Non-biomedical factors | Application/examples | Inappropriate antibiotic use (including prevention use) | |
Antibiotic use behaviour outcomes | References | ||
Knowledge | |||
General knowledge about antibiotics/AMR | Combined 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 |
Literacy | Being able to recognise antibiotics Knowing when/how to use antibiotics | No evidence available to date | – |
Knowledge about the infection | The participant’s knowledge about the specific infection (eg, URTI symptoms will dissipate naturally) | No evidence available to date | – |
AMR awareness | The participant’s awareness of AMR as a health threat on individual or on the society as a whole | No evidence available to date | – |
Attitudes | |||
Attitudes towards antibiotic misuse behaviours | The participant’s accepting attitudes towards storing/self-medicating with antibiotics | Self-medication with antibiotics Storing antibiotics at home | 28 52 |
Self-efficacy | The participant’s perception of his/her or others’ competence in engaging in caring for the infection or in antibiotic use | No evidence available to date | – |
Medical background | The participants or their family members having some level of medical education | Asking/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 experience | Participants use of antibiotics on previous occasions | Over-the-counter purchase | 76 |
Perceptions | |||
Perceived susceptibility | Self-rated health status | Self-medication with antibiotics Combined behaviour score | 28 46 63 |
Perceived severity | The 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 purchase | 32 |
Perceived benefits and disbenefits | The 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 barriers | The 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 dynamics | Family members who might influence the healthcare decisions of caregiver or the patients | Self-medication with antibiotics | 28 45 |
Doctor–patient relationships | Having a regular doctor Following all the advice from physicians | Asking/pressuring doctors for antibiotics Self-medication with antibiotics | 18 30 |
Access to antibiotics | Access to antibiotics, with or without prescription | ||
Access to non-prescription antibiotics | Over-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 prescriptions | Asking/pressuring doctors for antibiotics The education level, training, specialty or seniority of the doctors | The likelihood to be prescribed with antibiotics by doctors | 22–24 |
Cues to action | External trigger mechanisms to prompt engagement in antibiotic use behaviour | ||
Symptoms | Presence of fever | No evidence available to date | – |
Information sources and seeking for therapeutic purposes decisions | Expectation for antibiotic use knowledge | Combined behaviour score | 63 |
Socio-contextual factors | |||
Age | The age of the participant or caregiver | Asking/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 |
Gender | The gender of the participant or caregiver | Self-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 |
Education | The education level of the participant, his/her parent or the caregiver | Asking/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 |
Income | The household income or monthly allowance of the participant or caregiver | Self-medication with antibiotics Storing antibiotics at home Taking antibiotics as prophylaxis | 20 29 32 40 45 50 51 |
Location | The rural/urban of residence of the participant or caregiver | Asking/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 |
Region | Region of residence of the participant or caregiver—geographic area or economic development stage | Asking/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 |
Policy | Health 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 |
Norm | Participants’ 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-care | Prescribing habits/capacity might vary at different levels of health facilities: tertiary hospital, secondary/county hospital, community health centres/township hospital or private clinics/village clinics | No evidence available to date | – |
*Non-predictor: effect is implied.
AMR, antimicrobial resistance; URTI, upper respiratory tract infections.