Nair Mohit, Engel Nora, Zeegers Maurice P, Burza Sakib
Maastricht University, Maastricht, Netherlands.
London School of Hygiene & Tropical Medicine, London, UK.
J Infect Prev. 2023 May;24(3):113-118. doi: 10.1177/17571774231158778. Epub 2023 Feb 24.
Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India.
We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment.
Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas.
Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.
抗菌素耐药性对公众健康构成重大威胁。尽管2008年至2016年间印度零售部门人均抗生素消费量增长了约22%，但针对初级医疗保健中抗生素滥用问题的政策或行为干预措施的实证研究却很匮乏。我们的研究旨在评估印度门诊抗生素滥用方面干预措施的认知以及政策与实践中的差距。
我们对学术界、非政府组织、政策、宣传、制药、医学等不同背景的23名关键信息提供者进行了半结构化深度访谈。数据被整理成框架矩阵，并采用归纳与演绎相结合的混合主题分析法进行分析。根据社会生态模型，从个体到促进环境的各个层面分析和组织主题。
关键信息提供者主要关注从结构角度解决抗生素滥用的社会生态驱动因素的重要性。人们认识到，针对个体或人际互动的教育干预措施大多无效，政策干预措施应纳入行为助推干预措施，改善医疗基础设施，并采用任务转移来纠正农村地区的人员配备差距。
处方行为被认为受获取途径的结构问题以及公共卫生基础设施的限制所支配，这些因素为抗生素过度使用创造了有利环境。干预措施应超越对抗菌素耐药性的临床和个体行为改变关注，力求使印度现有特定疾病项目之间以及医疗服务的非正式和正式部门之间在结构上保持一致。
