抗生素与活动空间：一项关于行为、边缘化和知识传播的探索性研究方案
Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion.
作者信息
Haenssgen Marco J, Charoenboon Nutcha, Zanello Giacomo, Mayxay Mayfong, Reed-Tsochas Felix, Jones Caroline O H, Kosaikanont Romyen, Praphattong Pollavat, Manohan Pathompong, Lubell Yoel, Newton Paul N, Keomany Sommay, Wertheim Heiman F L, Lienert Jeffrey, Xayavong Thipphaphone, Warapikuptanun Penporn, Khine Zaw Yuzana, U-Thong Patchapoom, Benjaroon Patipat, Sangkham Narinnira, Wibunjak Kanokporn, Chai-In Poowadon, Chailert Sirirat, Thavethanutthanawin Patthanan, Promsutt Krittanon, Thepkhamkong Amphayvone, Sithongdeng Nicksan, Keovilayvanh Maipheth, Khamsoukthavong Nid, Phanthasomchit Phaengnitta, Phanthavong Chanthasone, Boualaiseng Somsanith, Vongsavang Souksakhone, Greer Rachel C, Althaus Thomas, Nedsuwan Supalert, Intralawan Daranee, Wangrangsimakul Tri, Limmathurotsakul Direk, Ariana Proochista
机构信息
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK.
出版信息
BMJ Glob Health. 2018 Mar 28;3(2):e000621. doi: 10.1136/bmjgh-2017-000621. eCollection 2018.
BACKGROUND
Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people's antibiotic-related health behaviour through three research questions.RQ1: What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways?RQ2: Will people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices?RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?
METHODS
We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1-3), social network analysis (RQ2) and latent class analysis (RQ3).
DISCUSSION
Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour.
TRIAL REGISTRATION NUMBER
NCT03241316; Pre-results.
背景
抗菌药物耐药性（AMR）是全球卫生领域的优先事项。英国及全球领先的应对AMR的战略文件认识到其社会和行为层面，但当前旨在改善抗菌药物（如抗生素）合理使用的政策措施仅限于教育和提高认识活动。针对这种方法在概念、方法和实证方面的不足，我们通过三个研究问题来研究人们与抗生素相关的健康行为。研究问题1：患者就医过程中存在问题的抗生素使用的表现形式和决定因素是什么？研究问题2：人们接触抗生素意识活动是否会导致行为改变，并在相互竞争的医疗行为网络中传播或消散？研究问题3：哪些替代指标有助于在社区内部和社区之间检测出存在问题的抗生素行为？
方法
我们应用了一个跨学科分析框架，该框架借鉴了公共卫生、医学人类学、社会学和发展经济学文献。我们的研究包括对泰国北部（清莱）和老挝南部（沙拉湾）农村居民寻求治疗行为的社会调查。我们对约4800名成年人进行抽样，以生成地区层面具有代表性的社会网络数据。另外60次认知访谈有助于调查问卷的开发和数据解读。我们的调查数据分析技术包括事件序列分析（研究问题1）、多层回归分析（研究问题1 - 3）、社会网络分析（研究问题2）和潜在类别分析（研究问题3）。
讨论
AMR领域的社会研究尚处于起步阶段，但我们关于微观层面就医行为的前所未有的详细数据有助于理解超越意识和自由选择的行为，例如突出决策限制、边缘化问题、获得医疗服务的困难以及关于理想行为的相互冲突的观念。
试验注册号
NCT03241316；预结果。
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