Cross-cultural differences in lay attitudes and utilisation of antibiotics in a Belgian and a Dutch city
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).
References (38)
- et al.
Variation in antibiotic use in the European Union
Lancet
(2001) - et al.
EU conference ‘The Microbial Threat’
Int. J. Antimicrob. Agents
(1999) The impact of personality and religion on attitude towards substance use among 13–15 year olds
Drug Alcohol Depend.
(1997)- et al.
Effect of religion and religiosity on alcohol use in a college student sample
Drug Alcohol Depend.
(1998) - et al.
Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries
Fam. Pract.
(1992) - et al.
Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice?
Fam. Pract.
(1997) - et al.
Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats
Br. Med. J.
(1998) Differences in use of medicines in Europe
Medische Antropologie
(1990)- et al.
The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance
New. Engl. J. Med.
(1997) - et al.
Strategies for promoting judicious use of antibiotics by doctors and patients
Br. Med. J.
(1998)
Health promotion as a public health strategy for the 1990s
Annu. Rev. Publ. Hlth.
Uncomfortable prescribing decisions: a critical incident study
Br. Med. J.
How patients look at drug therapy: consequences for therapy negotiations in medical consultations
Fam. Pract.
The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: a questionnaire survey
Br. Med. J.
Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study
Br. Med. J.
Reducing antibiotics for respiratory tract symptoms in primary care: consolidating ‘why’ and considering ‘how’ [see comments]
Br. J. Gen. Pract.
Antibacterial use in community practice: assessing quantity, indications and appropriateness, and relationship to the development of antibacterial resistance
Drugs
Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians
JAMA
Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network
Br. Med. J.
Cited by (57)
Psychological and cultural factors influencing antibiotic prescription
2023, Trends in MicrobiologyStudy of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use?
2019, Journal of Affective DisordersCitation Excerpt :In almost all European countries, pharmaceutical sales volumes have increased, whereas sales values have declined probably because of changes in reimbursement policies, copayment and generic promotion as main measures to control drug spending (Leopold et al., 2014; Vogler et al., 2011). GDP has been described as a determinant in drug use in other studies (Deschepper et al., 2002; Hoebert et al., 2017; Martin et al., 2014). However, an increase in GDP would not necessary mean an increase in health expenditure as some countries have experienced a decline in their GDP but not in their PE (Buysse, 2010; Leopold et al., 2014).
How do hospital respiratory clinicians perceive antimicrobial stewardship (AMS)? A qualitative study highlighting barriers to AMS in respiratory medicine
2017, Journal of Hospital InfectionCitation Excerpt :Significant variation in antibiotic use between countries in the procalcitonin study suggests the presence of significant cultural influences on prescribing behaviour, even within the context of a clinical trial. Social, behavioural and interprofessional factors are observed to have a significant influence on antibiotic prescribing [17–20], and have been identified to influence antibiotic use and appropriateness in the treatment of respiratory infections in primary care [20,21]. Interventions that incorporate behavioural elements have been shown to be effective in reducing inappropriate antibiotic prescribing in respiratory infections, and in primary care and dentistry [22–24].
Clinical and social barriers to antimicrobial stewardship in pulmonary medicine: A qualitative study
2017, American Journal of Infection ControlCitation Excerpt :In addition, other issues have been raised, such as potential toxicity associated with some empirical treatment options, leaving risk stratification, clinical interpretation, and local antibiograms as critical components in decision-making for antibiotic choice in pulmonary infections.17 Social and behavioral factors have been observed to have a significant influence on antibiotic prescribing more broadly,18-21 and in primary care, cultural influences have been identified to influence antibiotic uptake in pulmonary infections.20,22 In addition, a hospital-based survey of CAP treatment identified the influence of senior doctors on junior doctors as a significant barrier to guideline adherence.23
Healthcare professionals behaviours regarding the infectious risk: Which influences and how to motivate change?
2016, Journal des Anti-InfectieuxThe effects of reasoned shared decision-making on consultation outcomes: Results of a randomized controlled experiment among a student population
2015, Studies in Communication SciencesCitation Excerpt :In all items, in addition to the correct answer, five distractors as well as the option I don’t know were given. For the recall of the diagnosis with tonsillitis, different other conditions often associated with the common cold were used as distractors (Deschepper, Van der Stichele, & Haaijer-Ruskamp, 2002). To test the recall of the proposed medication and the additional action plan, different fictitious medications and preventive behaviors were added as distractors.