Abstract
To identify preferences of the Swedish public regarding antibiotic treatment characteristics and the relative weight of antibiotic resistance in their treatment choices. A questionnaire including a discrete choice experiment questionnaire was answered by 378 Swedish participants. Preferences of the general public regarding five treatment characteristics (attributes) were measured: contribution to antibiotic resistance, cost, side effects, failure rate and treatment duration. Latent class analysis models were used to determine attribute-level estimates and heterogeneity in preferences. Relative importance of the attributes and willingness to pay for antibiotics with a lower contribution to antibiotic resistance were calculated from the estimates. All attributes influenced participants' preferences for antibiotic treatment. For the majority of participants, contribution to antibiotic resistance was the most important attribute. Younger respondents found contribution to antibiotic resistance more important in their choice of antibiotic treatments. Choices of respondents with lower numeracy, higher health literacy and higher financial vulnerability were influenced more by the cost of the antibiotic treatment. Older respondents with lower financial vulnerability and health literacy, and higher numeracy found side effects to be most important. All attributes can be considered as potential drivers of antibiotic use by lay people. Findings also suggest that the behaviour of lay people may be influenced by concerns over the rise of antibiotic resistance. Therefore, stressing individual responsibility for antibiotic resistance in clinical and societal communication has the potential to affect personal decision making.
Highlights
The rapid development of multi-drug-resistant bacteria is one of the most significant threats to public health globally [1]
A discrete choice experiment (DCE) is used to elicit individuals’ preferences for a medical intervention, such as antibiotic treatment, under the assumption that: (i) the treatment can be described by separate characteristics (‘attributes’), which are further specified by variants called ‘attribute levels’; and (ii) when showed alternative hypothetical treatment options that consist of different combinations of levels, individuals prefer the combination of attributes and levels that gives them the highest utility [14]
There were four questions to test knowledge, and while approximately 66% of respondents answered the antibiotic use questions correctly, they were less knowledgeable about antibiotic resistance (AR) (6.1% and 29.1% answered correctly, respectively)
Summary
The rapid development of multi-drug-resistant bacteria is one of the most significant threats to public health globally [1]. The excessive use of antibiotics is an issue in countries where antibiotics are prescription drugs (i.e. where they can only be dispensed to patients if there is a medical prescription). Patients can influence antibiotic prescription by showing positive expectations for antibiotic treatment, but it is the case that prescribers can assume that patients want to be prescribed these drugs. It has been shown that prescribers tend to prescribe antibiotics more often when they believe that their patients expect them [6,7]. Antibiotic prescription is not determined merely by medical exigencies but is heavily influenced by social factors. AR is a collective action dilemma; it can be mitigated only if sufficiently large numbers of people contribute to the common good and refrain from harmful behaviour
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