Shutt Alison, Mukherjee Arunima Sehgal, Nampoothiri Vrinda, Holmes Alison, Charani Esmita
National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK.
Centre for Sustainable Healthcare, University of Oslo, Oslo, Norway.
JAC Antimicrob Resist. 2025 Sep 4;7(5):dlaf141. doi: 10.1093/jacamr/dlaf141. eCollection 2025 Oct.
Antimicrobial resistance (AMR) intersects with social determinants of health (SDoH) influencing individual and population infectious disease exposure, spread and outcomes. A decade after the WHO recommended global AMR awareness campaigns to assess people's knowledge, attitude and practices (KAP), we reviewed existing KAP studies conducted among populations considered vulnerable, marginalized or deprived by SDoH indicators.
We conducted a sub-analysis of KAP studies from a broader systematic review that explored the intersection of SDoH, AMR, infections and vulnerable populations. We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library, PsycINFO and Scopus for studies published in English between 2000 and 2022. Titles, abstracts and full texts were screened, and qualitative analysis performed using thematic coding. Key findings were synthesized using a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework.
Of the 126 papers included in the original review, 40 KAP studies met the inclusion criteria for this sub-analysis. Studies reported limited public knowledge about AMR and widespread practices of antibiotic self-medication. Existing recommendations emphasized continued health education. Although KAP studies describe 'what' antibiotic use behaviours are prevalent, they rarely address 'why' these behaviours occur-particularly in the context of SDoH and cultural norms. There is a pressing need to shift the research focus toward upstream drivers of behaviour, rather than solely on individual actions.
Current KAP studies prioritize individual behaviours without adequately considering the broader social, structural and environmental determinants. While these upstream factors remain unaddressed, the practice of sub-optimal self-medication is likely to persist, despite ongoing education efforts.
抗菌药物耐药性（AMR）与健康的社会决定因素（SDoH）相互交织，影响个体和人群的传染病暴露、传播及结局。在世界卫生组织建议开展全球抗菌药物耐药性认知运动以评估人们的知识、态度和行为（KAP）十年后，我们回顾了在那些被SDoH指标认定为易受影响、边缘化或贫困的人群中开展的现有KAP研究。
我们对一项更广泛的系统评价中的KAP研究进行了子分析，该系统评价探讨了SDoH、AMR、感染与弱势群体之间的交叉关系。我们在Ovid MEDLINE、Ovid Embase、Cochrane图书馆、PsycINFO和Scopus中检索了2000年至2022年期间以英文发表的研究。对标题、摘要和全文进行筛选，并使用主题编码进行定性分析。使用优势、劣势、机会和威胁（SWOT）框架综合关键研究结果。
在纳入原始综述的126篇论文中，40项KAP研究符合本次子分析的纳入标准。研究报告称，公众对抗菌药物耐药性的了解有限，抗生素自我用药的行为普遍存在。现有建议强调持续开展健康教育。尽管KAP研究描述了哪些抗生素使用行为是普遍存在的，但它们很少探讨这些行为为何发生，尤其是在SDoH和文化规范的背景下。迫切需要将研究重点转向行为的上游驱动因素，而不是仅仅关注个体行为。
当前的KAP研究优先考虑个体行为，而没有充分考虑更广泛的社会、结构和环境决定因素。如果这些上游因素得不到解决，尽管一直在进行教育努力，但次优自我用药的做法可能会持续存在。
