We aimed to gain an in-depth understanding of public views and ways of talking about antibiotics. Four focus groups were held with members of the public. In addition, 39 households were recruited and interviews, diaries of medicine taking, diaries of any contact with medication were used to explore understanding and use of medication. Discussions related to antibiotics were identified and analyzed. Participants in this study were worried about adverse effects of antibiotics, particularly for recurrent infections. Some were concerned that antibiotics upset the body’s “balance”, and many used strategies to try to prevent and treat infections without antibiotics. They rarely used military metaphors about infection (e.g., describing bacteria as invading armies) but instead spoke of clearing infections. They had little understanding of the concept of antibiotic resistance but they thought that over-using antibiotics was unwise because it would reduce their future effectiveness. Previous studies tend to focus on problems such as lack of knowledge, or belief in the curative powers of antibiotics for viral illness, and neglect the concerns that people have about antibiotics, and the fact that many people try to avoid them. We suggest that these concerns about antibiotics form a resource for educating patients, for health promotion and social marketing strategies.
References
[1]
American Academy of Microbiology. Antibiotic Resistance: An Ecological Perspective on an Old Problem; American Academy of Microbiology: Washington, DC, USA, 2009.
[2]
Okeke, I.N.; Laxminarayan, R.; Bhutta, Z.A.; Duse, A.G.; Jenkins, P.; O’Brien, T.F.; Pablos-Mendez, A.; Klugman, K.P. Antimicrobial resistance in developing countries. Part I: Recent trends and current status. Lancet Infect. Dis. 2005, 5, 481–493, doi:10.1016/S1473-3099(05)70189-4.
[3]
Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance. The Path of Least Resistance; Department of Health: London, UK, 1998.
[4]
Dameh, M.; Norris, P.; Green, J. Antibiotic sales at private pharmacies in Abu Dhabi, United Arab Emirates. Pharm. World Sci. 2010, 32, 643–650, doi:10.1007/s11096-010-9418-5.
[5]
V??n?nen, M.H.; Pietil?, K.; Airaksinen, M. Self-medication with antibiotics—Does it really happen in Europe? Health Policy 2006, 77, 166–171.
[6]
Pechère, J. Patients’ interviews and misuse of antibiotics. Clin. Infect. Dis. 2001, 33, S170–S173, doi:10.1086/321844.
[7]
Britten, N. Patient demand for prescriptions: A view from the other side. Fam. Pract. 1994, 11, 62–66, doi:10.1093/fampra/11.1.62.
[8]
Miller, E.; MacKeigan, L.; Rosser, W.; Marshman, J. Effects of perceived patient demand on prescribing anti-infective drugs. CMAJ 1999, 161, 139–142.
[9]
Coenen, S.; Michiels, B.; Renard, D.; Denekens, J.; van Royen, P. Antibiotic prescribing for acute cough: The effect of perceived patient demand. Br. J. Gen. Pract. 2006, 56, 183–190.
[10]
Stevenson, F.A.; Greenfield, S.M.; Jones, M.; Nayak, A.; Bradley, C.P. GPs’ perceptions of patient influence on prescribing. Fam. Pract. 1999, 16, 255–261, doi:10.1093/fampra/16.3.255.
[11]
Britten, N.; Ukoumunne, O. The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: A questionnaire survey. Br. Med. J. 1997, 315, 1506–1510, doi:10.1136/bmj.315.7121.1506.
[12]
Norris, P.; Chong, C.; Chou, A.; Hsu, T.; Lee, C.; Su, C.; Wang, Y. Knowledge and reported use of antibiotics amongst school-teachers in New Zealand. Pharm. Pract. 2009, 7, 238–241.
[13]
Norris, P.; Churchward, M.; Fa’alau, F.; Va’ai, C.; Arroll, B. Understanding and use of antibiotics amongst Samoan people in New Zealand. J. Prim. Health Care 2009, 1, 30–35.
[14]
Norris, P.; Ng, L.; Kershaw, V.; Hanna, F.; Wong, A.; Talekar, M.; Oh, J.; Azer, M.; Cheong, L. Knowledge and reported use of antibiotics amongst immigrant ethnic groups in New Zealand. J. Immigr. Minor. Health 2009, 12, 107–112.
[15]
Eng, J.V.; Marcus, R.; Hadler, J.L.; Imhoff, B.; Vugia, D.J.; Cieslak, P.R.; Zell, E.; Deneen, V.; McCombs, K.G.; Zansky, S.M.; et al. Consumer attitudes and use of antibiotics. Emerg. Infect. Dis. 2003, 9, 1128–1135, doi:10.3201/eid0909.020591.
[16]
Haynes, D.; Mainous, A.; Oler, M.; Zoorob, R. Patient knowledge of upper respiratory infections: Implications for antibiotic expectations and unnecessary utilization. J. Fam. Pract. 1997, 45, 75–83.
[17]
Wilson, A.A.; Crane, L.A.; Barrett, P.H.; Gonzales, R. Public beliefs and use of antibiotics for acute respiratory illness. J. Gen. Intern. Med. 1999, 14, 658–662, doi:10.1046/j.1525-1497.1999.08118.x.
[18]
Hawkings, N.; Wood, F.; Butler, C. Public attitudes towards bacterial resistance: A qualitative study. J. Antimicrob. Chemother. 2007, 59, 1155–1160, doi:10.1093/jac/dkm103.
