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Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis

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  • Olivia Hawkins
  • Anna Mae Scott
  • Amy Montgomery
  • Bevan Nicholas
  • Judy Mullan
  • Antoine van Oijen
  • Chris Degeling

Abstract

Background: Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use. Methods: National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public’s KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model. Results: Policies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden. Conclusions: Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.

Suggested Citation

  • Olivia Hawkins & Anna Mae Scott & Amy Montgomery & Bevan Nicholas & Judy Mullan & Antoine van Oijen & Chris Degeling, 2022. "Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis,," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-26, January.
    • Handle: RePEc:plo:pone00:0261917
    DOI: 10.1371/journal.pone.0261917
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    References listed on IDEAS

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    1. Scott H. Podolsky, 2018. "The evolving response to antibiotic resistance (1945–2018)," Palgrave Communications, Palgrave Macmillan, vol. 4(1), pages 1-8, December.
    2. Narmeen Mallah & Adolfo Figueiras & Bahi Takkouche, 2021. "Comparison of Longitudinal and Cross-Sectional Approaches in Studies About Knowledge, Attitude, and Practices Related to Antibiotic Misuse," Drug Safety, Springer, vol. 44(7), pages 797-809, July.
    3. Adam Hannah & Erik Baekkeskov, 2020. "The promises and pitfalls of polysemic ideas: ‘One Health’ and antimicrobial resistance policy in Australia and the UK," Policy Sciences, Springer;Society of Policy Sciences, vol. 53(3), pages 437-452, September.
    4. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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