Pilot study to evaluate patients understanding of key aspects of antimicrobial use in a rural province in South Africa including understanding of key terms : findings and implications

Sono, Tiyani Milta and Mboweni, Veronica and Jelić, Ana Golić and Campbell, Stephen M. and Markovic-Pekovic, Vanda and Ramdas, Nishana and Schellack, Natalie and Kumar, Santosh and Godman, Brian and Meyer, Johanna C. (2024) Pilot study to evaluate patients understanding of key aspects of antimicrobial use in a rural province in South Africa including understanding of key terms : findings and implications. Advances in Human Biology. ISSN 2321-8568 (In Press)

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Abstract

Background: Antimicrobial resistance (AMR) is a global concern, necessitating understanding of utilization patterns and their rationale. Pilot studies have been conducted in a rural province in South Africa to determine the extent of self-purchasing of antibiotics by patients from independent and chain pharmacies. It is imperative to understand the extent of knowledge and concerns of patients regarding key aspects of antibiotic use and AMR, and potential language barriers, when pharmacists and their assistants are discussing key aspects with patients. Consequently, the aim was to pre-test a patient questionnaire translated in three native languages (Sepedi, Tshivenda and Xitsonga) building on the findings from the English language pilot. Materials and Methods: The English patient questionnaire was translated into these three languages with 15 patients interviewed (5/language) leaving 10 chain and independent pharmacies for each part of the questionnaire (Parts 1 and 2) followed by interviews with patients to evaluate their understanding of the questions and key concepts. Results: 11 of 15 patients interviewed for Part 1 received antibiotics, including 8 without a prescription. Only independent pharmacies (8/10) dispensed antibiotics without prescriptions. Interviews revealed concerns about antibiotic knowledge and AMR and that certain terms including ‘antibiotic’ and ‘AMR’ posed challenges about patient understanding of the purpose of antibiotics. For instance, one patient self-purchased antibiotics for ‘cleansing’ of sexual transmitted infections. The questionnaires in the native languages were subsequently revised so that explanations for terms including ‘antibiotic’ and ‘AMR’ will be provided in the main study. Conclusion: Similar to the first pilots, self-purchasing of antibiotics was observed among independent pharmacies, albeit at varying rates, with similar indications. Continued health literate education for pharmacists and patients, especially with native language communication, are needed to address current challenges, and will be explored in the main study.