TY - JOUR T1 - Drivers of antibiotic use in Vietnam: implications for designing community interventions JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-005875 VL - 6 IS - 7 SP - e005875 AU - Shannon McKinn AU - Duy Hoang Trinh AU - Dorothy Drabarek AU - Thao Thu Trieu AU - Phuong Thi Lan Nguyen AU - Thai Hung Cao AU - Anh Duc Dang AU - Thu Anh Nguyen AU - Greg J Fox AU - Sarah Bernays Y1 - 2021/07/01 UR - http://gh.bmj.com/content/6/7/e005875.abstract N2 - Introduction Antimicrobial resistance is a global challenge that threatens our ability to prevent and treat common infectious diseases. Vietnam is affected by high rates of antimicrobial resistant infections, driven by the overuse of antibiotics and the Vietnamese government has recognised antimicrobial resistance as a health security priority. This study aimed to understand how people in Vietnam use antibiotics in community settings, and the factors that impact their practices and decision-making regarding antibiotics.Methods We conducted 43 qualitative in-depth interviews with 50 community members in two urban and two rural sites in Vietnam. We conducted iterative, inductive thematic analysis alongside data collection through a process of systematic debriefings based on detailed interview summaries. Through this process, we developed a coding framework that was then applied to transcribed interview data.Results Frequent and indiscriminate use of antibiotics was driven by the powerful appeal that antibiotics held for many Vietnamese consumers. Consumers were discerning in making decisions in their purchase and use of antibiotics. Consumers’ decisions were affected by perceptions of what constitutes high-quality medicine (effective, strong, accessible and affordable); privileging symptom control over diagnosis; social constructions of antibiotics as a trusted remedy with embodied evidence of prior efficacy, which is reinforced by advice from trusted sources in their community; and varied, generally incomplete, understanding of the concept of antibiotic resistance and its implications for individuals and for public health.Conclusion Antibiotic use at the community and primary care level in Vietnam is driven by community members’ social and economic response to what constitutes effective healthcare, rather than biomedical logic. Community-based interventions to reduce unnecessary antibiotic use need to engage with the entangled socio-structural factors that ‘resist’ current public health efforts to ration antibiotic use, alongside biomedical drivers. This study has informed the design of a community-based trial to reduce unnecessary antibiotic use.Data are available upon request. Data underlying our findings cannot be made public for ethical reasons, as they contain information that could compromise the privacy and consent of research participants. Data requests may be sent to the corresponding author. ER -