The facilitators of and barriers to antimicrobial use and misuse in Lalitpur, Nepal: a qualitative study

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Abstract

Background

Antimicrobial resistance (AMR) is a pressing global health concern driven by inappropriate antibiotic use, which is in turn influenced by various social, systemic, and individual factors. This study, nested within FIND’s AMR Diagnostic Use Accelerator clinical trial in Nepal, aimed to (i) explore the perspectives of patients, caregivers, and healthcare workers (HCWs) on antibiotic prescription adherence and (ii) assess the impact of a training and communication (T&C) intervention on adherence to antibiotic prescriptions.

Methods

Using qualitative, semi-structured interviews, pre-intervention and Day 7 follow-up components, and the Behaviour Change Wheel process, we investigated the facilitators of and barriers to the use and misuse of antibiotic prescriptions.

Results

Results of the study revealed that adherence to antibiotic prescriptions is influenced by a complex interplay of factors, including knowledge and understanding, forgetfulness, effective communication, expectations, beliefs and habits, attitudes and behaviours, convenience of purchasing, trust in medical effectiveness, and issues of child preferences. The T&C package was also shown to play a role in addressing specific barriers to treatment adherence.

Conclusions

Overall, the results of this study provide a nuanced understanding of the challenges associated with antibiotic use and suggest that tailored interventions, informed by behaviour frameworks, can enhance prescription adherence, may be applicable in diverse settings and can contribute to the global effort to mitigate the rising threat of AMR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-18690-9.

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Most cited references 19

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The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Susan Michie, Maartje M. van Stralen, Robert H. West (2012)

Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

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The antibiotic resistance crisis: part 1: causes and threats.

C Lee Ventola (2015)

Decades after the first patients were treated with antibiotics, bacterial infections have again become a threat because of the rapid emergence of resistant bacteria-a crisis attributed to abuse of these medications and a lack of new drug development.

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The Social Determinants of Health: It's Time to Consider the Causes of the Causes

Paula Braveman, Laura Gottlieb (2014)

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Author and article information

Contributors

Summita Udas: sudas@oucru.org

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 May 2024

Publication date PMC-release: 2 May 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 1219

Affiliations

[1 ]Oxford University Clinical Research Unit Nepal, Patan, Nepal

[2 ]School of Health and Social Care, University of Essex, ( https://ror.org/02nkf1q06) Colchester, UK

[3 ]GRID grid.452485.a, ISNI 0000 0001 1507 3147, FIND, ; Geneva, Switzerland

[4 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, , University of Oxford, ; Oxford, UK

[5 ]Evidence & Impact Oxford, Oxford, UK

Article

Publisher ID: 18690

DOI: 10.1186/s12889-024-18690-9

PMC ID: 11067172

PubMed ID: 38698360

SO-VID: 081a316f-762f-44d0-aed0-f7c004cdf4a8

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 November 2023

Date accepted : 23 April 2024

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ScienceOpen disciplines: Public health

Keywords: amr,evidence-based intervention,social and behavioural science,knowledge and awareness,doctor–patient interaction

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ScienceOpen disciplines: Public health

Keywords: amr, evidence-based intervention, social and behavioural science, knowledge and awareness, doctor–patient interaction

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The facilitators of and barriers to antimicrobial use and misuse in Lalitpur, Nepal: a qualitative study

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

Related collections

Point-Of-Care Testing for AMR

Most cited references 19

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

The antibiotic resistance crisis: part 1: causes and threats.

The Social Determinants of Health: It's Time to Consider the Causes of the Causes

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