In a recent study published in the Journal of Antimicrobial Chemotherapy, researchers developed an antibiotic resistance (ABR) awareness scale to assess ABR awareness among human healthcare professionals (HHCPs) and animal healthcare professionals (AHCPs).
ABR poses a great threat to population health worldwide, and methods for reliable tools assessing ABR awareness are needed for guiding and evaluating health interventions. Psychometry specialists have devised methods to develop and validate scales for objective measurements of knowledge, abilities, and skills and subjective measurements of values, attitudes, and interests of individuals.
The procedures for developing and validating the measurement methods involve the development of items (identification of domains and the generation of items), development of scale ( the identification of constructs, pretesting of questions, and the extraction of factors), and the evaluation of scale (including method’s dimensionality, reliability, and validity).
About the study
In the present study, researchers designed and tested a 23-item ABR awareness scale for the quantitative evaluation of ABR awareness among HCPs residing in low-income nations and middle-income nations.
The scale comprised questionnaires filled out by HHCPs and AHCPs licensed for prescribing and dispensing antibiotics across six nations, i.e., Nigeria, Ghana, Vietnam, Thailand, Peru, and Tanzania. Individuals were invited via print, mail, or telephonic requests to participate in the study. Invitations were circulated across private clinics, hospitals, postgraduate education programs, and professional healthcare bodies.
The questionnaires comprised four modules: demographics, ABR awareness, practice items, and context items. Psychometrical analysis questions in the ABR awareness scale were based on the Rasch measurement theory. Bivariate-type analysis was performed to identify ABR awareness-associated factors. The questionnaires targeted HHCPs and AHCPs, recognizing ABR as a One Health issue.
The steps involved in the design and testing of the HCP ABR awareness questionnaire included (i) the development of a conceptual design (based on literature reviews and qualitative research); (ii) the development of items by mapping to the conceptual design; (iii) translation and back translation based on linguistic and conceptual equivalence; (iv) pre-testing based on items, words, or response scales; (v) field plots; (vi) psychometric analysis of item fit validity, targeting, item dependence, reliability, stability of items and model fit; and (vii) scale recommendations, including use limitations.
A total of 941 HCPs (86%, including 625 and 316 HHCPs and AHCPs, respectively) across six nations were analyzed. The ABR awareness scale had high coefficients for reliability (0.9 and 0.9 for HHCPs and AHCPs, respectively) but showed better intra-nation performance compared to inter-nation performance. The median scores for ABR awareness ranged between 55 among Tanzanian HHCPs and 64 among Peruvian HHCPs and between 55 among Vietnamese AHCPs to 64 for Thai AHCPs.
Veterinarians and physicians showed greater scores compared to other HCPs across the nations tested. HCPs documented working with inadequate healthcare infrastructure, and >95.0% of HCPs showed interest in receiving training and/or information on antibiotic stewardship and antibiotic resistance. The 23 items of the ABR scale were included under four domains of ABR knowledge, i.e., ABR mechanisms, ABU (antibiotic use) as the main factor driving ABR, infection control measures for organisms showing antimicrobial resistance, and ABR identification.
Participant responses to the modules mirrored the difficulty level of the conceptual design for AHCPs and HHCPs. The scores for antibiotic resistance awareness significantly correlated with the level of training, profession, and practice type for human HCPs; however, ABR scores were not associated with age or sex.
For AHCPs, the demographic variables were not associated with the ABR scores, except for the practice type among Vietnamese AHCPs, with those employed in government hospitals showing significantly greater scores, in comparison to HCPs employed in private hospitals (66 vs. 58). Over 34% of HHCPs had reportedly attended ABR training (31%, 35%, 43%, 25% and 39% in Ghana, Nigeria, Peru, Tanzania, and Vietnam, respectively).
In Vietnam and Peru, HCPs who were provided lessons on ABR in their curriculum showed significantly greater ABR awareness scores for AHCPs and HHCPs, respectively, compared to HCPs who were not taught about ABR. Among AHCPs, fewer Peruvian HCPs (25.0%) received particular ABR in comparison to Thai AHCPs (78.0%) or Vietnamese AHCPs (55.0%). Factual context-related factors such as the presence or absence of particular resources, the presence of other diseases, or receiving information provided reliable findings.
Across most nations, HHCPs and AHCPs documented that they prescribed antibiotics since they feared poor outcomes of diseases and had greater sanitation and hygiene concerns than antimicrobial resistance concerns. Chronic infections such as tuberculosis, human immunodeficiency virus infections, malaria, and accidents and trauma were considered more important by HHCPs in Africa. Among animal HCPs, >50% had more concerns about chronic illnesses in Thailand, Vietnam, and Peru.
Nearly 67% of the HCPs reported that ABR information received was inadequate for informing regular practice. In the majority of settings, HCPs documented that ABR monitoring was not performed at their workplaces, with the exception of Thai AHCPs. The HHCPs and AHCPs receiving samples from medical healthcare representatives showed greater ABR awareness compared to other HCPs.
The study findings showed that HCPs’ awareness of ABR could be reliably assessed with the validated ABR scale across the nations tested. Using the ABR scale with context questions and objective measurement of practices could inform healthcare interventions for improved antibiotic usage.