Study finds factors at national level more influential to combat antibiotic misuse

LAWRENCE — Every year thousands of people from around the world die because of antibiotic-resistant microbials. Overprescription and misuse of antibiotics have led to the growing crisis, and a new study from the University of Kansas has found that factors at the national level are more likely to help combat the problem than an individual approach.

Nation-by-nation antibiotic resistance also is an international problem that can’t be addressed individually.

“These are global problems that we can’t address without looking at them on a global scale,” said Hong Vu, assistant professor of journalism & mass communications.

Vu co-wrote the study with Yvonnes Chen, associate professor of journalism & mass communications. The authors analyzed data from the 2016 European Commission’s Eurobarometer survey of more than 27,000 people from 28 European Union countries and member candidates. The study analyzed how nation-level or structural factors and individual factors were associated with identification of and following proper antibiotic treatment. Data showed structural factors such as access to information and communications, health and wellness, and nutrition and basic medical care contributed the most variation in individuals’ identification of proper antibiotic use.

That finding is significant in that media campaigns have long focused on raising awareness of antibiotic resistance and proper use on an individual level. While such efforts can be successful, it can be too costly, time-consuming and inadequate to address a problem on an international scale. The authors argue approaching the problem on a national scale would be more effective and that the findings can help policymakers decide where to invest in addressing antibiotic-resistant microbials and antibiotic misuse. That echoes the approach the World Health Organization has called for in its One Health Initiative, which advocates for health professionals, government and media jointly addressing the problem.

Among structural-level variables, access to advanced education and access to information via internet connectivity were strong predictors of individuals properly using antibiotics. Somewhat surprisingly, a nation’s gross domestic product did not predict people’s knowledge about proper antibiotic use.

“In this study it was interesting to me that GDP was not an indicator of intention to properly use antibiotics,” Vu said. “Usually people in richer countries have better access to health care and information, but we didn’t find a significant indicator here.”

Individual factors that indicated proper use of antibiotics included health literacy as influenced by using mass media, friends and family as sources of health information, as well as their trust in mass media in health professionals. Factors such as age, gender, income level and living in urban or rural settings did not have as much effect on proper use.

Above all, the findings support the argument that the approach to fighting antibiotic resistance and misuse should incorporate multiple levels including government, health professionals and mass media as opposed to trying to reach individuals.

“We know one’s behavior is influenced by one’s environment, their access to health care, information, access to food, wellness and also by government policy, among other factors,” Chen said. “But I don’t think we have a sense of urgency on the individual level when it comes to antibiotic resistance. Governments are starting to encourage people to act, as is the World Health Organization. If we don’t do anything about it, it will only continue to negatively affect our health.”

Chen and Vu collaborated on the study, published in the International Journal of Communication, given their respective research specialties. Chen has studied how media literacy influences people’s health decisions, and Vu has studied international communications and how structural variables influence behaviors.

While campaigns to educate individuals can create change, they can be hard to sustain and require large investments of money and media power. Investments in communication technology, especially in developing countries, when combined with media and health industry efforts to improve knowledge of proper antibiotic use, can be an effective approach.

“Given that health literacy is a dynamic process and that ecological determinants have a profound impact on health literacy in the area of information-seeking and sources of information, our findings show that antibiotic resistance is a structural-related issue, as opposed to a purely individual-based medical problem,” Chen and Vu wrote. “Investing in a country’s information environment and improving health care access and quality while working with the medical communities and mass media in tandem could generate a trickle-down effect on citizens’ knowledge and behavioral intention related to antibiotic use.”

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