What is it about?

Developing countries play a central role in responding to the global health threat of drug resistance – not only because they are likely to bear the largest burden of drug resistance, but also because they represent formidable obstacles to tackling this global health crisis. To understand the social dimensions of drug resistance in low- and middle-income countries in Southeast Asia, we carried out health behaviour surveys in rural areas in Thailand and Lao PDR. Examining how people think about and use antibiotics, we documented the widespread knowledge of antibiotics, which, however, were often talked about in colloquial and potentially ambiguous terms. We also uncovered surprisingly high levels of seeming “awareness” of drug resistance, but again technically correct interpretations of the term were uncommon. Both these findings could fundamentally complicate global public awareness campaigns that are commonly recommended to change populations’ antibiotic use. Yet more problematic was the finding that people who were (as the World Health Organisation recommends) against the over-the-counter purchase of non-prescription antibiotics were also more likely to consume prescription antibiotics from registered health practitioners – presumably not because these additional antibiotics were medically necessary. Taken together, our study highlights the social realities that complicate antibiotic awareness campaigns. Rather than tweaking public communication, we instead recommend that researchers explore complementary social policy interventions like unemployment insurance that help complement and overcome the barriers to public behaviour change.

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Why is it important?

Drug resistance is a global health priority. Because of the widespread use of antibiotics and other antimicrobials in health and agriculture, common infections are becoming increasingly difficult to treat. Campaigns globally advocate that people change the way in which they use medicine, but this study shows that education and awareness-raising campaigns are likely to miss important drivers of human behaviour.


Too many arguments in public health behaviour change rest on a model of ‘information deficits.’ This idea that people behave irrationally because they don’t have the right information finds little support in our research. Basic awareness about drug resistance and antibiotics is widespread but does not contribute to better behaviour. New information can be empowering in principle, but people themselves decide how they will use this new ‘power’ in their daily lives. Unnecessary antibiotic use may then rather reflect privilege, resistance to patronising norms, or interference between local and Western ideas of what good care ought to be. Ours is not an isolated case. Colleagues in China found for instance that more educated people were more likely to buy non-prescription medicine from unregistered stores, and the behavioural sciences have long established that information alone only accounts for a fraction of healthcare decisions. Public health has to catch up! To tackle the superbug crisis, we need to shift our attention to human decision-making processes and to people’s behavioural responses to local contexts.

Dr Marco J Haenssgen
University of Warwick

Read the Original

This page is a summary of: Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia, BMJ Open, August 2019, BMJ, DOI: 10.1136/bmjopen-2018-028224.
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