| BackgroundAntibiotic is one of the most widely used and most significantly abused drugs of the world, and it is really more serious of the drugs abusing and the unreasonable behavior of the medicine using in primary health care institutions of the rural. Overusing of antibiotics is harmful greatly, for the preschoolers are the main people of the respiratory infection, so the parents play the important role in regulating the use of antibiotics in children. It is an important factor that rural residents lack medical knowledge, poor awareness of rational drug use contributed to the irrational use of antibiotics, and the expectation of patients will have a major impact on doctor’s prescription. Educational intervention which is an important means could promote the rational use of antibiotics, but the intervention research for parents of children in rural areas is less. In this study, to explore the impact of the approach of the integrated educational interventions on KAP on antibiotics of parents is by the cluster randomized controlled trial, and then the effect of interventions is evaluated, by which explore effective interventions for rational use of antibiotics of the children, try to establish a model of the children’s antibiotic intervention, promote rational use of antibiotics and improve the children’s health.ObjectiveThe purpose of this study was to evaluate the role of health education in the rational use of antibiotics for the parents in rural areas.MethodsParents whose children aged 0-7 in rural areas were selected as the participants of the study, and the design type is the cluster randomized controlled design (CRCT), the parents whose children are 0 to 7 in each administrative village are as a group, and this study is a longitudinal design research, belonging to the quasi-experimental study. This study has a control group and a self controlled. After calculation, the sample capacity of 720 people was determined by PPS sampling method to select 12 sample villages in Yanggu County Yanlou town, and divided into two groups in a completely random way, and six villages are in the intervention group and 6 villages in control group. In the end,60 parents or grandparents whose children are 0-7 year-old in each village.The intervention group received the intervention, while the control group did not receive any interventions. Prior to the implementation of interventions, baseline survey was done to all the objects included in the study, and then after the intervention measures, the second survey was done. This study’s main interventions are health education, including regular lectures on rational use of antibiotics, putting up posters and distributed brochures on the rational use of the drug. Education and training were conducted three times, and unified done by a pediatric clinician. We conducted personal interviews to collect understand the information which questionnaires did not collect. This study used the difference-in-difference method to assess the effect of the intervention, did subgroup analysis, and cluster design effect was considered in the analysis process.OutcomesKnowledge about widely used antibiotics was improved both in the intervention group and the control group after the intervention. It’s increased more significant from average 7.29 kinds of antibiotics before intervention to 10.63 after intervention in the intervention group, and it’s increased from average 7.13 to 9.58 in the control group. Education interventions improved the kinds of antibiotics that children’s parents aware (coefficient=0.9, P<0.05) by the difference-in-difference analysis. Meanwhile, interventions can significantly improve the knowledge of parents of children on the "abuse of antibiotics increases resistance" (OR= 4.12, P<0.01) and the "antibiotics should be prescribed by the doctor" (OR= 3.21, P<0.01).Attitude about use of antibiotics for common diseases was significantly changed (OR= 2.47, P<0.01) after the intervention, mainly performance in decreasing the use of antibiotics. Attitudes of parents of children changed better on several items, including "antibiotics can help prevent diseases" (OR= 1.76, P> 0.05), "better to use antibiotics with combined" (OR= 1.36, P> 0.05), "stop use antibiotics when symptom was improved" (OR= 1.43, P> 0.05), "it’s necessary to buy antibiotics after the doctor prescribed" (OR= 1.76, P> 0.05), and "request antibiotics from the doctor". But only the attitude towards "requests antibiotics from the doctor" changed significantly.The possibility of reducing the frequency of "adjust the dose all by oneself, "use antibiotics with combined" and "intermittent use of antibiotics" respectively increased 127%(P<0.05),135%(P<0.01), and 29%(P> 0.05). The time of stop using drug become more reasonable (OR= 2.33, P<0.05) because of the educational interventions, but there’s no effect for reducing the irrational behavior of prophylaxis use of antibiotics (OR= 0.80, P> 0.05). A comprehensive index, "the proportion of irrational use of antibiotics" decreased from 92% to 84.92% in intervention group, while increased from 88.85% to 91.33%. Irrational use of antibiotics by parents for their children reduced 9.56% (OR= 0.29, P<0.01) due to the educational interventions.The results showed that the effects vary with different relationships and different levels of education of parents. The effect of intervention was better for mothers (OR= 0.23, P 0.01) than grandmothers (OR= 0.31, P> 0.05), and better for parents that with high levels of education (OR= 0.22, P<0.01) than low levels of education (OR= 0.52, P> 0.05).Conclusions and Suggestions:The comprehensive intervention measures which mainly include health education have a certain degree of effect on children’s parents in rural areas of Yanggu county, Shandong province. Parents can get more information about antibiotics, then change their incorrect recognition and attitude towards antibiotics, eventually part of the children’s parents will put it into practice, correct their behavior of the irrational use of antibiotics for children, and maintain reasonable use. After a subgroup analysis, we find that these intervention measures have a better effect on children’s mother than grandmother, and the effect is better for the parents who have a higher education level than those whose education levels are low.According to the conclusions above, this study put forward several suggestions as follows:1、Health institutions and relevant departments can contain antibiotics abuse, promote the rational use of antibiotics through health education, in order to improve the level of people’s health.2、To make sure that an effective result can be attained,when we implement this rational use of antibiotics intervention project for the community children’s parents, we’d better choose children’s mother or parents whose education level is high as main objects; when we use a family as an intervention unit, we should also view these two kinds of people as breakthrough points:children’s mother and children’s parents with high education level. What’s more, we need to use different measures that are easily accepted according to people of different education degree.3、Results showed that some attitudes and behaviors are failed to be changed, which means the follow-up studies can verify whether these attitudes and behaviors can be changed by health education through some methods, such as extend intervention time or intensify the intervention. |
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