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Toolbox  –  Measure

Knowledge, attitudes, beliefs and practices

Understanding knowledge, attitudes, beliefs and practices (KABP) regarding bacteria, antibiotic use, and antibiotic resistance in different target audiences can provide practical information when planning and evaluating interventions to influence behavior change.

Here you find resources and tools to help develop surveys for investigating knowledge, attitudes, beliefs and practices within the field of antibiotic resistance or related topics. The section also highlights some studies that have been performed to better understand the current knowledge and attitudes among a variety of professionals, students, and the general public working in the human and animal sectors

A study to assess perceptions and intentions to reduce antimicrobial usage among pig farmers in Europe:

Pig farmers and veterinarians in Belgium, Denmark, France, Germany, Sweden and Switzerland were asked questions about their practices and knowledge.

Farmers were asked to estimate how much antibiotics were used on their farm compared to other farms, if they had experienced incidents related to resistance, the benefits and risks of using antibiotics and how much the current use could be reduced while still being economically manageable. Veterinarians were asked about their continued training in addition to questions on use and resistance.

Key results:

  • Farmers and veterinarians perceived the risks and benefits of using antimicrobials in a similar way
  • But, farmers where less optimistic about possibilities to reduce use.
  • For pig farmers, the most important factor for willingness to reduce antibiotic use was efficiency of alternative measures. In other words, what are the alternatives and how well do they work, for example stricter hygiene and having their pigs vaccinated.

Recommendation for more prudent use: 1) Educational efforts for farmers that suggest which measures that can be introduced and how beneficial these are. 2) Strengthened advisory role of veterinarians, including abilities to support and educate farmers.

The resources below have been sorted into the following tables:

  • KABP surveys: Tools and guidelines
  • Data and reports

Selected Resources

KABP surveys: Tools and guidelines

Resource Description
Antibiotic resistance: Multi-country public awareness survey Templates. This public awareness survey on the use of antibiotics and knowledge of antibiotic resistance was conducted in 12 countries in 2015, commissioned by the WHO. For inspiration to set up your own public awareness survey, see Annex 1 “full questionnaire” (p. 46 in report. Mix of online and face-to-face interviews ). Targeting the public.
Antimicrobial Resistance Module for Population-Based Survey (PDF) Templates. This module generates household-level information on knowledge and behavior regarding antimicrobial medicines and raises awareness on resistance among communities. Provides questionnaires and data collectors guide, and also describes pretest done in Zambia. Targeting the public.
Development and assessment of a questionnaire for a descriptive cross – sectional study concerning parents’ knowledge, attitudes and practises in antibiotic use in Greece Journal article with template. Describes the process of developing a questionnaire to assess parents’ Knowledge, Attitude and Practices on the role of antibiotics when children suffer from upper respiratory infections. Also evaluates response rates, completeness and reliability (Cronbach) of the questionnaire. Includes questionnaire. Targeting the public.
Antibiotic prescribing and resistance: Views from low- and middle-income prescribing and dispensing professionals (PDF) Report with interview questions. Summarizes 9 studies assessing awareness of resistance and knowledge of antibiotics among 246 prescribers or dispensers in LMICs (India, Philippines, Vietnam, Sierra Leone, Nigeria and Ethiopia). Qualitative methods were used including semi-structured interview and rapid ethnographic observation. Appendix 1 provides selected useful interview questions. Targets animal and human health professionals.
Clean Care is Safer Care: Tools for evaluation and feedback Tools and templates from WHO for evaluation and feedback on hand hygiene interventions, including:

  • Perception Survey for Health-Care Workers
  • Perception Survey for Senior Managers
  • Data Entry Analysis Tools

Targeting health care workers and managers

Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study Journal article with template. A study investigating knowledge and practices among prescribers from public and private health care facilities in Ghana using quantitative and qualitative methods. Questionnaire included as an additional file that can be downloaded for inspiration and adaption to other contexts. Targeting prescribers.
Antimicrobial resistance and causes of non-prudent use of antibiotics in human medicine in the EU Templates. This report describes results of the ARNA (‘Antimicrobial resistance and the causes of non-prudent use of antibiotics’) project, focusing on reasons for non-prescription use of antibiotics in the EU, and actions to prevent such use. Carried out under a contract with the European Commission. Appendix A and B provides questionnaires used in the surveys:

  1. Questionnaire Member State survey: Non-prudent use of antibiotics in Europe: public health measures and legislation
  2. Patient questionnaire
  3. General Practitioners questionnaire
  4. Pharmacist questionnaire
Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students Journal article with template. Questions and the grading standard of the questionnaire are included with this study that analyzes the present status of KAP of Chinese medical and non-medical students on the use of antibiotics, and examines the influence of the Chinese medical curriculum on appropriate usage of antibiotics among medical students. Targeting students.
Improving Medicines Access and Use for Child Health -A Guide to Developing Interventions Practical manual for those developing interventions to improve access to and use of medicines, including antibiotics, for child illness. Special focus on low-resource settings. Different tools and methods are described that can be used to measure appropriate use and access to medicines, such as:

  • Key questions and indicators when assessing quality of child health care
  • Hypothetical example of rating a set of problems identified during an assessment
  • Example of Focus Group Discussion Guide
Advocacy, communication and social mobilization for TB control: A guide to developing knowledge, attitude and practice surveys Guide and tools that provides a theoretical framework, practical suggestions, and a handful of resources for conducting KAP studies for tuberculosis control, which can be useful in developing similar surveys for antibiotic resistance. Published by WHO in collaboration with the Stop TB Partnership.
TREND statement and checklist Checklist: 22 item list to guide standardized reporting of nonrandomized evaluations of behavioral and public health interventions, developed by the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) group.

Data and reports

Resource Description
Antibiotic Prescribing in DR Congo: A Knowledge, Attitude and Practice Survey among Medical Doctors and Students Journal article: A study that surveyed knowledge, attitudes and practices of antibiotic prescribing among medical students and doctors in Kisangani, DR Congo.
Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States Journal article: To better inform public health efforts to improve prescribing of antibiotic drugs, the CDC conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections.
A study assessing public knowledge, belief and behavior of antibiotic use in an Omani population Journal article. A 12-item self-administered questionnaire is available here that was used to assess public knowledge, belief and behavior towards antibiotics use in a general population in the Sultanate of Oman.
Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study Journal article: The aim of this study was to assess knowledge, behavior and attitude toward antibiotics use among adult Jordanians.
Medical students’ views on the current and future antibiotic resistance situation (PDF, 2MB) Study report:Medical students’ views on the current and future antibiotic resistance situation.