Understanding patient and community members views regarding antimicrobial use : a scoping review

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Ramdas, Nishana and Meyer, Johanna and Schellack, Natalie and Godman, Brian and Turawa, Eunice and Campbell, Stephen (2025) Understanding patient and community members views regarding antimicrobial use : a scoping review. International Journal of Infectious Diseases, 152 (Supple). 107753. ISSN 1201-9712 (https://doi.org/10.1016/j.ijid.2024.107753)

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Abstract

Introduction Antimicrobial resistance (AMR) poses a significant global threat. In 2019, AMR contributed to an estimated 4.95 million deaths with 1.27 million deaths attributed to AMR. It is influenced by factors including antibiotic usage and supply chain patterns, patient-provider dynamics, and community attitudes. Understanding patient views regarding the appropriate use of antibiotics for bacterial infections and inappropriately for viral infections, is crucial for addressing inappropriate antibiotic use and combating AMR. Africa experiences high death rates from AMR but there are little data or understanding of patient views especially in primary healthcare (PHC). This scoping review focused on PHC settings in low- and middle-income countries (LMICs) like South Africa. It aimed to identify key themes surrounding patient and community members views regarding antimicrobial use in PHC in LMICs. Methods The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines and included qualitative studies, close-ended questionnaires, and descriptive observational designs. The Covidence web-based platform was used for literature screening and data extraction including population characteristics, methods, tools and/or questionnaires used, and key findings and the Critical Appraisal Skills Programme (CASP) qualitative checklist was used for qualitative papers. Results The review identified several key themes related to: 1) patient factors including patient beliefs, expectations, knowledge and understanding, and perceptions of antibiotics, resistance and illness severity; satisfaction with and trust in healthcare providers and shared decision making and empowerment; community attitudes, perceptions and beliefs, and sociocultural factors; 2) provider factors including patient-provider relationship, healthcare utilisation and antibiotic prescribing provision and practices and healthcare delivery in PHC; 3) healthcare system factors including resource constraints and healthcare delivery, diagnostic tools and testing and technological advances and access to care, and 4) uptake, implementation, effectiveness and impact of educational interventions. Patients demonstrated varied levels of knowledge regarding infections and antibiotic resistance, influenced by factors such as migration, cultural background, and health literacy. Motivations for seeking antibiotics included cultural beliefs, family influences, and concerns about illness severity. Discussion Understanding patient and healthcare provider perspectives and understanding are crucial for designing effective interventions to combat AMR. This study emphasizes the need for enhancing antibiotic stewardship programs, addressing information needs, and considering population diversity and health literacy in educational interventions. Challenges related to resource scarcity and power dynamics within the healthcare system must also be considered, Conclusion Despite the growing awareness that a substantial portion of antibiotic consumption occurs within PHC settings, patients' roles in the use of antibiotics have often been overlooked. This review emphasizes the importance of understanding patient perspectives in LMICs regarding antibiotic use in PHC settings. The focus should be on implementing targeted interventions for both patients and providers to promote judicious antibiotic use and mitigate the global threat of AMR.

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