Abstract
BACKGROUND
Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.
OBJECTIVE
To explore patients’ interpretations of ‘antibiotic resistance’ and to consider the implications for strategies to contain antibiotic resistance.
DESIGN
Multi country qualitative interview study.
PARTICIPANTS
One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).
APPROACH
Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.
RESULTS
The dominant theme was antibiotic resistance as a property of a ‘resistant human body’, where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients’ explanations, whether they viewed resistance as located in either the body or in bacteria.
CONCLUSIONS
Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician–patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.
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Contributors
We wish to acknowledge the contribution of the network facilitators from the nine European networks in recruiting patients, conducting the interviews and arranging translation of the interviews: Alicia Borras (Barcelona), Curt Brugman and Meriam Scholten (Utrecht), Iso Vincene (Balatonfüred), Jarek Krawczyk (Łódź ), Jon Vilijar Anderseen and Kristin Jakobsen (Tromsø), Mel Davies (Cardiff), Niels Adriaenssens (Antwerp), Paolo Tarsia (Milan), and Tricia Worby (Southampton). We thank Roisin Pill and Nancy Hawkings for their advice as members of the Steering Group.
Funders
The study was funded by the European Union 6th Research Framework Programme as part of the GRACE (Genomics to combat Resistance against Antibiotics in Community acquired LRTI in Europe) network of excellence (Reference: LSHM-CT-2005-518226). This research reports on data from the second study undertaken as part of GRACE Workpackage 8. The funders have no involvement in the authors’ work. The South East Wales Trials Unit is funded by the National Institute for Health and Social Care Research (NISCHR). Additional support was provided by the NISCHR funded Wales School of Primary Care Research.
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None disclosed.
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Brookes-Howell, L., Elwyn, G., Hood, K. et al. ‘The Body Gets Used to Them’: Patients’ Interpretations of Antibiotic Resistance and the Implications for Containment Strategies. J GEN INTERN MED 27, 766–772 (2012). https://doi.org/10.1007/s11606-011-1916-1
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DOI: https://doi.org/10.1007/s11606-011-1916-1