Table 2

Non-biomedical factors influencing outpatient and community antibiotic use for common community-acquired infections

Non-biomedical factorsApplication/examplesInappropriate antibiotic use
(including prevention use)
Antibiotic use behaviour outcomesReferences
Knowledge
General knowledge about antibiotics/AMRCombined knowledge score
Inadequate diagnostic knowledge of doctors
Misconceptions (eg, antibiotic is an anti-inflammatory drug)
Asking/pressuring doctors for antibiotics
Self-medication with antibiotics
Storing antibiotics at home
Taking antibiotics as prophylaxis
Healthcare seeking behaviour
The likelihood to be prescribed with antibiotics by doctors
Combined behaviour score
14 17 25 36 46 63
LiteracyBeing able to recognise antibiotics
Knowing when/how to use antibiotics
No evidence available to date
Knowledge about the infectionThe participant’s knowledge about the specific infection (eg, URTI symptoms will dissipate naturally)No evidence available to date
AMR awarenessThe participant’s awareness of AMR as a health threat on individual or on the society as a wholeNo evidence available to date
Attitudes
Attitudes towards antibiotic misuse behavioursThe participant’s accepting attitudes towards storing/self-medicating with antibioticsSelf-medication with antibiotics
Storing antibiotics at home
28 52
Self-efficacyThe participant’s perception of his/her or others’ competence in engaging in caring for the infection or in antibiotic useNo evidence available to date
Medical backgroundThe participants or their family members having some level of medical educationAsking/pressuring doctors for antibiotics
Self-medication with antibiotics
Over-the-counter purchases
Storing antibiotics at home
Taking antibiotics as prophylaxis
The likelihood to be prescribed with antibiotics by doctors
Combined behaviour score
13 19 20 28 34 40 41 43 44 47–51
Prior experienceParticipants use of antibiotics on previous occasionsOver-the-counter purchase76
Perceptions
Perceived susceptibilitySelf-rated health statusSelf-medication with antibiotics
Combined behaviour score
28 46 63
Perceived severityThe participant’s assessment/perception of the severity of the situation regarding the infection (eg, self-diagnosed symptoms experienced)
The participant’s perception of potential harm of over-the-counter purchase
Over-the-counter purchase32
Perceived benefits and disbenefitsThe participant’s mistaken understanding of antibiotics (eg, considering antibiotics as Xiaoyanyao, anti-inflammatory drugs) (misconceptions)Asking/pressuring doctors for antibiotics
Self-medication with antibiotics
Taking antibiotics as prophylaxis
36
Perceived barriersThe participant’s assessment/perception of barriers to engaging in antibiotic use (health insurance and knowledge of current policy)Self-medication with antibiotics
Healthcare seeking behaviour
14 28
Family dynamicsFamily members who might influence the healthcare decisions of caregiver or the patientsSelf-medication with antibiotics28 45
Doctor–patient relationshipsHaving a regular doctor
Following all the advice from physicians
Asking/pressuring doctors for antibiotics
Self-medication with antibiotics
18 30
Access to antibioticsAccess to antibiotics, with or without prescription
Access to non-prescription antibioticsOver-the-counter purchase
Antibiotics stored at home
Leftover prescriptions
Self-medication with antibiotics
Taking antibiotics as prophylaxis
17 18 28 31 41 42 46 50 51
Access to antibiotic prescriptionsAsking/pressuring doctors for antibiotics
The education level, training, specialty or seniority of the doctors
The likelihood to be prescribed with antibiotics by doctors22–24
Cues to actionExternal trigger mechanisms to prompt engagement in antibiotic use behaviour
SymptomsPresence of feverNo evidence available to date
Information sources and seeking for therapeutic purposes decisionsExpectation for antibiotic use knowledgeCombined behaviour score63
Socio-contextual factors
AgeThe age of the participant or caregiverAsking/pressuring doctors for antibiotics
Self-medication with antibiotics
Over-the-counter purchase
Storing antibiotics at home
Taking antibiotics as prophylaxis
Healthcare seeking behaviour
The likelihood to be prescribed with antibiotics by doctors (oral, intravenous or both)
Combined behaviour score
13 14 18–20 32 40 41 45 47 48 50 51 76
GenderThe gender of the participant or caregiverSelf-medication with antibiotics
Storing antibiotics at home
Taking antibiotics as prophylaxis
Healthcare seeking behaviour
Combined behaviour score
13–15 19 20 28 35 45 48–51
EducationThe education level of the participant, his/her parent or the caregiverAsking/pressuring doctors for antibiotics
Self-medication with antibiotics
Storing antibiotics at home
Over-the-counter purchases
Taking antibiotics as prophylaxis
Healthcare seeking behaviour
Combined behaviour score
13 14 18–20 28 29 38 42 45 49–51 63 76
IncomeThe household income or monthly allowance of the participant or caregiverSelf-medication with antibiotics
Storing antibiotics at home
Taking antibiotics as prophylaxis
20 29 32 40 45 50 51
LocationThe rural/urban of residence of the participant or caregiverAsking/pressuring doctors for antibiotics
Self-medication with antibiotics
Over-the-counter purchases
Storing antibiotics at home
Taking antibiotics as prophylaxis
The likelihood to be prescribed with antibiotics by doctors
Combined behaviour score
13 18–20 24 29 43–45 47 49 50
RegionRegion of residence of the participant or caregiver—geographic area or economic development stageAsking/pressuring doctors for antibiotics
Self-medication with antibiotics
Over-the-counter purchases
Storing antibiotics at home
Taking antibiotics as prophylaxis
The likelihood to be prescribed with antibiotics by doctors
13 20 28 50 51
PolicyHealth policy or AMR programme that might affect prescribing or access to antibiotics (eg, measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines and policy that bans over-the-counter purchases)
Financial incentives for antibiotic prescribing of doctors
Self-medication with antibiotics
Over-the-counter purchases*
The likelihood to be prescribed with antibiotics by doctors
23 24 28
NormParticipants’ view of how others treat illnesses and/or use antibiotics (non-China and non-predictor)*
Healthcare providers reviewing others’ prescriptions (non-predictor)*
The likelihood to be prescribed with antibiotics by doctors*59 75 77–79
Point-of-carePrescribing habits/capacity might vary at different levels of health facilities: tertiary hospital, secondary/county hospital, community health centres/township hospital or private clinics/village clinicsNo evidence available to date
  • *Non-predictor: effect is implied.

  • AMR, antimicrobial resistance; URTI, upper respiratory tract infections.