Understanding maternal attitudes to antibiotic use: a community-based case study

Background Antibiotics are vital in treating infections and improving health conditions. However, overuse has led to the rapid development of antimicrobial resistance contributing to about 700,000 deaths globally per year. In United Kingdom primary healthcare settings, antibiotics for young children are prescribed in up to 50% of all consultations, often for viral infections for which antibiotics are ineffective. As mothers are usually the primary carers of their children, their attitudes and expectations to using antibiotics have a profound influence on their behaviour and the decisions they make on behalf of their children. Any reduction in antibiotic consumption in young children will decrease the risk of antibiotic resistance developing; this remains a significant and real threat to healthcare. The aim of this study is to understand maternal attitudes to antibiotic use in children. Method A mixed methods case study design was selected consisting of a quantitative and qualitative phase. In phase one, primary care antibiotic prescribing data was collected for children under five years old between July 2016 and July 2017. The results from phase one were used to explore and inform the second, qualitative phase of the study. This phase involved the recruitment of mothers of children under five years old, from local playgroups. Mothers’ narratives were gathered from six focus groups of between two and five mothers per group, as well as from 14 one to one interviews undertaken between October 2017 and April 2018. Results The key findings of the research suggested mothers trust and rely on antibiotics, which are powerful symbols of safety and recovery from illness. However, maternal decision making regarding antibiotics usage is complex, with many variables including the influence of maternal emotions, previous experience, the relationship with their healthcare professional and ultimately their belief and trust in antibiotics. Continuity in healthcare services is important to mothers and supports them in managing their children’s illness. Austerity measures have resulted in a decrease in health visitor access and has led to mothers seeking alternative services for providing support and advice. Conclusion Understanding maternal attitudes to antibiotics for young children is vitally important in reducing inappropriate antibiotic prescription. Antibiotics represent recovery and healing and this trust in antibiotics influences maternal expectations of treatment and interactions with healthcare services. However, to address inappropriate antibiotic prescribing in children, more robust national and local data collection is needed. By understanding the extent of antibiotic prescribing in young children, healthcare professionals will be more able to support mothers in their healthcare decisions.

Using local communities to establish geographical boundaries for case studies

Aim: To discuss using local communities to establish geographical boundaries in a case study approach. Background: Case study is widely used in the social sciences to explore complex phenomena within a real-life setting. Applying case boundaries is vital to ensure cases are easily identifiable and similar enough to be treated as instances of the same phenomenon. Discussion: Post codes can be used to define geographical boundaries. A broad range of statistical data is collected from these populations including demographic information, which can assist in identifying communities that have issues or characteristics which may benefit from further research. Data collection from communities allows researchers to access appropriate populations. Conclusion: Using local communities to identify case boundaries helps to provide a clear periphery to the case, and generate local solutions to local problems. Implications for research/practice: Researchers using this approach benefit from being able to immerse themselves in the local community. This close engagement helps to ensure local community engagement with research projects and findings

Mixed methods case study exploring primary care antibiotic prescribing practices and maternal attitudes to the use of antibiotics in children

Background. Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance. Most antibiotics in the United Kingdom (71.4%) are prescribed in primary care by general practitioners, with about half prescribed for viral rather than bacterial illnesses. Aims. To explore antibiotic prescribing and factors which may influence maternal decision making to seek antibiotics for their young children. Methods. Data for children under five years was gathered using a mixed methods case study approach. Quantitative general practice antibiotic prescribing data (n= 697 children) was statistically analysed and these results were further explored in six focus groups with mothers (n=19) of children under five. The qualitative data was thematically analysed. Results. Quantitative data identified nearly half of children received antibiotics. Children under one were prescribed the fewest antibiotics. Qualitative focus group data showed mothers trusted their general practitioner to provide expert care for their child and often wanted convenient and timely access to advice and reassurance, rather than treatment. Conclusion. Antibiotics are frequently prescribed for young children in primary care. Healthcare professionals need to understand the maternal influences contributing to antibiotic use in children and consider strategies and interventions to reduce unnecessary antibiotic prescriptions

