Social Innovation on Drug Resistance, Boston University, Boston, Massachusetts.
Department of Biomedical Engineering, College of Engineering, Boston University, Boston, Massachusetts.
Am J Trop Med Hyg. 2022 Jul 5;107(2):474-483. doi: 10.4269/ajtmh.22-0042. Print 2022 Aug 17.
Antimicrobial resistance (AMR) is a public health emergency. There is insufficient information on AMR in the context of humanitarian settings. An understanding of behavioral and institutional-level factors can strengthen antimicrobial stewardship. This study used a semistructured questionnaire to assess both knowledge, attitudes, and practices (KAP) on antimicrobial use, resistance and stewardship, and options to improving prescribing, among prescribers at the Primary Healthcare facilities of the United Nations' Relief and Works Agency Jordan field office. Responses to the KAP questions were evaluated using the Capability, Opportunity, Motivation, Behavior (COM-B) framework and Bloom's cutoffs. For each framework component, Bloom's cutoffs and interpretations were as follows: ≥ 80%, "good"; 60-79%, "moderate"; and < 60%, "poor." Fourteen options to improve prescribing were each assessed using 5-point Likert scales from very unhelpful to very helpful, aggregated by helpful and very helpful and ranked as follows: > 90%, best/most acceptable; > 80-90%, acceptable; and 70-80% as maybe acceptable/good. The questionnaire response rate was 59% (37/63) with a completion rate of 92% (34/37). Aggregate scores for real knowledge on AMR was 97%; opportunity to improve prescribing 88%; and motivation 16%-participants did not believe that there was a connection between their prescribing and AMR or that they had a key role in helping control AMR. Good options (74% aggregate score) to improving prescribing were the availability of guidelines and resistance data. There was good knowledge of AMR and good opportunities, but poor motivation for rational prescribing or behavioral change. There is a clinical need for AMR data to promote rational antibiotic prescribing.
抗菌素耐药性（AMR）是一种公共卫生紧急情况。在人道主义环境中，关于 AMR 的信息不足。了解行为和机构层面的因素可以加强抗菌素管理。本研究使用半结构式问卷评估初级保健设施的医生在抗菌素使用、耐药性和管理方面的知识、态度和实践（KAP），以及改善处方的选择。使用能力、机会、动机、行为（COM-B）框架和布鲁姆的截止值评估对 KAP 问题的回答。对于每个框架组件，布鲁姆的截止值和解释如下：≥80%，“良好”；60-79%，“中等”；<60%，“差”。使用 5 点李克特量表（从非常无益到非常有益）评估了改善处方的 14 个选择，通过有益和非常有益进行汇总，并按以下顺序进行排名：>90%，最佳/最可接受；>80-90%，可接受；70-80%，也许可接受/良好。问卷的回复率为 59%（37/63），完成率为 92%（34/37）。AMR 实际知识的综合得分为 97%；改善处方的机会为 88%；动机为 16%-参与者认为他们的处方与 AMR 之间没有联系，或者他们在帮助控制 AMR 方面没有关键作用。改善处方的良好选择（综合得分为 74%）是指南和耐药数据的可用性。对抗菌素耐药性有很好的了解，也有很好的机会，但在合理处方或行为改变方面的动机不足。临床需要 AMR 数据来促进合理的抗生素处方。
