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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:

To understand perceptions and intentions towards antibiotic resistance, use and reduction of use, a survey was conducted among pig farmers and veterinarians in Belgium, Denmark, France, Germany, Sweden and Switzerland.

Farmers were asked to estimate how much antibiotics were used on their farm in relation to other farms, if they had experienced incidents related to resistance, the benefits and risks of using antibiotics as well as 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.

The results indicated that farmers and veterinarians perceived the risks and benefits of using antimicrobials in a similar way, but that farmers where less optimistic about possibilities to reduce use. In order to promote appropriate use, different strategies were suggested for the two groups. For pig farmers, the most important predictor of the willingness to reduce antibiotic use was the efficacy of alternative measures (for example to follow stricter hygiene measures and have their pigs vaccinated). Thus, educational efforts suggesting which measures that can be introduced and how beneficial these measures are for the farmer are important. Veterinarians were recommended to strengthen their advisory role as well as their 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.
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
Clean Care is Safer Care: Tools for evaluation and feedback Tools and resources 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
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 about the use of antibiotics with a specific focus on non-prescribed antibiotics:

  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
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. A study with the objective to describe the process of developing a questionnaire to assess parents’ Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics when children suffer from URIs, as well as to evaluate the response rates, the completeness and the reliability (Cronbach) of the questionnaires. Includes questionnaire. Targeting the public.
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. The aim was to identify gaps in knowledge, document prescription practices and guide policy recommendations. The questionnaire used in the study is included as an additional file which can downloaded for inspiration and adaption to other contexts. Targeting prescribers.
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.
A study assessing public knowledge, belief and behavior of antibiotic use in an Omani population Template: 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. Targeting the public.
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
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.
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.
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.
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.