Abstract
ObjectivesIn the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and needing urgent effective actions. Our objectives were to systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers' antibiotic use globally, in order to inform future interventions to improve practices in antibiotic use. MethodsData sources were PubMed, EMBASE, PsycINFO, and Cochrane. Study eligibility criteria were original and empirical studies that identified factors for healthcare consumers' antibiotic use. Participants were healthcare consumers. Assessment of risk of bias used adapted BMJ survey appraisal tools, the Critical Appraisal Skills Programme checklist, and the Mixed Methods Appraisal Tool for quality assessment. Methods of data synthesis employed the Social Ecological Framework and Health Belief Model for data synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use. ResultsWe included 71 articles for systematic review and analysis; 54 were quantitative, nine were qualitative, and eight were mixed-methods studies. Prevalent non-prescription antibiotic use and irresponsible prescriptions were reported globally, especially in low-to-middle-income countries. Barriers to healthcare—wait time, transportation, stigmatization—influenced people's practices in antibiotic use. Further, lack of oversight and regulation in the drug manufacturing and a weak supply chain have led to the use of substandard or falsified antibiotics. Knowledge had mixed effects on antibiotic use behaviours. Meta-analyses identified pro-attitudes towards self-medication with antibiotics, relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for self-medication with antibiotics. ConclusionsNon-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and are driven largely by a mixed collection of non-biomedical factors specific to the respective setting. Future antimicrobial resistance strategies should incorporate an implementation science approach for community-based complex interventions that address drivers of the target behaviours tailored to local contexts.
Highlights
This systematic review shows that non-prescription antibiotic use and irresponsible antibiotic prescriptions are prevalent across the world and are influenced largely by multifaceted nonbiomedical factors
In consultation with the Health Belief Model, we found antibiotic uses were influenced by individual's sociodemographic variables [32,43,46,50,52,56,57], perceptions of vulnerability and susceptibility to the infections [34,43,51,62,91,92], and access to drugs [50,56]
Qualitative studies showed that socialecontextual factors such as barriers to health care could interfere with people's care-seeking behaviours, resulting in avoiding medical interactions while purchasing antibiotics over the counter and self-medication with antibiotics [61,69,82e84]
Summary
In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and needing urgent effective actions. Our objectives were to systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers' antibiotic use globally, in order to inform future interventions to improve practices in antibiotic use. Study eligibility criteria were original and empirical studies that identified factors for healthcare consumers' antibiotic use. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use. Knowledge had mixed effects on antibiotic use behaviours. Conclusions: Non-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and are driven largely by a mixed collection of non-biomedical factors specific to the respective setting.
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