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‘The Body Gets Used to Them’: Patients’ Interpretations of Antibiotic Resistance and the Implications for Containment Strategies

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Abstract

BACKGROUND

Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.

OBJECTIVE

To explore patients’ interpretations of ‘antibiotic resistance’ and to consider the implications for strategies to contain antibiotic resistance.

DESIGN

Multi country qualitative interview study.

PARTICIPANTS

One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).

APPROACH

Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.

RESULTS

The dominant theme was antibiotic resistance as a property of a ‘resistant human body’, where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients’ explanations, whether they viewed resistance as located in either the body or in bacteria.

CONCLUSIONS

Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician–patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.

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REFERENCES

  1. Goossens H, Ferech M, Vander Stichele R, Elseviers M, for the ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. The Lancet. 2005;365:579–87.

    Google Scholar 

  2. Hughes JM. Preserving the Lifesaving Power of Antimicrobial Agents. JAMA. 2011;305:1027–8.

    Article  PubMed  CAS  Google Scholar 

  3. Hawkings N, Wood F, Butler C. Public Attitudes Towards Bacterial Resistance: a qualitative study. J Antimicrob Chemother. 2007;29:1115–60.

    Google Scholar 

  4. 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;25:341–8.

    Article  PubMed  Google Scholar 

  5. Cals JW, Boumans D, Lardinois RJ, Gonzales R, Hopstaken RM, Butler CC, Dinant GJ. Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study. Br J Gen Pract. 2007;57:942–7.

    Article  PubMed  Google Scholar 

  6. McNulty C, Nichols T, Boyle PJ, Woodhead M, Davey P. The English antibiotic awareness campaigns: did they change the public’s knowledge of and attitudes to antibiotic use? J Antimicrob Chemother. 2010;65:1526–33.

    Article  PubMed  CAS  Google Scholar 

  7. Huttner B, Goossens H, Verheij T, Harbarth S, on behalf of the CHAMP consortium. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. The Lancet. 2010;10:17–31.

    Article  Google Scholar 

  8. Simpson S, Wood F, Butler C. General practitioners' perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007;59:292–6.

    Article  PubMed  CAS  Google Scholar 

  9. Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialities concerning antimicrobial use and resistance. Archives of internal medicine. 2004;164:1451–6.

    Article  PubMed  Google Scholar 

  10. Wester C. Antibiotic resistance: A survey of physician perceptions. Arch Intern Med. 2002;162:2210–6.

    Article  PubMed  Google Scholar 

  11. Trepka M, Belongia E, Chyou P, Davis J, Schwartz B. The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children. Pediatrics. 2001;107:E6.

    Article  PubMed  CAS  Google Scholar 

  12. Madle G, Kostkova P, Mani-Saada J, Weinberg J, Williams P. Changing public attitudes to antibiotic prescribing: can the internet help? Informat Prim Care. 2004;12:19–26.

    Google Scholar 

  13. Grigoryan L, Burgerhof JG, Degener JE, et al. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study. Pharmacoepidemiology and Drug Safety. 2007;16:1234–43.

    Article  PubMed  Google Scholar 

  14. Palmer D, Bauchner H. Parents' and physicians' views on antibiotics. Pediatrics. 1997;99:e6.

    Article  PubMed  CAS  Google Scholar 

  15. Emslie M, Bond C. Public knowledge, attitudes and behaviour regarding antibiotics. The Eur J Gen Pract. 2003;9:84–90.

    Article  Google Scholar 

  16. André M, Vernby A, Berg J, Lundborg C. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. J Antimicrob Chemother. 2010;65:1292–6.

    Article  PubMed  Google Scholar 

  17. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay A. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. Br Med J 2010:c2096.

  18. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrance Database Systematic Reviews 2005;3.

  19. Smith S, Fahey T, Smucny J, Becker L. Antibiotics for acute bronchitis. Cochrance Database Systematic Reviews 2004;4.

  20. National Institute for Health and Clinical Excellence. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care (Clinical guideline 69). London: NICE; 2008.

    Google Scholar 

  21. Cals JWL, Butler CC, Hopstaken RM, Hood K, Dinant G-J. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009;338:1112–6.

    Article  Google Scholar 

  22. Davey P, Pagliari C, Hayes A. The patient's role in the spread and control of bacterial resistance to antibiotics. Clin Microbiol Infect. 2002;8(suppl. 2):43–68.

    Article  PubMed  Google Scholar 

  23. Butler C, Hillier S, Roberts Z, Dunstan F, Howard A, Palmer S. Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E.coli UTIs. Br J Gen Pract. 2006;56:686–92.

    PubMed  Google Scholar 

  24. Hart AM, Pepper GA, Gonzales R. Balancing acts: deciding for or against antibiotics in acute respiratory infections. J Fam Pract. 2005;55:320–5.

