Assessing physicians’ intention to prescribe antimicrobials for chronic HIV/AIDS associated diarrhea among adults in Nigeria, using the theory of planned behavior

Abstract

Chronic diarrhea remains one of the commonest manifestation of HIV and a leading cause of morbidity and mortality despites gains in greater access to antiretroviral drugs and treatments of opportunistic infections globally. Yet, there is lack of precise evidence about the place of antimicrobials in chronic HIV associated diarrhea among adults. Physicians have continued to prescribe antimicrobials empirically or otherwise for chronic HIV associated diarrhea among adults. The aim of this study is to assess Physicians’ intension to prescribe antimicrobials in chronic HIV associated diarrhea among adults in Nigeria using the constructs of theory of planned behavior: Attitudes, Subjective Norms and Perceived behavioral control. An exploratory cross sectional survey was carried out. A structured questionnaire was developed following a pilot study to elicit salient beliefs among Physicians and a review of the literature. The study was carried out in 3 Northern Nigerian states among Physicians in Primary/Secondary and Tertiary hospitals in 2014. Data was analyzed using SPSS and STATA. After descriptive statistics, multiple logistic regression analysis was used to determine the relationship between the key constructs of TPB and Physician’s intension to prescribe antimicrobials in chronic HIV associated diarrhea among adults. We found strong intention to prescribe antimicrobials among Physicians respondents. The constructs of the theory of planned behavior explained 40% of variance of the Physicians’ intention to prescribe antimicrobials for chronic AIDS associated diarrhea in adults. Perceived control behavior and knowledge were the most important components of the model associated with intention. This study has further added new knowledge to the pool of evidence that Perceived Control Beliefs and Knowledge significantly influence Physicians’ intention to prescribe antimicrobials in chronic AIDS associated diarrhea. This finding reinforces the utility of theory of planned behavior as a tool to study health care service provision and utilization. There is need for future studies to test if changes in perceived control behavior and knowledge will leads to changes in intention to prescribe antimicrobials for chronic AIDS associated diarrhea and ultimately leading to a change in the clinical practice of managing chronic AIDS associated diarrhea in adults.