Rakotosamimanana Sitraka, Harimanana Aina, Razafindrabesa Timothée, Ravololomihanta Voahirana, Kapesa Laurent, Mattern Chiarella, Kassié Daouda
Institut Pasteur de Madagascar, Antananarivo, 101, Madagascar.
Direction de la santé Familiale, Ministère de la santé Publique de la République de Madagascar, Antananarivo, 101, Madagascar.
BMC Public Health. 2025 May 24;25(1):1922. doi: 10.1186/s12889-025-23140-1.
The Q-method is a research approach that combines quantitative and qualitative techniques to study people's subjectivity on a given theme. In Madagascar, antibiotic usage practices remain largely unstudied, particularly among pregnant and breastfeeding women. This study aims to use the Q-method to document the opinions of pregnant and breastfeeding women on antibiotic use practices in the Northwest region of Madagascar.
The Q-method was applied to 115 pregnant and breastfeeding women from two districts, one urban and one rural, in Northwest Madagascar. The participants ranked 36 statements about antibiotic use on a 7-point scale ranging from - 3 (strong disagreement) to + 3 (strong agreement). Principal component analysis (PCA) was used to analyze the rankings and identify groups of women with differing or similar viewpoints. The Wilcoxon and Kruskal-Wallis rank sum tests were employed to assess significant differences among participants in each group and to evaluate the differences between these groups. Additionally, semistructured interviews were conducted to explore the participants' reasoning behind their rankings and to complement the quantitative findings.
Among the 115 women, 51% (59/115) resided in urban areas, while 49% (56/115) lived in rural regions. PCA identified two main groups of women with distinct viewpoints on antibiotic use. Group 1 comprised 55.6% (64/115) of the women and consisted of women who only complied with medical indications and instructions by being vigilant. Group 2 represented 35.6% (41/115) of the respondents and included women who believed in antibiotic usage based on receiving information first from multiple sources (medical staff or personal experience or other nonmedical relatives). 10 women (8.8%) could not be classified under either of the two groups. Differences in opinions were observed in Group 1 based on age (p = 0.004), marital status (p = 0.013), educational level (p = 0.007), gravidity (p = 0.062), and area of residence (p = 0.125), and in Group 2 based on educational level (p = 0.065) and gravidity (p = 0.127). Insights from the semistructured interviews enriched the interpretation of these groups' classification.
Pregnant and breastfeeding women surveyed in Northwest Madagascar believe that the best approach to antibiotic use is to follow the recommendations of health care professionals. However, some rely on advice from others, whether medical or nonmedical. To improve adherence to antibiotic treatments based solely on medical prescriptions and ensure their proper use in Madagascar, the communication between health care providers and patients must be strengthened.
Q 方法是一种结合定量和定性技术来研究人们对给定主题的主观性的研究方法。在马达加斯加，抗生素使用情况在很大程度上仍未得到研究，尤其是在孕妇和哺乳期妇女中。本研究旨在使用 Q 方法记录马达加斯加西北部地区孕妇和哺乳期妇女对抗生素使用情况的看法。
Q 方法应用于来自马达加斯加西北部两个地区（一个城市地区和一个农村地区）的 115 名孕妇和哺乳期妇女。参与者对 36 条关于抗生素使用的陈述按照从 -3（强烈反对）到 +3（强烈同意）的 7 分制进行排序。主成分分析（PCA）用于分析排序结果并识别观点不同或相似的女性群体。采用 Wilcoxon 检验和 Kruskal-Wallis 秩和检验来评估每组参与者之间的显著差异，并评估这些组之间的差异。此外，还进行了半结构化访谈，以探讨参与者排序背后的推理，并补充定量研究结果。
在 115 名女性中，51%（59/115）居住在城市地区，而 49%（56/115）生活在农村地区。主成分分析确定了两组在抗生素使用方面有不同观点的女性。第 1 组包括 55.6%（64/115）的女性，她们是通过保持警惕仅遵守医学指征和医嘱的女性。第 2 组占受访者的 35.6%（41/115），包括那些基于首先从多个来源（医务人员、个人经验或其他非医学亲属）获得信息而相信抗生素使用的女性。10 名女性（8.8%）无法归入这两组中的任何一组。在第 1 组中，根据年龄（p = 0.004）、婚姻状况（p = 0.013）、教育水平（p = 0.007）、妊娠次数（p = 0.062）和居住地区（p = 0.125）观察到意见差异，在第 2 组中，根据教育水平（p = 0.065）和妊娠次数（p = 0.127）观察到意见差异。半结构化访谈的见解丰富了对这些组分类的解释。
在马达加斯加西北部接受调查的孕妇和哺乳期妇女认为，抗生素使用的最佳方法是遵循医护人员的建议。然而，一些人依赖他人的建议，无论是医学方面还是非医学方面的。为了提高仅基于医学处方对抗生素治疗的依从性并确保其在马达加斯加的正确使用，必须加强医护人员与患者之间的沟通。
