Abstract
BackgroundSocial and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use.MethodsNational antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public’s KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model.ResultsPolicies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden.ConclusionsInteractions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.
Highlights
Responding to the risk posed by antimicrobial resistance (AMR) became a key concern of governments, transnational organisations, and associated policy-makers at the turn of the century [1, 2]
Public education campaigns can contribute to mitigating AMR
The relative success of policy approaches taken in Sweden suggests that practice level interventions may be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use
Summary
Responding to the risk posed by antimicrobial resistance (AMR) became a key concern of governments, transnational organisations, and associated policy-makers at the turn of the century [1, 2]. Social and behavioural drivers of inappropriate antibiotic use have been identified as one of the key contributing factors to the emergence of AMR. Since 2015, population-based knowledge, attitude and practices (KAP) surveys are part of the monitoring and evaluation framework proposed by the WHO Global Action Plan on Antimicrobial Resistance [12, 15]. KAP surveys endeavour to provide an understanding of some of the social drivers of inappropriate antibiotic use (either misuse or overuse) in the population. Aligned with the global action plan on AMR, it is proposed that surveillance of the levels of knowledge and awareness can contribute to the design of interventions, which can change the population’s behaviour on antibiotic use which could potentially lead to a reduction in AMR. Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR).
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