Health literacy on antibiotics in Thai population: a national household survey in 2017

Abstract

Excessive and inappropriate use of antibiotic is one of the factors accelerating antibiotic resistance. The WHO multi-country public awareness survey on antibiotic resistance and Eurobarometer survey in Europe found that general population had low to moderate level of knowledge and awareness on antibiotics and antibiotic resistance especially in low and middle income countries. This study assesses factors which affect the levels of knowledge about antibiotics, awareness on antibiotic resistance, and antibiotic-use behavior. We use data from antibiotics module in the 2017 National Health and Welfare Survey conducted by the National Statistical Office in March 2017. The survey applied stratified two stage sampling, where 25,803 adults aged over 15 years were interviewed face-to-face. Descriptive and inferential statistics including Chi-square test and multivariable regression analysis were employed. A large gap of health literacy on antibiotics was reflected by 67% of respondents reporting that they had never heard about antibiotic resistance or people should not use antibiotic unnecessarily. Around 3% used antibiotics in the last month. Health literacy on antibiotics was assessed by five true and false statements. Only 3% of the respondents were able to give correct answer to all five statements. 71% of the respondents who received antibiotics information decided to change their behavior on antibiotic use. Knowledge and awareness about antibiotics and antibiotic resistance were positively associated with wealth quintiles and education level. Females and university-level graduation tended to have better reported appropriate behaviors on antibiotic use. Findings show the positive relationship between access the information, knowledge and awareness level and behavior on antibiotic use in line with the concept of health literacy. Multivariable analysis showed that after adjusting for all key covariates, people with better knowledge and reported behaviors on antibiotic use were approximately two-fold more likely to have ever accessed to information about antibiotics (p = 0.000). In conclusion, access to antibiotic information is the integral component contributing to better appraisal and appropriate application of health information, which can ultimately lead to the improvement of antibiotic use. Policies to improve literacy on antibiotic use should focus on the less-off populations as these are populations with reported lower level of health literacy on antibiotics.