Assessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework

doi:10.1016/j.ajic.2004.12.004

American Journal of Infection Control

Volume 33, Issue 3, April 2005, Pages 175-181

https://doi.org/10.1016/j.ajic.2004.12.004 Get rights and content

Background

Antimicrobial resistance (AR) is a threat to hospitalized children, and more information is needed to motivate physicians to adopt evidence-based practices such as those in the Centers for Disease Control and Prevention's (CDC) Campaign to Prevent Antimicrobial Resistance.

Methods

The framework of the Health Belief Model (HBM) was used to assess personal perceptions and cues to action related to the prevention of AR in 3 national focus groups in August 2003.

Results

Twenty-five physicians who treat hospitalized children participated; all reported that they had cared for a patient with an antimicrobial-resistant organism. Physicians perceived that AR was more of a problem nationally (92%) than in their institution (76%) or practice (60%) and reported that issues such as nursing shortage, cost of health care, and lack of specialty services presented more of a challenge to the care of hospitalized children than AR. Reported preferences of cues to action included journal articles (80%), infectious disease experts (76%), and colleagues (52%).

Conclusions

The HBM provides insight into physicians' perceptions about AR and preferred cues to action, which yield valuable information concerning the modes, methods, and messengers to intervene on problems such as antimicrobial resistance in hospitalized children.

Section snippets

Methods

Three focus groups, 1 in-person focus group in Atlanta, GA, and 2 national conference call focus groups, were conducted in August 2003. The HBM was used to examine the background characteristics of physicians regarding the prevention of antimicrobial resistance; the personal perceptions of these physicians regarding the prevention of antimicrobial resistance, including how do these physicians rank antimicrobial resistance among other issues related to the care of hospitalized children; and the

Results

Twenty-five physicians who treat hospitalized children participated in 1 of 3 focus group sessions in August 2003. The first focus group was in-person in Atlanta, GA, and the other 2 were nationwide teleconferences in which all 4 US geographic regions (Northeast, South, Midwest, and West) were represented equally. The participants represented the pediatric subspecialties of general pediatrics (20%), neonatology (20%), hematology/oncology (16%), intensive care/critical care (16%), general

Discussion

In this study, we conducted focus groups with 25 physicians utilizing the HBM to examine background factors, personal perceptions, and cues to action related to the prevention of antimicrobial resistance in hospitalized children. The physicians who participated in the focus groups had a variety of background factors, including a range of pediatric subspecialties and a range of 2 to 31 years of practice. All participants reported that they had treated a patient with an antimicrobial-resistant

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A systematic search of qualitative research on antibiotic prescribing for adult hospital patients published between 2007 and 2017 was conducted. Drawing on the Health Belief Model, a framework synthesis was conducted to assess threat perceptions associated with antimicrobial resistance, and perceived benefits and barriers associated with antibiotic stewardship.
The risk of antimicrobial resistance was generally perceived to be serious, but the abstract and long-term nature of its consequences led physicians to doubt personal susceptibility. While prescribers believed in the benefits of optimizing prescribing, the direct link between over-prescribing and antimicrobial resistance was questioned, and prescribers' behaviour change was frequently considered futile when fighting the complex problem of antimicrobial resistance. The salience of individual patient risks was a key barrier to more conservative prescribing. Physicians perceived broad-spectrum antibiotics to be effective and low risk; prescribing broad-spectrum antibiotics involved low cognitive demand and enabled physicians to manage patient expectations. Antibiotic prescribing decisions in low-income countries were shaped by a context of heightened uncertainty and risk due to poor microbiology and infection control services.
When tackling antimicrobial resistance, the tensions between immediate individual risks and long-term collective risks need to be taken into account. Efforts to reduce diagnostic uncertainty and to change risk perceptions will be critical in shifting practice.
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Although all dermatologists attending the focus groups agreed that antimicrobial resistance is a problem nationally, only 61% agreed that it is also a problem in their practice. This is consistent with previous research in other specialties.7-10 Similarly, all dermatologists perceived CA-MRSA as a national problem, but only half (50%) viewed it as a problem in their practice.
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Major ArticleAssessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Infect Control

J Pediatr

J Pediatr

Am J Infect Control

J Pediatr

Am J Infect Control

Report of the ASM Task Force on Antibiotic Resistance

An overview of nosocomial infection, including the role of the microbiology laboratory

Clin Microbiol Rev

Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus

Clin Infect Dis

Combating antimicrobial resistance in hospitals

Emerg Ther Targets

Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals

Infect Control Hosp Epidemiol

Multiple-antibiotic-resistant pathogenic bacteria: a report on the Rockefeller University Workshop

N Engl J Med

Summary, conclusions, issues and options

New intervention strategies for reducing antibiotic resistance

Chest

Brief report: infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene

N Engl J Med

Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility

J Antimicrob Chemother

Prevention of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), and vancomycin-resistant enterococci (VRE) colonization/infection

AFC

The global impact of vancomycin-resistant enterococci

Curr Opin Infect Dis

Public Health Dispatch: vancomycin-resistant Staphylococcus aureus- Pennsylvania, 2002

MMWR

Vancomycin use in pediatric hematology-oncology patients

Infect Control Hosp Epidemiol

Vancomycin use in pediatric cardiothoracic surgery patients

Pediatr Infect Dis J

Epidemiology of vancomycin usage at a children's hospital, 1993 through 1995

Pediatr Infect Dis J

SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus

Infect Control Hosp Epidemiol

Major Article
Assessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework