title: Parental knowledge about antibiotic use: results of a cluster-randomized, multicommunity intervention.
abstract: OBJECTIVE
  The goal was to determine the impact of a community-wide educational intervention on parental misconceptions likely contributing to pediatric antibiotic overprescribing.
  
  
  METHODS
  We conducted a cluster-randomized trial of a 3-year, community-wide, educational intervention directed at parents of children < 6 years of age in 16 Massachusetts communities to improve parental antibiotic knowledge and attitudes and to decrease unnecessary prescribing. Parents in 8 intervention communities were mailed educational newsletters and exposed to educational materials during visits to local pediatric providers, pharmacies, and child care centers. We compared responses from mailed surveys in 2000 (before the intervention) and 2003 (after the intervention) for parents in intervention and control communities. Analyses were performed on the individual level, clustered according to community.
  
  
  RESULTS
  There were 1106 (46%) and 2071 (40%) respondents to the 2000 and 2003 surveys, respectively. Between 2000 and 2003, the proportion of parents who answered > or = 7 of 10 knowledge questions correctly increased significantly in both intervention (from 52% to 64%) and control (from 54% to 61%) communities. We did not detect a significant intervention impact on knowledge regarding appropriate antibiotic use in the population overall. In a subanalysis, we did observe a significant intervention effect among parents of Medicaid-insured children, who began with lower baseline knowledge scores.
  
  
  CONCLUSIONS
  Although knowledge regarding appropriate use of antibiotics is improving without additional targeted intervention among more socially advantaged populations, parents of Medicaid-insured children may benefit from educational interventions to promote judicious antibiotic use. These findings may have implications for other health education campaigns.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA. sshuang@partners.org
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Jamie
authors.initials: J
authors.lastname: Kotch
authors.forename: Nancy
authors.initials: N
authors.lastname: Schiff
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stille
authors.forename: Ron
authors.initials: R
authors.lastname: Steingard
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D016000:Cluster Analysis; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010290:Parents; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents