Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion
Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion
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DOI：
10.1136/bmjgh-2017-000621
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发表时间：
2018-03-01
影响因子：
8.1
通讯作者：
Ariana, Proochista
中科院分区：
文献类型：
--
作者：
Haenssgen, Marco J.;Charoenboon, Nutcha;Ariana, Proochista
背景抗菌素耐药性（AMR）是全球卫生优先事项。英国和全球对抗AMR的主要战略文件认识到其社会和行为层面，但目前改善抗菌药物（如抗生素）普及使用的政策反应仅限于教育和提高认识活动。针对这种方法在概念、方法和经验方面的弱点，我们通过三个研究问题来研究人们与艾滋病相关的健康行为。RQ 1：在患者的就医途径中，有问题的抗生素使用的表现和决定因素是什么？第二个问题：人们接触抗生素意识活动是否会改变行为，并在相互竞争的医疗保健实践网络中扩散或消散？RQ 3：哪些替代指标有助于发现社区之间和社区内的有问题的抗生素行为？方法我们采用跨学科的分析框架，借鉴了公共卫生，医学人类学，社会学和发展经济学文献。我们的研究涉及泰国北方（清莱）和老挝人民民主共和国南部（Salavan）农村居民寻求治疗行为的社会调查。我们对大约4800名成年人进行了抽样，以产生地区一级的代表性和社交网络数据。另外60次认知访谈有助于调查工具的开发和数据解释。我们的调查数据分析技术包括事件序列分析（RQ 1）、多水平回归分析（RQ 1 -3）、社会网络分析（RQ 2）和潜在类别分析（RQ 3）。讨论AMR的社会研究尚处于起步阶段，但我们对微观层面寻求治疗行为的空前详细的数据可以有助于理解超越意识和自由选择的行为，突出例如决策限制，边缘化和缺乏医疗保健的问题以及关于理想行为的竞争性想法。
Background Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people's antibiotic-related health behaviour through three research questions. RQ1: What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways? RQ2: Will people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices? RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities?Methods We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1-3), social network analysis (RQ2) and latent class analysis (RQ3).Discussion Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour.