"Just as curry is needed to eat rice, antibiotics are needed to cure fever"-a qualitative study of individual, community and health system-level influences on community antibiotic practices in rural West Bengal, India
"Just as curry is needed to eat rice, antibiotics are needed to cure fever"-a qualitative study of individual, community and health system-level influences on community antibiotic practices in rural West Bengal, India
复制标题
DOI：
10.1136/bmjopen-2023-076616
复制
发表时间：
2024-02-01
期刊：
影响因子：
2.9
通讯作者：
Bloom，Gerald
中科院分区：
文献类型：
--
作者：
Gautham，Meenakshi;Bhattacharyya，Sanghita;Bloom，Gerald
目标为了全面地、以情境敏感的方式了解社区抗生素实践及其驱动因素，我们探讨了影响印度西孟加拉邦农村地区社区抗生素实践的个人、社区和卫生系统层面的因素。利用焦点小组讨论和深入访谈设计定性研究。设置印度西孟加拉邦南 24 帕尔加纳斯区的两个对比鲜明的村庄集群。实地调查于 2019 年 11 月至 2020 年 1 月期间进行。参与者有目的地选择了 98 名成年社区成员（42 名男性和 56 名女性）进行 8 次焦点小组讨论。对 16 名社区关键信息提供者（7 名教师、4 名当选村代表、2 名医生和 3 名社会工作者）和 14 名社区卫生工作者进行了深入访谈。结果个人层面的重要主题包括社会人口统计学（年龄、性别、教育）、认知因素（非生物医学信仰体系中对现代抗生素的知识和看法）、情感影响（对适当药物消费的情感解释）和经济限制（抗生素课程的负担能力和抗生素课程的总体成本）。护理）。抗生素被视为基本的退烧药，类似于退烧药，中途停止使用抗生素的决定受到长期使用与毒性相关的非生物医学信念的影响。社区和卫生系统层面的主题包括村庄领导的健康管理作用以及非正式提供者、药剂师和公共部门认可的社会健康活动家的知识经纪。然而，这些社区资源缺乏足够的知识来解决人们的疑虑和担忧。合格的医生在身体和社交上都难以接近，这给寻求专业知识造成了障碍。结论社会人口、认知和情感因素以及个人层面的经济限制的相互作用，凸显了抗生素使用的复杂性。此外，社区领袖和卫生工作者成为关键参与者，但他们的知识差距和缺乏赋权给解决公众关切带来了挑战。这项综合分析强调需要采取有针对性的干预措施，解决个人信仰和社区健康动态，以促进明智的抗生素使用。
ObjectivesTo understand community antibiotic practices and their drivers, comprehensively and in contextually sensitive ways, we explored the individual, community and health system-level factors influencing community antibiotic practices in rural West Bengal in India.DesignQualitative study using focus group discussions and in-depth interviews.SettingTwo contrasting village clusters in South 24 Parganas district, West Bengal, India. Fieldwork was conducted between November 2019 and January 2020.Participants98 adult community members (42 men and 56 women) were selected purposively for 8 focus group discussions. In-depth interviews were conducted with 16 community key informants (7 teachers, 4 elected village representatives, 2 doctors and 3 social workers) and 14 community health workers.ResultsSignificant themes at the individual level included sociodemographics (age, gender, education), cognitive factors (knowledge and perceptions of modern antibiotics within non-biomedical belief systems), affective influences (emotive interpretations of appropriate medicine consumption) and economic constraints (affordability of antibiotic courses and overall costs of care). Antibiotics were viewed as essential fever remedies, akin to antipyretics, with decisions to halt mid-course influenced by non-biomedical beliefs associating prolonged use with toxicity. Themes at the community and health system levels included the health stewardship roles of village leaders and knowledge brokering by informal providers, pharmacists and public sector accredited social health activists. However, these community resources lacked sufficient knowledge to address people’s doubts and concerns. Qualified doctors were physically and socially inaccessible, creating a barrier to seeking their expertise.ConclusionsThe interplay of sociodemographic, cognitive and affective factors, and economic constraints at the individual level, underscores the complexity of antibiotic usage. Additionally, community leaders and health workers emerge as crucial players, yet their knowledge gaps and lack of empowerment pose challenges in addressing public concerns. This comprehensive analysis highlights the need for targeted interventions that address both individual beliefs and community health dynamics to promote judicious antibiotic use.