Rational antibiotics use-related behavior patterns and associates: a cross-sectional survey among Chinese community adults
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摘要:
目的 定量探究公众抗生素使用行为模式及鉴别不同模式的影响因素,为公众抗生素使用精准管理、精准施策提供证据支持。 方法 于2020年11月5 — 19日,对湖北省、河北省、江苏省3省社区481名居民采用线上调查方式(问卷星)开展实证调查,搜集公众抗生素使用行为、影响因素和社会人口学信息,采用潜在类别分析方法鉴别公众抗生素使用行为模式,采用多分类logistic回归探索不同抗生素使用行为模式发生的影响因素。 结果 有效调查413人,共识别3种公众抗生素不合理使用行为模式,即抗生素使用不合理组(27.12%)、抗生素自我药疗组(27.12%)和抗生素相对合理组(45.76%)。多分类logistic回归显示,抗生素不合理使用组与抗生素使用相对合理组相比,公众在技能(OR = 0.663,P = 0.037)、社会影响(OR = 0.475,P = 0.002)、环境资源(OR = 0.643,P = 0.042)、能力信念(OR = 0.589,P = 0.034)、行为意向(OR = 0.504,P = 0.004)维度得分越高,是公众不合理使用抗生素的危险因素;越有可能出现抗生素使用相对合理行为模式,家人患有慢性病(OR = 1.895,P = 0.039)抗生素自我药疗组与抗生素使用相对合理组相比,公众在社会影响(OR = 0.565,P = 0.004)、行为强化(OR = 0.486,P = 0.013)、知识(OR = 0.379,P = 0.019)维度得分越高,越有可能出现抗生素使用相对合理的行为模式。 结论 公众存在3种不同抗生素使用行为模式,技能不足、不良社会影响、不充分的资源环境、能力信念不足、强烈的抗生素使用意向以及家人患慢性病是影响公众不合理使用抗生素的主要危险因素。 -
关键词:
- 抗生素合理使用 /
- 行为模式 /
- 潜在类别分析 /
- logistic回归
Abstract:Objective To explore behavior patterns of rational antibiotics use and their impact factors among community residents for providing evidence to implement targeted-promotion of rational antibiotics use in China. Methods Using convenient sampling and a questionnaire self-designed according to capacity-opportunity-motivation-behaviors (COM-B) model, we conducted an online survey among 481 adults ( ≥ 18 years) from three urban communities in Hubei, Hebei and Jiangsu province during 5 – 19 of September, 2020. Latent class analysis was used to identify the public antibiotic use behavior patterns and multi-nominal logistic regression model was adopted in analyses on influencing factors of different behavior patterns. Results Among the 413 participants with valid responses, three behavioral patterns of antibiotic use were identified, namely “irrational antibiotics use”, “antibiotic self-medication”, “relatively rational antibiotics use”, and the proportion of the participants for the three groups was 27.12% 27.12% and 45.76%, respectively. The results of logistic regression analysis showed that in comparison with the participants assessed as having “relatively rational antibiotics use ”, higher scores of medication-related skills (odds ratio [OR] = 0.663, P = 0.037), social influence (OR = 0.475, P = 0.002), resource and environment (OR = 0.643, P = 0.042), self-capability beliefs (OR = 0.589, P = 0.034), and intentions (OR = 0.504, P = 0.004) were protective factors against irrational antibiotics use but with a family member suffering from chronic diseases (OR = 1.895, P = 0.039) was a promoting factor for irrational antibiotics use for the participants assessed as having “irrational antibiotics use”; for the participants having “antibiotic self-medication”, higher scores of social influence (OR = 0.565, P = 0.004), behavioral reinforcement (OR = 0.486, P = 0.013) and knowledge (OR = 0.379, P = 0.019) were significant protective factors against irrational antibiotics use. Conclusion In this survey, three different antibiotic use behavior patterns were identified among community adults in China; lack of relevant skills, adverse social influence, inadequate environment resources, insufficient belief in ability, strong intention to use antibiotics, and with family member suffering from chronic diseases are risk factors for irrational antibiotics use in the adults. -
表 1 调查对象社会人口学特征(n = 413)
变量 人数 比例(%) 性别 男性 152 36.80 女性 261 63.20 年龄(岁) ≤ 24 69 16.71 25~34 123 29.78 35~44 124 30.02 45~54 83 20.10 ≥ 55 14 3.39 文化程度 初中及以下 19 4.60 高中或中专 34 8.23 大专 81 19.13 本科 200 48.43 硕士及以上 79 19.76 家庭月总收入(元) ≤ 3000 41 9.93 3001~5000 105 25.42 5001~10000 161 38.98 10001~15000 52 12.59 15001~20000 23 5.57 >20000 31 7.51 本人或家人具有医学背景 是 123 28.78 否 290 70.22 居住地 城市 215 52.06 城乡结合地区 109 26.39 农村 89 21.55 医保类型 城镇职工基本医疗保险 271 65.62 城乡居民基本医疗保险 142 34.38 本人是否患有慢性病 是 46 11.14 家人是否患有慢性病 是 127 30.75 表 2 调查对象过去1年抗生素不合理使用行为现状(n = 413)
条目及内容 是 否 人数 比例(%) 人数 比例(%) A1 过去1年,您是否主动要求医生使用抗生素 69 16.71 344 83.29 A2 过去1年,您是否感觉症状好转就停止使用抗生素 285 69.01 128 30.99 A3 过去1年,您是否未按医嘱或说明书要求自行增加抗生素剂量 45 10.90 368 89.10 A4 过去1年,您是否未按医嘱或说明书要求自行减小抗生素剂量 118 28.57 295 71.43 A5 过去1年,您是否在家中储备有抗生素 222 53.75 191 46.25 A6 过去1年,您是否在没有医生处方的情况下去药店购买抗生素 171 41.40 242 58.60 A7 过去1年,您是否与他人分享抗生素 95 23.00 318 77.00 A8 过去1年,您是否在周围人感冒时使用抗生素加以预防 82 19.85 331 80.15 A9 过去1年,您是否未就医而自行使用抗生素治疗疾病 153 37.05 260 62.95 表 3 人群存在不同数量行为模式下的潜在类别分析模型拟合指标
人群潜在
类别数量AIC BIC aBIC Entropy LMT 最小分类占比 1 4212.731 4248.942 4220.383 2 3595.494 3671.939 3611.648 0.845 0.000 0.37772 3 3564.897 3681.577 3589.554 0.748 0.005 0.27119 4 3544.812 3701.726 3577.971 0.802 0.475 0.08475 5 3539.969 3737.118 3581.630 0.795 0.035 0.07748 表 4 9种抗生素使用行为在不同抗生素使用行为模式下的条件概率分布
使用行为条目 抗生素不合理
使用组(类别1)抗生素自我
药疗组(类别2)抗生素使用相对
合理组(类别3)A1(主动要求) 0.580 0.004 0.020 A2(好转停药) 0.918 0.813 0.468 A3(增加剂量) 0.376 0.000 0.017 A4(减少剂量) 0.533 0.268 0.144 A5(储备) 0.942 0.076 0.189 A6(无处方购买) 0.896 0.590 0.000 A7(共享) 0.546 0.258 0.017 A8(预防用药) 0.423 0.167 0.081 A9(自行用药) 0.873 0.404 0.039 表 5 公众不同抗生素使用行为模式多分类logistic回归分析结果
抗生素使用行为影响因素 β $S_{\bar x}$ χ2 值 P 值 OR 值 95%CI 抗生素不合理使用组(类别1) 技能维度 – 0.411 0.197 4.351 0.037 0.663 0.451~0.976 社会影响维度 – 0.744 0.242 9.426 0.002 0.475 0.296~0.764 环境资源维度 – 0.442 0.217 4.145 0.042 0.643 0.420~0.984 能力维度 – 0.530 0.250 4.496 0.034 0.589 0.361~0.961 行为意向维度 – 0.684 0.240 8.127 0.004 0.504 0.315~0.807 家人患有慢性病 0.643 0.309 4.268 0.039 1.895 1.333~2.633 抗生素自我药疗组(类别2) 社会影响维度 – 0.570 0.198 8.292 0.004 0.565 0.383~0.833 行为强化维度 – 0.721 0.291 6.115 0.013 0.486 0.275~0.861 知识维度 – 0.971 0.414 5.503 0.019 0.379 0.168~0.852 注:参照组为抗生素使用相对合理组(类别3)。 -
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