Attitudes and knowledge about use of antibiotics and antibiotic resistance: the role of socio-economic factors and origin of birth

Project supported by CARe, involving Fredrik Carlsson, Gunnar Jacobsson, Sverker Jagers, Elina Lampi, and Björn Rönnerstrand

One documented reason for why antibiotics are prescribed too easily is that physicians believe their patients to expect them to prescribe medications. This perceived expectation can result in prescriptions also in cases when antibiotics are not needed, which, in its turn, will increase the problem of antibiotics resistance. However, it might also be the complete opposite, that the perception of the expectations changes the behavior of general practitioners.
Patients differ regarding attitudes towards antibiotics use and knowledge about antibiotic resistance. Moreover, both expectations and attitudes are most likely correlated with different socio-economic characteristics such as gender, age, and income but also with cultural differences. Previous studies have found that patient characteristics such as education, knowledge, and concern about diseases are factors that affect patients’ expectations to get antibiotics. However, it is not clear which of these factors are the most important in relation to both expectations of getting antibiotics and to the actual prescription level. A smaller survey study conducted in two healthcare centers in Sweden found that respondents born outside of Sweden have poorer knowledge about antibiotics and they have significantly more liberal attitudes towards use of antibiotics compared to respondents born in Sweden. Moreover, those born outside of Sweden expected more often to get antibiotics than patients born in Sweden. On the other hand, a report by Public Health Agency of Sweden found that patients with national origin outside EU receives less antibiotics prescriptions than patients born in Sweden.
Thus with a larger immigration, especially from countries where attitudes towards antibiotics use and antibiotics resistance might differ from the views currently held in Sweden, it is possible that attitudes and use rates will be become more heterogeneous. Importantly, there is also a risk of too low level of antibiotics prescriptions when physicians try to decrease the number of antibiotics prescriptions. If so, it is possible that those who are of non-Swedish origin are more likely to be denied antibiotics than patients born in Sweden, due for example language problems. The objectives of this study are therefore i) to compare attitudes and knowledge concerning the use of antibiotics and the problems with antibiotics resistance across individuals with different origins of birth. ii) to investigate whether individuals born outside of Sweden has been more often declined antibiotics than patients born in Sweden. The research is primarly based on surveys to the general population of Sweden.