Development and validation of a psychometric scale for assessing pharmacy students' perceptions and attitudes toward antimicrobial resistance and antimicrobial stewardship in Indonesia: the PATARAS study

Abstract

Appropriate perceptions and attitudes of pharmacists toward antimicrobial resistance (AMR) are essential. However, AMR attitudes and perceptions have not been assessed in Indonesia. This study aimed to develop and validate a questionnaire to evaluate pharmacy students' Perceptions and Attitudes toward Antibiotic Resistance and Antimicrobial Stewardship (PATARAS) and investigate the relationship between students' perceptions and attitudes toward antibiotic resistance and stewardship. Using purposive sampling, 500 undergraduate pharmacy students were included in the study. The 20-item PATARAS questionnaire with 5-point Likert scales was developed. The PATARAS includes perception (rational drug use (RDU) and antimicrobial stewardship (AMS)) and attitude (professional role (PRO) and inappropriate practice (IPP)) domains. The validity (convergent and discriminant) of the PATARAS was investigated using confirmatory factor analysis (CFA). The CFA model fit was assessed using various goodness-of-fit indices. Reliability was assessed using Cronbach's alpha (α) and McDonald's Omega (ω) values. The relationship between subdomains was evaluated using structural equation modeling (SEM). The PATARAS questionnaire achieved acceptable convergent and discriminant validity. The CFA model achieved a good fit. The reliability was good with α and ω values of 0.817 and 0.845, respectively. The SEM showed that RDU and AMS were positively correlated with PRO (β = 0.121 and 0.539, respectively, p < 0.05); RDU and IPP were also positively correlated (β = 0.313, p < 0.05), while AMS and IPP were negatively correlated (β = - 0.275, p < 0.05). The PATARAS is a valid and reliable instrument for assessing undergraduate pharmacy students' perceptions and attitudes toward AMR and AMS.

Keywords: Antimicrobial; Attitude; Perception; Pharmacy students; SEM.

Fig. 1

Confirmatory factor analysis diagram. The loading factor value is depicted by the direction of the arrow toward each item, and the discriminant validity values were based on the correlation values for each subdomain. RDU: Rational Drug Use; AMS: Antimicrobial Stewardship; PRO: Professional Role; IPP: Inappropriate Practice

Fig. 2

Structural equation modeling diagram for the PATARAS subdomains. Circles indicate subdomains or constructs, squares indicate manifest variables (item indicators), and triangles indicate errors, or residuals [35]. RDU: Rational Drug Use; AMS: Antimicrobial Stewardship; PRO: Professional Role; IPP: Inappropriate Practice