Understanding antibiotic seeking behaviour: A qualitative study of mothers of children aged five and under

Aims. To explore what factors influence mothers' decisions to seek antibiotics for their young children. Design. Qualitative case study using postcode boundaries. Methods. Thematic analysis of qualitative data from mothers of children under 5, recruited via community playgroups within the case. Data were collected between October 2018 and May 2019, from six focus groups (n = 19) and one-to-one interviews (n = 14). Thematic analysis of the data consisted of six phases: data familiarization; generating initial codes; searching for themes; reviewing themes; defining and naming themes; and producing the report. Results. Mothers were influenced by their belief and trust in antibiotics. Antibiotics were identified as symbolic of recovery, healing and of providing protection and safety. Conclusion. By understanding the symbolic power of antibiotics on maternal decision making, all antibiotic prescribers may be able to offer and provide reassuring alternative and acceptable treatment options to mothers, rather than using antibiotics. Impact. This paper introduces the concept of antibiotics as powerful symbols which influence antibiotic seeking behaviour. This in turn may result in inappropriate use of antibiotics which contributes to the risk of antimicrobial resistance developing. Although the majority of antibiotics are still prescribed by doctors, the number of nurse prescribers has been increasing. Therefore, an increased awareness of antibiotic symbolism, in all prescribing clinicians, is important to enable future local and national strategies to be developed, to support maternal decision making and reduce antibiotic seeking behaviour

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Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

BACKGROUND: Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma. AIM: The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data. METHODS: Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence. RESULTS: Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment - all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment - immediate and long-term side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma - 22% of studies reported that embarrassment contributed to poor adherence. CONCLUSIONS: Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence

Noncompliance with Antihypertensive Medications: The Impact of Depressive Symptoms and Psychosocial Factors

OBJECTIVE: Addressing the epidemic of poor compliance with antihypertensive medications will require identifying factors associated with poor adherence, including modifiable psychosocial and behavioral characteristics of patients. DESIGN: Cross-sectional study, comparing measured utilization of antihypertensive prescriptions with patients' responses to a structured interview. STUDY POPULATION: Four hundred ninety-six treated hypertensive patients drawn from a large HMO and a VA medical center. DATA COLLECTION: We developed a survey instrument to assess patients' psychosocial and behavioral characteristics, including health beliefs, knowledge, and social support regarding blood pressure medications, , satisfaction with health care, depression symptom severity, alcohol consumption, tobacco use, and internal versus external locus of control. Other information collected included demographic and clinical characteristics and features of antihypertensive medication regimens. All prescriptions filled for antihypertensive medications were used to calculate actual adherence to prescribed regimens in a 365-day study period. MAIN OUTCOME OF INTEREST: Adjusted odds ratios (ORs) of antihypertensive compliance, based on ordinal logistic regression models. RESULTS: After adjusting for the potential confounding effects of demographic, clinical, and other psychosocial variables, we found that depression was significantly associated with noncompliance (adjusted OR per each point increase on a 14-point scale, 0.93; 95% confidence interval [95% CI], 0.87 to 0.99); in unadjusted analyses, the relationship did not reach statistical significance. There was also a trend toward improved compliance for patients perceiving that their health is controlled by external factors (adjusted OR per point increase, 1.14; 95% CI, 0.99 to 1.33). There was no association between compliance and knowledge of hypertension, health beliefs and behaviors, social supports, or satisfaction with care. CONCLUSIONS: Depressive symptoms may be an underrecognized but modifiable risk factor for poor compliance with antihypertensive medications. Surprisingly, patient knowledge of hypertension, health beliefs, satisfaction with care, and other psychosocial variables did not appear to consistently affect adherence to prescribed regimens