Antibiotics nonadherence and knowledge in a community with the world's leading prevalence of antibiotics resistance: implications for public health intervention

Abstract

Background: Community determinants of antibiotics nonadherence, an important contributor of antibiotics resistance, remained unclear.

Objectives: Our objective was to investigate whether deficient antibiotics knowledge could contribute to nonadherence in a community with high prevalence of antibiotics resistance.

Methods: We recruited 465 people by random sampling from 5 urban areas in Hong Kong. A structured questionnaire was used to assess antibiotics knowledge and adherence. Adherence was defined as completing the most recent course of antibiotics entirely according to physicians' instructions. An antibiotics knowledge score ranging from 0 to 3 (highest) was composed based on the number of correctly answered questions.

Results: Of the 465 participants interviewed, 96.3% had heard of the term "antibiotics," and 80.6% recalled having previously received antibiotics prescription. Among the eligible 369 subjects, 32.9% showed nonadherence. Percentages of participants with antibiotics knowledge scores of 0, 1, 2, and 3 were 11%, 27%, 33%, and 29%, respectively. There was a higher prevalence of nonadherence among people with lower antibiotics knowledge score (P < .001). Furthermore, people with nonadherence had a significantly lower mean antibiotics knowledge score (1.3 ± 1.0 versus 2.0 ± 0.9, P < .001), with no interaction with education (P < .05). Adjusted for potential confounders, antibiotics knowledge scores of 2, 1, and 0 independently predicted increased risk of nonadherence by 1-fold (odds ratio [OR], 2.00; 95% confidence interval [CI]: 1.01-3.94; P = .047), 4-fold (OR, 4.77; 95% CI: 2.30-9.92; P < .001), and 17-fold (OR, 18.41; 95% CI: 6.92-48.97; P < .001) respectively, compared with the maximum score of 3.

Conclusion: Lack of antibiotics knowledge is a critical determinant of nonadherence independent of education in the community.

Fig 1

Percentage of subjects with antibiotics nonadherence in relation to antibiotics knowledge score. Score = 0: 69% (27/39); score = 1: 42% (42/99); score = 2: 26% (32/121); score = 3: 17% (18/107). P value for χ test < .001.

Fig 2

Mean antibiotics knowledge score in patients demonstrating adherence versus nonadherence across different education levels. Primary school: 1.3 ± 0.9 versus 0.7 ± 0.7, respectively, P = .037; form 5-6: 1.9 ± 0.8 versus 1.1 ± 0.9, respectively, P < .001; advanced levels and tertiary: 2.4 ± 0.7 versus 1.8 ± 1.0, respectively, P = .001. Overall mean antibiotics knowledge score across different education levels: 1.1 ± 0.9 (primary school) versus 1.6 ± 0.9 (form 5-6) versus 2.2 ± 0.8 (advanced levels and tertiary). All comparisons, P ≤ .001; overall trend, P < .001. All comparisons by t test.