Khare Shweta, Pathak Ashish, Stålsby Lundborg Cecilia, Diwan Vishal, Atkins Salla
Health Systems and Policy (HSP): Medicines, Focusing Antibiotics, Department of Global Public Health, Karolinska Institutet, Tomtebodavagen 18A, 171 77 Stockholm, Sweden.
Department of Public Health and Environment, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, Madhya Pradesh, India.
Antibiotics (Basel). 2022 Mar 29;11(4):459. doi: 10.3390/antibiotics11040459.
Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers that influence IHCPs' prescribing behaviour for common illnesses in children under five, with an emphasis on antibiotic use in rural areas of India. A total of 48 IHCPs participated in focus group discussions. Thematic framework analysis with an inductive approach was used, and findings were collated in the theoretical framework based on knowledge, attitude, and practice model which depicted that the decisions made by IHCPs while prescribing antibiotics are complex and influenced by a variety of external and internal drivers. IHCPs' internal drivers included the misconception that it is impossible to treat a patient without antibiotics and that antibiotics increase the effectiveness of other drugs and cure patients faster in order to retain them. Formal healthcare providers were the IHCPs' sources of information, which influences their antibiotic prescribing. We found when it comes to seeking healthcare in rural areas, the factors that influence their choice include 'rapid cure', 'cost of treatment', 'distance' and '24 h availability', instead of qualification, which may create pressure for IHCPs to provide a quick fix. Targeted and coordinated efforts at all levels will be needed to change the antibiotic prescribing practices of IHCPs with a focus on behaviour change and to help resolve misconceptions about antibiotics.
在全球范围内，抗生素耐药性是一个重大的公共卫生问题，抗生素的使用对此有很大影响。在资源有限的环境中，针对非正规医疗服务提供者（IHCPs）对于实现全民健康覆盖和有效的抗生素管理至关重要。因此，我们旨在分析影响IHCPs对五岁以下儿童常见疾病处方行为的内部和外部驱动因素，重点关注印度农村地区的抗生素使用情况。共有48名IHCPs参加了焦点小组讨论。采用了归纳法进行主题框架分析，并将研究结果整理在基于知识、态度和实践模型的理论框架中，该模型表明IHCPs在开具抗生素处方时所做的决定是复杂的，受到多种外部和内部驱动因素的影响。IHCPs的内部驱动因素包括一种误解，即没有抗生素就无法治疗患者，并且抗生素能提高其他药物的疗效并更快治愈患者以留住他们。正规医疗服务提供者是IHCPs的信息来源，这会影响他们的抗生素处方。我们发现，在农村地区寻求医疗服务时，影响他们选择的因素包括“快速治愈”“治疗费用”“距离”和“24小时可及性”，而不是资质，这可能给IHCPs带来提供快速解决方案的压力。需要在各级开展有针对性和协调性的努力，以改变IHCPs的抗生素处方行为，重点是行为改变，并帮助消除对抗生素的误解。
