Elsevier

Patient Education and Counseling

Volume 48, Issue 2, October–November 2002, Pages 161-169
Patient Education and Counseling

Cross-cultural differences in lay attitudes and utilisation of antibiotics in a Belgian and a Dutch city

https://doi.org/10.1016/S0738-3991(02)00017-4Get rights and content

Abstract

Cultural differences are probably an important factor in the considerable variation in antibiotic use between countries. The objective of this study was to explore local cultural differences in the lay perspective on coping with URTD and using antibiotics. We interviewed 30 persons in a Dutch and a Belgian city. Twenty-one were interviewed a second time after 3 months. Between the first and second interview, they noted in a diary all URTD episodes experienced by themselves and their family members (N=69) and how they coped with them. The Dutch participants labelled most URTD episodes as “common cold” or “flu”. The Flemish participants labelled most of their URTD episodes as “bronchitis” and used more antibiotics. Four categories of antibiotic users could be distinguished. Participants with a Protestant background were more sceptical about medicines than those with a Catholic background. A thorough understanding of the cultural context is necessary to design effective campaigns to promote rational antibiotic use.

Introduction

Considerable variation between countries in antibiotic use has been reported [1], [2]. It is unlikely that these differences can be explained by epidemiological factors only. Cultural factors are also mentioned as important but few studies explain exactly what these differences consist of [3], [4], [5].

A more restrictive and rational use of antibiotics is needed since epidemic outbreaks of multi-resistant germs are becoming a worldwide problem [6], [7]. A better understanding of the role of cultural factors is pivotal, in developing strategies to reduce the use of antibiotics [4], [8], [9].

This study focused on the lay perspective because pressure from patients is an important reason for prescribing antibiotics [10] and decisions about the use of antibiotics are often made within the family [11]. Physicians often give in to unwarranted prescribing in order not to endanger good relations with the patient. But doctors are also influenced indirectly by their perceptions of patients’ expectations, even if these perceptions are mistaken [4], [11], [12], [13].

The aim of the study is to understand how different consumption levels of antibiotics are related to cross-cultural differences in lay perspective towards disease labelling, initial coping strategies and antibiotics utilization. In this qualitative anthropological study, we have focussed on the use of antibiotics for upper respiratory tract diseases (URTD) because they are the most common and the most criticised reason for prescribing antibiotics in general practice [14], [15], [16]. We compared a Dutch and a Flemish (Belgian) community, the former of which has a low consumption of antibiotics and the latter, a high consumption [1], [17].

Section snippets

Methods

The design and the analysis of this exploratory, qualitative study were inspired by grounded theory, as a method for the gradual development of analytical concepts from unstructured qualitative data [18].

The settings were two neighbouring cities in two adjacent countries, Middelburg in The Netherlands and Bruges in Flanders, the Dutch speaking part of Belgium. Both cities are characterised by a rich, well preserved cultural heritage and limited industrialisation. They are socio-economically

Results

Thirty lay persons (parents N=17, people living alone N=5, and partners in childless families N=8) gave their informed consent to participate. After two explorative interviews in each city, the 26 remaining participants all agreed to fill out the diaries and made an appointment for a second interview. Two Flemish participants dropped out after giving initial consent. Hence, 11 participants in Belgium (representing 36 family members) and 13 in The Netherlands (representing 33 family members)

Discussion and conclusion

We observed a marked disparity in disease labelling, coping strategies and attitudes towards antibiotics in the two communities from The Netherlands and from Flanders (the Dutch speaking part of Belgium). The differences are in the frequency with which URTD is labelled “bronchitis”, “cold” or “flu” and in the frequency with which the use of these labels triggers a visit to the primary care physician. Surveillance programmes in Belgium and The Netherlands did not point to extreme differences in

Acknowledgements

This study was supported by the Fund for Scientific Research–Flanders (Belgium).

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