Identifying key beliefs of self medication with antibiotics in Yogyakarta City

Indonesia (by applying the Theory of Planned Behavior)

Aris Widayati 1,3,4, Sri Suryawati 2, Charlotte de Crespigny3, Janet E. Hiller 4,5

1 Faculty of Pharmacy Sanata Dharma University Yogyakarta Indonesia

2 Faculty of Medicine Gadjah Mada University Yogyakarta Indonesia

3 School of Nursing, 4 School of Population Health and Clinical practice University of Adelaide Australia

5 Faculty of Health Sciences Australian Catholic University Australia

Presented at the 3rd ICIUM 2011 (International Conference for Improving Use of Medicines), Antalya Turkey, 14 – 18 November, 2011

Background

Slide 2

Self medication with antibiotics

(SMA)

antibiotic resistance(WHO, 2001)

Indonesia:

Antibiotics are prescription–

only medicines

People may purchase antibiotics

without prescription

(Hadi, 2008)

Strategies to improve the use of antibiotics

health practitioners (Norris, 2007).

Investigation about individual’s behaviour related to SMA is required

Theoretical framework: Theory of Planned Behavior (Ajzen, 1991)

Slide 3

Intention to SMA

Behavioral beliefs (BB) X Outcome evaluation

(OE)= Attitude

Normative beliefs (NB) X Motivation to comply (MC)= Subjective norm

Control beliefs (CB) X Power of control beliefs

(P) = Perceived Behavioral Control

(PBC)

SMA Behavior

Figure: TPB framework

Objectives and methods

Slide 4

Exploring beliefs about SMA: Behavioural

advantages disadvantages

Normative approval disapproval

control facilitator barrier

Identifying beliefs affecting intent to SMA

Mixed methods TPB questionnaire

Cluster random sampling

Analysis (n=283): descriptive

statistics logistic regression

In-depth interview: 25 respondents

Thematic -content analysis

to develop TPB questionnaire

Adults (over 18 years)

Phas

e 1 Phase 2

Beliefs regarding SMA reported by respondents(Findings of the interviews – Phase 1)

Slide 5

Behavioural beliefsAdvantages of SMA: Saving time Saving money Avoiding over-

prescription

Disadvantages:Concerns about: side/adverse effects, antimicrobial

resistance, misdiagnosing, inappropriate

antibiotics selection

Normative beliefs

Approval for SMA practice: families + friends,

particularly with health education / industry background,

pharmacy staffDisapproval: doctors (GPs).

Control beliefsFactors that facilitate

SMA: availability of

antibiotics over-the-counter;

sucessful experience in using antibiotics;

perception about similar antibiotics prescribed by doctors;

respondents’ knowledge about antibiotics

Barriers of SMA: medication for

children

Overall results of the survey (Phase 2 )

Attitude: respondents negatively evaluated SMA practice

Subjective norm: respondents expressed no social pressure to practice SMA

Perceived behavioural control: respondents reflected a negative control of doing SMA - SMA is quite tricky

Slide 6

Beliefs that affect intent to SMARespondents are more likely to intend to

SMA if: they have successful experience in using

antibiotics; OR=0.32 (0.16 – 0.66) They purchase antibiotics without

prescription from outlets other than kiosks ; OR=0.15 (0.03 – 0.81).

Slide 7

ImplicationsPolicy:

• Enhancing public awareness regarding the risks of SMA • Strengthening regulations regarding antibiotics supply and

distribution• Improving prescribing policies

Practice: Health messages to public should focus on disadvantages of

SMA Health practitioners should improve the provision of

information about the safe use of antibiotics

Slide 8

Lessons learnt

• The Theory of Planned Behavior framework + mixed methods are useful to explore individual factors regarding SMA behavior.

Developing the TPB questionnaire is time consuming. Potential biases should be considered in future research , such

as: Self-report responses, Inclusion criteria of sample.

Slide 9

Specific studies for future research agenda

In-depth interview with a group of the surveyed population: to explore underlying factors of SMA practice

Focus group discussion with stake holders and policy makers: to formulate strategies regarding policy and practice for

improving the safe use of antibiotics.

Slide 10

References

1. WHO, WHO global strategy for containment of antimicrobial resistance, 2001, Switzerland: WHO.

2. Hadi U, et al: Survey of antibiotic use of individuals visiting public healthcare facilities in Indonesia. International Journal of Infectious Diseases, 2008, 12:622-629.

3. Norris, P., Intervention to improve antimicrobial use: evidence from ICIUM 2004, 2007, Switzerland: WHO Press.

4. Ajzen, I., The Theory of Planned Behavior. Organizational Behavior and Human Decision Process, 1991. 50: p. 179-211.

5. Tashakkori, A. and C. Teddlie, Eds. (2003). Handbook of Mixed Methods in Social and Behavioral Research. California, Sage Publications Inc.

Slide 11

Acknowledgements and funding This is a component of the first’s author PhD thesis in the

School of Population Health and Clinical Practice University of Adelaide Australia.

Research funding: the Ministry of Education, Indonesia (DIKTI Scholarship).

Travel funds: the WHO-SEARO. Acknowledges:

Colleagues at the Centre of Clinical Pharmacology and Drug Policy Study Yogyakarta;

Writing Group at the Faculty of Pharmacy Sanata Dharma University Yogyakarta Indonesia;

The Public Health Thesis Writing Group at the University of Adelaide.

Findings of the phase 1 had been presented at the 4th Asia-Pacific ISPOR at Thailand; travel funds: The University of Adelaide Australia.