. The SAR-study differentiated between prescribed antibiotics and self-medication with antibiotics.
Significant positive correlations were found for Power Distance Index with use of prescribed antibiotics in the three studies (rho between 0.59 and 0.62) and with self-medication (rho = 0.54) in the SAR study. Positive significant correlations were found for the Uncertainty Avoidance Index with the use of antibiotics as reported in two studies (rho between 0.57 and 0.59; for the SAR study the correlations were insignificant). Masculinity was not significantly correlated, except in one study after controlling for GDP (r = 0.81). For Individualism and Long-Term Orientation no significant correlations were found.
Power Distance is a cultural aspect associated with antibiotic use, suggesting that the culture-specific way people deal with authority is an important factor in explaining cross-national differences in antibiotic use. There are indications that Uncertainty Avoidance also plays a role but further research is needed to better understand the complex effect of cultural dimensions.
抗生素是广泛使用的药物，人们主张更谨慎地使用抗生素以尽量减少耐药性的产生。存在相当大的跨国差异，而流行病学差异和医疗保健结构的变化只能部分解释这些差异。本研究的目的是探讨抗生素使用（处方和非处方）的跨国差异是否与霍夫斯泰德文化维度模型（权力距离、个人主义、男性气质、不确定性规避和长期导向）所描述的国家文化差异相关。
将各国抗生素处方使用和抗生素自我药疗的数据与从霍夫斯泰德获得的特定国家文化维度得分进行关联。抗生素使用数据由三项欧洲研究提供，这些研究基于不同的方法和/或国家：欧洲抗生素自我药疗与耐药性研究（SAR），基于2003年对19个国家抗生素报告使用情况的调查；欧洲抗菌药物消费监测，基于门诊护理中抗生素的分发和报销情况（1997 - 2002年）；以及2002年基于访谈的欧洲晴雨表研究，询问受访者在过去12个月内是否服用过抗生素。这些研究总共提供了27个欧洲国家的抗生素使用数据，同时也有这些国家的文化维度得分。SAR研究区分了处方抗生素和抗生素自我药疗。
在三项研究中，权力距离指数与处方抗生素的使用之间存在显著正相关（相关系数在0.59至0.62之间），在SAR研究中与自我药疗也存在显著正相关（相关系数 = 0.54）。在两项研究中，不确定性规避指数与抗生素的使用存在显著正相关（相关系数在0.57至0.59之间；在SAR研究中相关性不显著）。除了在一项控制国内生产总值后的研究中（相关系数 = 0.81），男性气质没有显著相关性。对于个人主义和长期导向，未发现显著相关性。
权力距离是与抗生素使用相关的一个文化方面，这表明人们处理权威的特定文化方式是解释抗生素使用跨国差异的一个重要因素。有迹象表明不确定性规避也起作用，但需要进一步研究以更好地理解文化维度的复杂影响。
