title: Antibiotics nonadherence and knowledge in a community with the world's leading prevalence of antibiotics resistance: implications for public health intervention.
abstract: BACKGROUND
  Community determinants of antibiotics nonadherence, an important contributor of antibiotics resistance, remained unclear.
  
  
  OBJECTIVE
  Our objective was to investigate whether deficient antibiotics knowledge could contribute to nonadherence in a community with high prevalence of antibiotics resistance.
  
  
  METHODS
  We recruited 465 people by random sampling from 5 urban areas in Hong Kong. A structured questionnaire was used to assess antibiotics knowledge and adherence. Adherence was defined as completing the most recent course of antibiotics entirely according to physicians' instructions. An antibiotics knowledge score ranging from 0 to 3 (highest) was composed based on the number of correctly answered questions.
  
  
  RESULTS
  Of the 465 participants interviewed, 96.3% had heard of the term "antibiotics," and 80.6% recalled having previously received antibiotics prescription. Among the eligible 369 subjects, 32.9% showed nonadherence. Percentages of participants with antibiotics knowledge scores of 0, 1, 2, and 3 were 11%, 27%, 33%, and 29%, respectively. There was a higher prevalence of nonadherence among people with lower antibiotics knowledge score (P < .001). Furthermore, people with nonadherence had a significantly lower mean antibiotics knowledge score (1.3 ± 1.0 versus 2.0 ± 0.9, P < .001), with no interaction with education (P < .05). Adjusted for potential confounders, antibiotics knowledge scores of 2, 1, and 0 independently predicted increased risk of nonadherence by 1-fold (odds ratio [OR], 2.00; 95% confidence interval [CI]: 1.01-3.94; P = .047), 4-fold (OR, 4.77; 95% CI: 2.30-9.92; P < .001), and 17-fold (OR, 18.41; 95% CI: 6.92-48.97; P < .001) respectively, compared with the maximum score of 3.
  
  
  CONCLUSIONS
  Lack of antibiotics knowledge is a critical determinant of nonadherence independent of education in the community.
authors: School of Public Health, the University of Hong Kong, Hong Kong. chanwill@hku.hk
authors: Yap-Hang
authors: YH
authors: Chan
authors: Mandy M
authors: MM
authors: Fan
authors: Chun-Man
authors: CM
authors: Fok
authors: Zara L
authors: ZL
authors: Lok
authors: Michael
authors: M
authors: Ni
authors: Chun-Fung
authors: CF
authors: Sin
authors: Kwok-Kei
authors: KK
authors: Wong
authors: Sze-Man
authors: SM
authors: Wong
authors: Roanna
authors: R
authors: Yeung
authors: Terence T
authors: TT
authors: Yeung
authors: Wing-Cheong
authors: WC
authors: Chow
authors: Tai-Hing
authors: TH
authors: Lam
authors: C Mary
authors: CM
authors: Schooling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011634:Public Health; D012111:Residence Characteristics; D012306:Risk; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents