| Objectives: To examine the level of knowledge about antibiotics,and interaction/compliance/using non-prescribed medicine among rural residents;and to explore the associations of antibiotics use behaviors.According to these findings,to develop and evaluate Planned Behavior Theory-based interventions to promote the rational antibiotics utilization in rural Anhui,China.Methods: Multi-stage sampling method was adopted to identify participate village clinics and the study communities.12 village physicians from different parts of Anhui as South,Middle and North areas were recruited into the study,the service communities of the physicians were also recruited as study areas.From July 2015 to August 2015,we used structured questionnaire to perform baseline research.Questionnaire was designed to collect information about: 1)knowledge about antibiotics,and interaction/compliance/using non-prescribed medicine among rural residents;2)associations with antibiotics use behaviors.Based on the findings from cross-sectional study,interventions were developed under the context of Planned Behavior Theory.Evaluating Measures used included changes between baseline and endpoint in terms of: percentages of patients with symptomatic respiratory or gastrointestinal tract infections being prescribed antibiotics;delivery of essential service procedures;patients' beliefs and knowledge about antibiotics and infection prevention;and also includedresidents' knowledge and behavior changes from household surveys before and after intervention.Results: The main findings from baseline survey included:(1)Rural residents demonstrated extremely low level of knowledge about antibiotics and most believed that antibiotics can cure viral infections.(2)Patient demand may be a misunderstanding or an excuse of physicians for over-prescription.Our study showed only a small proportion with 14.3% of respondents reported they had requested specific prescriptions and the majority with 72%(n=1848)expressed no concerns about leaving the consultation without a prescription.(3)Selfmedication was observed.Nearly one third of the respondents had bought medicines over-the-counter without prescription for symptoms of “common cold”,“gastritis and diarrhea”,and “urethritis”.Among those who could recall the name of medicine bought(n=624),62.7% had bought at least one type of antibiotic.About 14.5% of respondents said they had used pills left over from a previous illness or from relatives or friends.For the recently URTI symptom management process,14.6% took left-over drugs and 13.8% bought medicine over-the-counter,among which 67.9% and 78.0% from the above mentioned channels received antibiotics treatment respectively.(4)Simple knowledge improvement dose not necessary lead to behavior change.Baseline survey demonstrated that respondents who could name at least one kind of antibiotic were more likely to ask doctors to prescribe a specific drug(OR=1.41,95% CI: 1.08,1.84),buy antibiotics without prescription(OR=2.11,95% CI: 1.38,3.22),and use pills left over(OR=1.88,95% CI: 1.40,2.53).Under the Planned Behavior Theory,interventions were developed which included participating training,online decision support system,and commitmentletter targeting physicians;information delivery through different materials such as calendar,wall calendar,poster targeting residents,etc.Evaluation demonstrated that village doctors of intervention group were doing better on the key diagnosis and treatment process than the control group;patients of intervention group had better knowledge on illness management and disease prevention than the control group.It also reduced antibiotics prescription for Respiratory Tract Infections(from 87.1% to 64.3%,P<0.001)and Gastrointestinal Tract infections(from 94.7% to 52.4%,P<0.001).Household survey revealed an improvement of knowledge with residents after intervention,however behaviors of residents did not showed expected change.After intervention,residents were more acceptable about non-prescription behavior of physician(follow-up 73.3% vs.baseline 50.8%;?2=321.95,P<0.01);however follow-up survey also showed higher frequency of behaviors such as asking for specific drugs(follow-up 27.2% vs baseline14.3%;?2=146.73,P<0.01)and stop taking medicine as soon as symptom relieved(follow-up 49.9% vs.baseline 44.7%;?2=15.77,P<0.01).Conclusions: This research was the first time to fully understand the antibiotics related knowledge,attitude,behaviors,and associations with behaviors among rural residents in Anhui Province.Under the Theory of Planned Behavior,multiple and comprehensive intervention methods were developed.Evaluating of the intervention demonstrated effectiveness in promoting rational antibiotics use.Feasible strategies can be introduced into routine antibiotics stewardship.However long-term effect and sustainability of intervention is hard to assess.Evaluation of intervention project is a complex process and the results influenced by multiple factors.It should strengthen process evaluationand using electronic records for assessment in further research. |
PDF Full Text Request