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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 beliefs
Advantages 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 staff
Disapproval:
doctors (GPs).
Control beliefs
Factors 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 SMA
Respondents 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
Implications
Policy:
• 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.
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