My team are behavioural scientists and we have been doing some work in UK, Ghana and other countries about antimicrobial prescribing. We too have seen the issues of community use of antibiotics in countries where they are available to purchase (this is mainly not the case in the UK), but also issues around broad spectrum antibiotics use where more specific antibiotics would be appropriate, prescribing for too long and patients not taking antibiotics as prescribed.
Some of the reasons for misuse are knowledge based (ie not knowing what to do or not to do) but, like most behaviours, there are issues around motivation (eg the financial incentives already discussed) and opportunity (eg the availability of a range of antibiotics, different costs of antibiotics). Some themes seem particularly salient across settings and are around infection control and access to health care services - people will be more willing to take / prescribe / buy antibiotics if this is an available option and they’re worried about infection due to poor infection control or they can’t access healthcare early enough to prevent infections developing.
It’s important to tackle antimicrobial stewardship as a part of a complex system of health, therefore, because the way we all behave is so influenced by all of our circumstances and experiences. The work we are doing at the moment is focusing on control of antibiotics in secondary care. In the UK there’s a lot about primary care also. Organisations like the Commonwealth Pharmacists Association are working at multi-levels to try to influence availability and control.
HIFA profile: Lucie Byrne-Davis is a Health Psychologist at Manchester Medical School in the United Kingdom. Professional Interests: Research into health professional practice, and the psychological determinants of change in practice. lucie.byrne-davis AT manchester.ac.uk