    Google Scholar 

  25. Wood F, Simpson S, Butler CC. Socially responsible antibiotic choices in primary care: a qualitative study of GPs' decisions to prescribe broad-spectrum and fluroquinolone antibiotics. Fam Pract. 2007;24:427–34.

    Article  PubMed  Google Scholar 

  26. Nunkoosing K. The problem with interviews. Qual Health Res. 2005;15:698–706.

    Article  PubMed  Google Scholar 

  27. Butler C, Hood K, Verheij J, et al. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. Br Med J 2009;338.

  28. Sampson H. Navigating the waves: the usefulness of a pilot in qualitative research. Qual Res. 2004;4:383.

    Article  Google Scholar 

  29. Beaton D, Bombardier C, Guillemin F, Ferraz M. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25:3186.

    Article  PubMed  CAS  Google Scholar 

  30. Britten N. Qualitative research: qualitative interviews in medical research. Br Med J. 1995;311:251.

    Article  CAS  Google Scholar 

  31. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, eds. Analyzing qualitative data. London: Routledge; 1994:173–94.

    Chapter  Google Scholar 

  32. Ritchie J, Spencer L, O'Connor W. Carrying out qualitative analysis. In: Ritchie J, Lewis J, eds. Qual Res Practice A guide for Social Science Students and Researchers. London: Sage; 2003:219–62.

    Google Scholar 

  33. Pope C, Ziebland S, Mays N. Qualitative research in health care: Analysing qualitative data. BMJ. 2000;330:114–6.

    Article  Google Scholar 

  34. NVIVO Qualitative Data Analysis Software: QSR International Pty Ltd; 2008.

  35. Street RJ, Haidet P. How Well Do Doctors Know their Patients? J Gen Intern Med: Factors Affecting Physician Understanding of Patients' Health Beliefs; 2010.

    Google Scholar 

  36. Gould D, Drey N, Millar M, Wilks M, Chamney M. Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection. Journal of Hospital Infection. 2009;72:1–8.

    Article  PubMed  CAS  Google Scholar 

  37. Lindberg M, Carlsson M, Hogman M, Skytt B. Suffering from methicillin-resistant Staphylococcus aureus: experiences and understandings of colonisation. Journal of Hospital Infection. 2009;73:271–7.

    Article  PubMed  CAS  Google Scholar 

  38. Finch RG, Metlay JP, Davey PG, Baker LJ, on behalf of the International Forum on Antibiotic Resistance colloquium (2002). Educational interventions to improve antibiotic use in the community: report from the International Forum on Antibiotic Resistance (IFAR) colloquium. The Lancet. 2004;4:44–53.

    Article  Google Scholar 

  39. Okeke IN, Klugman KP, Zulfiqar AB, Duse AG, Jenkins P, O’Brien TF, Pablos-Mendez A, Laxminarayan R. Antimicrobial resistance in developing countries. Part II: strategies for containment. The Lancet. 2005;5:568–80.

    Article  Google Scholar 

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Contributors

We wish to acknowledge the contribution of the network facilitators from the nine European networks in recruiting patients, conducting the interviews and arranging translation of the interviews: Alicia Borras (Barcelona), Curt Brugman and Meriam Scholten (Utrecht), Iso Vincene (Balatonfüred), Jarek Krawczyk (Łódź ), Jon Vilijar Anderseen and Kristin Jakobsen (Tromsø), Mel Davies (Cardiff), Niels Adriaenssens (Antwerp), Paolo Tarsia (Milan), and Tricia Worby (Southampton). We thank Roisin Pill and Nancy Hawkings for their advice as members of the Steering Group.

Funders

The study was funded by the European Union 6th Research Framework Programme as part of the GRACE (Genomics to combat Resistance against Antibiotics in Community acquired LRTI in Europe) network of excellence (Reference: LSHM-CT-2005-518226). This research reports on data from the second study undertaken as part of GRACE Workpackage 8. The funders have no involvement in the authors’ work. The South East Wales Trials Unit is funded by the National Institute for Health and Social Care Research (NISCHR). Additional support was provided by the NISCHR funded Wales School of Primary Care Research.

Conflict of Interest

None disclosed.

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Correspondence to Lucy Brookes-Howell BA (Hons) PhD.

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Brookes-Howell, L., Elwyn, G., Hood, K. et al. ‘The Body Gets Used to Them’: Patients’ Interpretations of Antibiotic Resistance and the Implications for Containment Strategies. J GEN INTERN MED 27, 766–772 (2012). https://doi.org/10.1007/s11606-011-1916-1

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  • DOI: https://doi.org/10.1007/s11606-011-1916-1

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