[19]
Rodis, J.L.; Green, C.G.; Cook, S.C.; Pedersen, C.A. Effects of a pharmacist-initiated educational intervention on patient knowledge about the appropriate use of antibiotics. Am. J. Health-Syst. Pharm. 2004, 61, 1385–1389.
[20]
Brooks, L.; Shaw, A.; Sharp, D.; Hay, A. Towards a better understanding of patients’ perspectives of antibiotic resistance and MRSA: A qualitative study. Fam. Pract. 2008, 25, 341–348, doi:10.1093/fampra/cmn037.
[21]
Gould, D.J.; Drey, N.S.; Millar, M.; Wilks, M.; Chamney, M. Patients and the public: Knowledge, sources of information and perceptions about healthcare-associated infection. J. Hosp. Infect. 2009, 72, 1–8, doi:10.1016/j.jhin.2009.01.024.
[22]
Easton, P.M.; Marwick, C.A.; Williams, F.L.R.; Stringer, K.; McCowan, C.; Davey, P.; Nathwani, D. A survey on public knowledge and perceptions of methicillin-resistant staphylococcus aureus. J. Antimicrob. Chemother. 2009, 63, 209–214.
[23]
Arnold, S.; Straus, S. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst. Rev. 2005, 4, doi:10.1002/14651858.CD003539.pub2.
[24]
Edgar, T.; Boyd, S.; Palame, M. Sustainability for behaviour change in the fight against antibiotic resistance: A social marketing framework. J. Antimicrob. Chemother. 2009, 63, 230–237, doi:10.1093/jac/dkn508.
[25]
Fresle, D.; Wolfheim, C. Public Education in Rational Drug Use: A Global Survey; World Health Organisation: Geneva, Switzerland, 1997; p. 79.
[26]
Arroll, B.; Everts, N. The common cold: What does the public think and want? N Z Fam. Physician 1999, 26, 51–56.
[27]
Martin, E. Flexible Bodies: Tracking Immunity in American Culture: From the Days of Polio to the Age of Aids; Beacon Press: Boston, MA, USA, 1994.
[28]
Dew, K.; Chamberlain, K.; Hodgetts, D.; Norris, P.; Radley, A.; Gabe, J. Home as a hybrid centre of medication practice. Sociol. Health Illn. 2013, doi:10.1111/1467-9566.12041.
[29]
Chamberlain, K.; Madden, H.; Gabe, J.; Dew, K.; Norris, P. Forms of resistance to medications within New Zealand households. Medische Antropologie 2011, 23, 299–308.
[30]
Hodgetts, D.; Chamberlain, K.; Gabe, J.; Dew, K.; Radley, A.; Madden, H.; Norris, P.; Nikora, L. Emplacement and everyday use of medications in domestic dwellings. Health Place 2011, 17, 353–360, doi:10.1016/j.healthplace.2010.11.015.
[31]
Nichter, M.; Nichter, M. Anthropology and International Health: Asian Case Studies; Routledge: New York, NY, USA, 1996; p. 455.
[32]
NVivo, QSR International Pty Ltd, Doncaster, Australia, 2008.
[33]
Oxford English Dictionary. Available online: http://www.oed.com/ (accessed on 27 May 2012).
[34]
Pound, P.; Britten, N.; Morgan, M.; Yardley, L.; Pope, C.; Daker-White, G.; Campbell, R. Resisting medicines: A synthesis of qualitative studies of medicine taking. Soc. Sci. Med. 2005, 61, 133–155, doi:10.1016/j.socscimed.2004.11.063.
[35]
Hawkings, N.; Butler, C.; Wood, F. Antibiotics in the community: A typology of user behaviours. Patient Educ. Couns. 2008, 73, 146–152, doi:10.1016/j.pec.2008.05.025.
[36]
Verbrugge, L.; Ascione, F. Exploring the iceberg: Common symptoms and how people care for them. Med. Care 1987, 25, 539–569, doi:10.1097/00005650-198706000-00008.
[37]
Cunningham-Burley, S.; Irvine, S. “And have you done anything so far?” An examination of lay treatment of children’s symptoms. Br. Med. J. 1987, 295, 700–702, doi:10.1136/bmj.295.6600.700.
[38]
Rogers, A.; Hassell, K.; Nicolaas, G. Demanding Patients: Analysing the Use of Primary Care; Open University Press: Buckingham, UK, 1999.
[39]
Brookes-Howell, L.; Elwyn, G.; Hood, K.; Wood, F.; Cooper, L.; Goossens, H.; Ieven, M.; Butler, C. “The body gets used to them” patients’ interpretations of antibiotic resistance and the implications for containment strategies. J. Gen. Intern. Med. 2011, doi:10.1007/s11606-011-1916-1.
[40]
Norris, P.; Toner, E.; Morris, K. Public understandings of bacteria, antibiotics and resistance. N Z Med. J. 2003, 116, e1177.
[41]
Bagge, M. Medicines in the Context of Older People’s Lives; University of Otago: Dunedin, New Zealand, 2012.
[42]
Payer, L. Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France; Henry Holt: New York, NY, USA, 1988.
[43]
National Prescribing Service (NPS) Australia MedicineWise. Common Cold. Available online: http://www.nps.org.au/bemedicinewise/common_colds (accessed on 3 November 2013).